bluuebunny/crossref_metadata_2025 huggingface dataset:
(A20) Injury Pattern and Disaster Plan for Landmines and Improvised Explosive Device Blast
Authors: Choudhary S.K.
Published: May 2011

Landmines and improvised explosive device (IED) explosions induce bodily injuries through the primary, secondary, tertiary, and quaternary mechanisms of blast among civilians, mostly children which results in a complicated, multidimensional injury pattern. If > 80 percent of countries can ensure the security of their borders without using anti-personnel mines, surely India can too. A change in mindset and a change in defense doctrine are needed, as well as an UN-backed world body campaigning against the use of landmines to urge the Indian government to sign a global treaty to ban the weapons. An estimated four to five million anti-personnel mines exist in India, which is the sixth-largest stockpile in the world. Non-state armed groups in the central, southern, northern, and northeastern regions frequently have used anti-personnel mines and improvised explosive devices to target convoys of soldiers and civilians. Using historical, current research and related literature reviews, this study provides description about the types of explosion, the device, pattern of injury, prehospital and emergency department care, and challenges for the disaster plan. Hand amputation is the most common type of upper limb amputation (more common among the 7–18-year age group) and below-knee amputation is the most common type of lower limb amputation. Using these data, a focused disaster response for future attacks has been created. It includes the planning, monitoring, and coordination of all aspects by hospitals and the regional disaster system's plan—“upside-down” triage—the most severely injured arrive after the less injured, which bypass emergency medical services (EMS) and go directly to the nearest hospitals. Details about the nature of the explosion, potential toxic exposures and environmental hazards, and casualty location from police, fire, EMS, health department, and reliable news sources must be recorded.
(A37) Characteristics and Evaluation of China's Earthquake Disaster Management Systems
Authors: Svirchev L. , Li Y. , Yan L. , He C. , Ma B.L.
Published: May 2011

Background

This presentation summarizes our ongoing hybrid sociological-geological research into China's earthquake disaster management systems. Our methodology is a grounded research approach, based firstly on field observations related to the Wenchuan earthquake, including interviews with survivors and professionals responsible for disaster management; secondly on an extensive review of the English-language disaster management literature. China's earth scientists, frequently in collaboration with international scientists, have created a substantial English-language literature, but the social literature on disasters in China is scant. China's geographic variation is complex, with significant fault lines criss-crossing the nation.

Discussion

Approximately half of the population lives in areas with a high risk of earthquakes. The two most-devastating of these since 1949 were the 1976 point-source Tangshan earthquake with mortality of 242,419, and the 2008 huge-area Wenchuan earthquake with mortality of 69,226. Our research has found that China's earthquake disaster management systems at the local, provincial, and national levels respond rapidly to earthquakes. National mobilization for rescue-relief after the Tangshan earthquake began within six hours, and within two hours for the Wenchuan earthquake. These systems are also characterized by reconstruction planning that functions in parallel to, and melds into, the relief effort streams. China's major infrastructure projects, such as hydro-electric power dams, are designed to resist extreme earthquake; however, rural mountain populations and the historic built-environment have low earthquake resistance, conditions which will endure for a long time.

Conclusions

As a result of the Wenchuan earthquake, China has undertaken ambitious three-dimensional monitoring and response programs. We recommend studies and action to reconnoiter, investigate, and prevent population exposure to geo-hazards, particularly in the Qinghai-Tibet Plateau. In summary, China excels at disaster response but has not yet entered a development era of preventing the population's exposure to earthquake hazards.
(A44) Roadmap to Disaster Medicine and Public Health Information
Authors: Arnesen S.J. , Norton E.
Published: May 2011

Reliable & easily accessible health information is needed before, during, and after disasters. The U.S. National Library of Medicine's Disaster Information Management Research Center has developed a portal linking to resources, guides, and tools for use by disaster/emergency personnel in preparing for, responding, to and recovering from disasters (http://disasterinfo.nlm.nih.gov). This session will introduce you to many of the disaster health information sources available on the Internet. Disaster information tools, such as the Wireless Information System for Emergency Responders (WISER) and the Radiation Emergency Medical Management (REMM) resource will be demonstrated. WISER assists responders in HazMat/CBRN incidents. Capabilities include support for substance identification, on-site incident management, and health management/guidance. The REMM tool provides guidance for health care personnel about clinical diagnosis & treatment of radiation injury during radiological & nuclear emergencies. WISER and REMM are available on the Web and as apps for a variety of mobile devices including the Blackberry and iPhone/iPod Touch/iPad. In addition how to access the disaster health literature from PubMed, the Resource Guide for Public Health Preparedness, and other sources will be discussed. Social medial tools for keeping up-to-date will be presented. Topics to be presented: NLM and other US resources for disaster health information. Other sources of disaster health information, including associations; non-governmental organizations, and international organizations. Databases and information aggregators. Disaster information tools and mobile applications Evaluating/assessing information on the web. How to stay up-to-date: listservs, RSS feeds, blogs, Twitter, etc.
(A58) Guidelines for Reports on Health Crises and Critical Health Events - A Tool for the Development of Disaster Medicine Research
Authors: Kulling P. , Birnbaum M. , Murray V. , Rockenschaub G.
Published: May 2011

To develop a common structure for reports on health crises and critical health events guidelines have recently been published (Kulling et al 2010). They try to capture the experiences gained and for promoting a standardized methodology for sharing results and lessons. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors. The development of this proposed method for common reporting on health crises and critical health events has been derived mainly from the following processes: (i) Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style; (ii) the Swedish Disaster Medicine Study Organization (KAMEDO); (iii) the Swedish Emergency Management Agency network of observers; (iv) the WHO Regional Office for Europe project (supported by the EU Health Programme) ‘Support Health Security, Preparedness Planning and Crisis Management in the EU, EU accession and neighboring (ENP) countries’ including expert consultations. The guidelines include the following headlines: Title, Preface, Authors, Executive Summary, Introduction/Material/Methodology, Pre-Event Status (Background, Preparedness, Hazard(s)involved, Risks, Vulnerability, Resilience), Health Crises and Critical Health Events (Damage, Consequences of Damage (Changes in Functions/Disturbances), Responses (Relief Responses, Recovery Responses), Development, Discussion, Lessons Identified and Actions Recommended, Conclusions, References, Appendices, Keywords, Index, Abbreviations. Pilot testing is suggested followed by an extensive review process. The guidelines should be supplemented further with determinants and indicators when the guidelines are used for in depth reporting to evaluate crisis response operations. Reference Kulling P, Birnbaum M, Murray V, Rockenschaub G. Guidelines for Reports on Health Crises and Critical Health Events.
(A53) A Community Home-Based Family Treatment Model in Disaster Areas
Authors: Gelkopf M. , Berger R.
Published: May 2011

The ongoing shelling of missiles on the city of Sderot in Israel for the past 8 years have caused damage in terms of life and property as well as have put more than 25,000 residents under significant and ongoing threat. A recent study examining the impact of living under these conditions has revealed that 28.4% of the area residents suffer from PTSD and 75%–94% of the children reported to experience posttraumatic symptoms (Gelkopf, Berger, Bleich, Cohen, submitted). Despite the psychological needs of the residents, mental health service utilization has been sparse due to many residents not feeling safe to leave their homeland fear the stigmatization in attending public mental-health clinics. In order to resolve this dilemma, we have developed a community home-based family intervention delivered through a mobile unit of professionals who provide mental-health services for to traumatized families in their homes. The model incorporates family systemic approach with trauma-focused cognitive-behavioral technique and narrative strategies. I will outline the model and present an evaluation of its efficacy in reducing PTSD and in improving daily functioning in adults and children. I will also describe several cases illustrating the model. Finally, we conclude that such a model may be useful in providing mental-health services in major disaster, such as Tsunamis, earthquakes and floods, particularly in developing countries where mental health capacity is limited and where local populations will not always have the means or be able to reach clinics.
(A70) Traumatic Brain Injuries at a Rural Teaching Hospital: Pattern of Presentation and Documentation
Authors: Agrawal A. , Kakani A. , Baisakhiya N. , Galwankar S. , Dwivedi S.
Published: May 2011

Background and Objectives

Analyses of causes and trends of traumatic brain injuries help to define public health policy priorities. There are not much TBI registries, thus making documentation of injuries inadequate and accessing these data problematic. This study is aimed at identifying the characteristics of TBI and determining the efficiency of documentation of patients' records in a tertiary hospital.

Patients and Methods

Based on WHO guidelines “Standards for Surveillance of Neurotrauma” we designed a proforma to collect data on traumatic brain injuries. A prospective data collection was done from January to June 2010. Data was collected on a paper form and then entered into the self-developed TBI registry database. Descriptive analysis was performed.

Results

Data for a total 414 patients were collected. Mean age was 33.00 years (SD ± 16.725, range 1–85 years), and 81% male. Most of the accidents took place on highways (57.2%), commonest being the road traffic accidents (55.1%), brought by relatives (74%). The mean duration for hospital stay was 5.42 days (SD ± 8.312 days, range 1-79 days). 10% patients required resuscitation at the time of admission. Details of Glasgow coma scale were available; details regarding CT scan findings were available for 300 patients. Good recovery was seen in 68.4% and the mortality was in 7.2%. Further details on vital parameters and investigations included in the study were also collected.

Conclusions

TBI related research in many developing countries is in the developmental stages with relatively few published data. Although early analysis of a TBI data can lead to useful information, there is further need for the development of a user-friendly secure web-based database system to continuously maintain and analyze the registry.
(A73) Burden of Maxillofacial Trauma at Level Trauma 1 Centre
Authors: Sagar S. , Singhal M. , Kataria K. , Kumar S. , Gupta A. , Mishra B.
Published: May 2011

Background

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide.

Method

A retrospective study of patients with maxillofacial fractures seen and treated at the Jai Parkash Narayan Apex Trauma Center, AIIMS, New Delhi, India between January 2007 to June 2010. Data extracted from the patients' records include aetiology, age, sex, types and sites of fractures, treatment modality and concomitant injuries.

Results

There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (56.8%) was the most common aetiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 years to 75 years (mean = 34.7) with a peak incidence in the 3rd decade with a male–female sex ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615(77%) and middle third 205(23%). With regards to mandibular fractures, the body (29.6%) was the commonest sites, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%) and Lefort III (3.3%). Majority of the patients were treated by Open reduction and internal fixation (70.6). Concomitant injuries were 10.8% with orthopaedic injuries accounting for the majority (63.9%). Head injury was associated with 16.3 % of cases.

Conclusion

Maxillofacial fractures are on the increase. We advocate the establishment of regionalized trauma centers with basic training available to all surgical residents for initial emergency room management.
(A78) EMS System Assessment & Gap Analysis
Authors: Skeen T.
Published: May 2011

Purpose

The World Health Organization Model Trauma System Policy suggests that Governments should undertake systematic reviews of the de facto prehospital transport systems for severely ill and injured persons. These systems, be they formal or informal, should be designed to optimize local resources with emphasis on standards of training, equipment, infrastructure and communications so as to assure delivery of prompt, quality, and equitable prehospital care. Scope of Review and Assessment a System Assessment and Gap Analysis (SAGA) tool has been developed to measure 127 key components of a high performance emergency transport system within the realms of Clinical, Organizational and Logistical functionality. The evaluation compares the current status of the specific components with those commonly expected to be seen in a formal international accredited EMS organization.

Methodology

The tool utilizes a thorough investigative process sufficient to produce credible and practical data which can be used to form a “System Improvement Plan.” While the scope of the project can be seen as relatively broad, the assessment process allows for adaptation to a wide variety of EMS system models which bring specific focus to the greatest areas of improvement opportunity with practical applications and alignment with those resources which are available to a given governmental entity.

Presentation

This abstract, (in both oral and poster presentation format), demonstrates a portional mock evaluation with focus on those components often overlooked by both evolving and mature formal system designs by the international EMS community. The SAGA approach is an invaluable tool for those responsible for integrating the functionality and needs of a broad range of stake holders into the overarching prehospital delivery system in building support for qualitative improvements.
(A82) Triage in the Prehospital Setting
Authors: Khorram- Manesh A. , Hedelin A. , Ortenwall P.
Published: May 2011

Introduction

The prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.

Aim

The aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.

Method and Material

Over 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.

Results

There was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.

Discussion and Conclusions

A mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
(A124a) Developing Pediatric Emergency Preparedness Performance Measures
Authors: Markenson D. , Reilly M.
Published: May 2011

Background

The most obvious deficiency in the current evaluation of disaster response is the lack of objective, quantifiable measures of performance. This frequently leads to assessments that are highly subjective depending on the evaluator, does not provide those who are planning with targets to achieve, and does not allow for measures that they have improved their preparedness. The goal of this research project is to offer recommendations for government agencies at the federal, regional, and local levels, public health departments, and health care institutions to aid in the development of pediatric emergency management performance measures.

Interventions

The goal was achieved through the application of traditional quality principles to the assessment of emergency management efforts and to the use of innovative analytic methodologies to develop comprehensive approaches to performance measurement in emergency management.

Discussion and Observations

When one discusses performance measures, it is important to remember that these are metrics we use to improve the quality of care. With regard to emergency management, performance measures are used to increase capacity and efficiency. A classic approach to health care performance measures is to discuss them with regard to the domains of structure, process, and outcome. Recently, in addition to these domains, volume has also become an important predictor of clinical outcomes. Although we believe that these domains can be applied to emergency management functions and the development of performance measures for disasters, there are some fundamental differences when compared with their use in development and categorization of traditional health care metrics which have been built in to our modification of these domains to emergency preparedness. This approach, quantitative methodology and consensus development process, when applied, will significantly advance pediatric preparedness. Ultimately, these pediatric specific measures must exist and be used to assess current levels of performance and guide resource allocation and targeted improvement efforts.
(A73) The Importance of Interagency Communications in the Tsunami Disaster Stricken Area in the 2011 East Japan Great Earthquake
Authors: Ogasawara M. , Ito K. , Saito K.
Published: May 2011

Introduction

In the 2011 East Japan Great Earthquake over 200 DMAT immediately headed to the disaster stricken area.

Progress

Land lines and all mobile telephones had interrupted service. Radio communication could only be used at a short distance in one area. Satellite phones were the only means of communication, but since there were limited number of devices, power shortages. DMAT used a management browser called EMIS (Emergency Medical Information System) to exchange information and coordinate activity, but the internet itself did not work. Without communication equipment, the victims could not send or receive information and even DMAT had trouble understanding the situation. There was rumor of many victims in a wide range of isolated evacuation shelters that were left behind. The land was flooded, vehicles were carried away, the town was buried under debris and mud, and fires occurred one after another. The wounded and sick could not access hospitals immediately. Because of the blackout, the suspension of the water supply, and prospect of restoring heating were not in sight, an immediate confirmation of medical needs and triage of the sick and wounded were required. Therefore, as the disaster front headquarters, the fire department, police department, self-defense force, Japan Red Cross medical care relief squad, the city, the prefecture, and the public health center, many organizations in collaboration held meetings every day at 5:30 and 18:30 aiming to gather information and establish strong collaboration. Four teams from the Japan Red Cross medical care squad and 4 teams from the Ground Self-Defense force were dispatched in replacement of the insufficient DMAT to manage the disaster front. They restored roads and headed to isolated shelters and hospitals. With the cooperation of the Air Self-Defense Force, DMAT was sent by helicopter to an isolated peninsula.

Result

We use helicopters, ambulances, and Self-Defense Force vehicles to transport as many patients to hospitals in other regions, because there was no place to return home. In one of the isolated hospitals, they had to use candlelight in a room temperature below zero, they were unable to use the aspirator, and four patients were already deceased. The remaining 38 inpatients were transported out of the disaster area and preventable death could be prevented.

Consideration

Because the local staff suffered damage from the earthquake, all organizations consisted of groups dispatched from other regions. With a communications network not functioning in the disaster stricken area, it is necessary to exchange information and share the best plans. Taking this into perspective, having two disaster relief measures meetings in one day was very effective.
(A87) Sea-Level Rise Disaster in Micronesia: Sentinel Event for Climate Change?
Authors: Keim M.
Published: May 2011

Background

In 2007, several atoll islands in the Federated States of Micronesia (FSM) were inexplicably flooded by sea water.

Objectives

To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations.

Methods

Households of Lukunoch and Oneop islands, FSM were assessed for demographics, asset damage, food availability, and water quantity and quality. Every fourth household on Lukunoch, (n = 40), was randomly selected and surveyed. All Oneop households were surveyed (n = 72). Prevalence data were analyzed.

Results

A total of 112 total households were surveyed representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%–30%) reported a complete loss of taro and four (10%) of the 40 households (95% Cl. 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11(28%) of 40 households, (95% Cl. 15%–43%) reported damage from well salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well.

Conclusion

These findings suggest that FSM populations experienced disastrous losses due to a sea level rise event damaging crop productivity and freshwater sources.
(A88) Public Health Consequences of Climate Change in the Republic of Palau: A Photojournalism Project
Authors: Mahany M. , Kuartei S. , Marumoto P.
Published: May 2011

Introduction

The Republic of Palau, like other small, island, developing states, is particularly vulnerable to climate change due to a number of factors, including: (1) small size; (2) remoteness; (3) limited natural resources; and (3) vulnerability to disasters and extreme weather events. Other factors include social and economic factors such as: (1) economies sensitive to external shocks; (2) high population growth rates and densities; (3) poorly developed infrastructure; (4) limited financial and human resources; and (5) emigration. The (US) Centers for Disease Control and Prevention (CDC) partnered with the Republic of Palau Ministry of Health (MoH) and Southern Illinois University (SIU) to investigate public health consequences in Palau. The goal of the project is to reduce morbidity and mortality due to climate change in Palau by improving awareness using three tools: (1) a photojournalism book to document the local experience in Palau; (2) a marketing campaign to increase awareness in Palau about climate change as it relates to human health; and (3) a Website to raise regional and international awareness of the findings, and act as a forum for discussion and resource-sharing.

Methods

The CDC, SIU, and Palau MoH conducted interviews with community members including government officials, traditional leadership, fishermen, gardeners, physicians, scientists and local residents to explore their experiences concerning climate change in their community. Photojournalists took thousands of images documenting locally identified effects of climate change that were perceived as having direct or indirect health consequences for the people of Palau.

Results

Coral bleaching, beach erosion, irregular rainfall, sea level rise, and salt water inundation directly impact food security and tourism in Palau, while other less obvious, but important consequences, such as potential loss of traditional practices and cultural identity were also identified.

Conclusions

The people of Palau reported significant impact from climate change on agriculture, economics, health, and culture.
(A97) Social Media and Social Networks in Disaster Management: The Haiti Model
Authors: Vroegindewey G.V.
Published: May 2011

Social media and social networks are integral components of our daily personal, professional, and community lives with Facebook, Friendster, and Twitter alone having > 750,000,000 registered users worldwide. All types of communication modalities are utilized in disasters for a variety of purposes. Experience with Exercise 24 and the Haiti Earthquake and public health response amplify both the power of social media and social networks and the need to research, understand, refine, and train in their utilization in disaster management. A Haiti Epidemic Advisory System was established to provide a mechanism for care providers to report health status in camps and treatment centers, exchange technical and logistical information, provide reach-back services such as GIS mapping and data shepherding, and provide a platform for emotional support. This information was incorporated into additional platforms including Haiti User Defined Operational Picture (UDOP) and Haiti Medical/Public Health Information Sharing Enterprise (MPHISE). Successes in the systems were seen in the early warning provided for cholera and social stress, the ability to link on-the-ground resources with local, national, and international assets, and the ability to inform policy makers through real-time reporting and advanced visualization. Many challenges were highlighted that deserve future study. These include: (1) how to manage the extreme volume of data flow including rating, ranking, filtering, and archiving; (2) how to effectively use social media and networks for response; (3) how to provide visualization in temporal and geospatial terms; and (4) how integrate social media with traditional media and official communications in an effective risk communication matrix.
(A117) Outcomes and Quality of Life after Injury
Authors: Turner J. , Nicholl J.
Published: May 2011

Background

Most research into the outcomes of injury has focused on mortality rather than the physical, social, and psychological sequelae of non-fatal injuries. The health and long-term outcomes of a cohort of accidentally-injured patients were studied in order to assess the impact on quality of life.

Methods

The cohort of patients was derived from six previous studies spanning 1988–2003. Patients were followed-up with to ascertain if they were still alive, and survivors were sent a follow-up questionnaire in 2006. The questionnaire asked about current problems resulting from past injuries, use of health services, and measures of health related quality of life (the EQ-5D and SF-36 or Nottingham Health Profile (NHP)). A sample of 114 also received detailed face-to-face interviews.

Results

A total of 2,418 patients were followed-up on between 4–15 years post-injury, of whom 311 had died. There were 580 completed follow-up questionnaires, and of these 64% reported health problems related to past injuries. The mean EQ-5D score at follow-up was 0.132 tariff points below the mean for a normal age-sex matched population, and SF-36 scores were 5–15 points worse than population norms. At all ages, EQ-5D and SF-36 scores were similar to those of the normal population aged 75. Interviewed patients also reported substantially more disability than the general population. Increasing injury severity was associated with almost all aspects of worse health at follow-up, and severe lower extremity injuries were strongly associated with poorer outcomes.

Conclusions

Injured patients continue to experience significant reductions in health and health-related quality of life for many years after their injury.
(A118) Evidence-Based Disaster Medicine: What Can We Learn from a “Science” Spread across 900 Journals?
Authors: Smith E. , Burkle F.M. , Aitken P. , Archer F.
Published: May 2011

Introduction

Disasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.

Methods

Using a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.

Results

A total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.

Conclusion

Given that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.
(A110) Cardiac Trauma in Children
Authors: Krivchenya D.U. , Rudenko Y.O. , Sokur P.P.
Published: May 2011

Heart trauma is a severe form of thoracic trauma with an incidence of 7–14%. Heart trauma can be either open or blunt, with the latter more prevalent during a disaster. Possible open heart injuries include: (1) pericardial injuries; (2) superficial myocardial and coronary vessels injuries; and (3) penetrating cardiac wounds. The variants of blunt heart trauma include: (1) heart concussion and contusion; (2) rupture of the heart wall and intracardiac structures; (3) rupture of cusps and cords of the heart valves; and (4) cardiac septa (i.e., post-traumatic heart lesions). The latter are characteristic of injuries caused by a fall, and/or a crushing event. The course of heart trauma is severe, and is complicated by the development of shock and catastrophic hemodynamic disorders due to the sudden occurrence of post-traumatic heart lesions and infarction. Thus, verifying cardiac trauma can be complicated. Diagnosing and assessing the severity of heart trauma requires the measurement of intra-arterial and central venous pressures, chest radiography, electrocardiography, pericardial puncture, echocardiography, magnetic resonance imaging, cardioangiography, and measurement of heart enzymes. One-hundred twenty-seven patients ages 2 to 42 years with open (92.1%) and blunt (7.9%) cardiac trauma were treated. Of these patients, 16.5% were children and teenagers. The challenges of treating heart trauma include simultaneously carrying out anti-shock treatment, surgical operation, and resuscitation measures. If post-traumatic heart lesions are diagnosed, surgical correction should be performed despite cardiac decompression. The use of cardiopulmonary bypass is essential.
(A129) A Pediatric Surgeon's Viewpoint of a Concealed Disaster
Authors: Fette A. , Paya K.
Published: May 2011

Childhood is one of the most vulnerable parts in a human's life. Thus, any physical and psychological harm against children requires special attention, especially if inflicted and not accidental. Such children should be considered multi-trauma victims and managed by a multidisciplinary team and trauma algorithm. In this team of specialized carers, the pediatric surgeon will import his/her expertise on general management and treatment and simultaneously refer basic knowledge to more junior doctors that might be in charge in the future. Fifty-eight injured victims (mean age = 1.5 years of age, range = 1 day–18 years of age, male:female ratio = 1:1) were analyzed in this study. Their injuries were subcategorized into battery (13), assault (11), neglect (3), sexual abuse (2), prevention failure (6), career-related (19), and miscellaneous (5). All victims were first seen by a pediatric surgeon before receiving multidisciplinary consultations. Treatment results and modalities varied according to the complexity of the diagnoses requiring a well-trained and skilled pediatric surgeon. Accompanying post-traumatic stress disorders within the children as well as psychological distress among the parents and grandparents were quite frequent. Besides medico-surgical treatment, empathic care is essential. In the majority of cases the children, benefited from pediatric surgical care.
(A133) Emergency Response and Vulnerable Older People: Some Keys for Better Practices
Authors: Maltais D. , Maala T.
Published: May 2011

Emergency response and vulnerable older people: some keys for better practices Danielle Maltais, Ph.D. professor and Taha-Abderrafie Maala, M.Sc student, Social Work Teaching Unit, Department of Human Sciences, University of Quebec in Chicoutimi (UQAC). In the event of a natural or technological disaster, certain groups of people, some of elderly, are more vulnerable than others because they do not have easy access to the community resources. For example, several older people, especially those with a physical or cognitive incapacity and those with a low income, do not generally have a car available which can hinder their evacuation during a flood, an earthquake or a hurricane. Moreover, several elders live in older buildings not built to resist to shocks of all kinds. Older people, particularly those with a physical or cognitive incapacity, those with a low income or those without a social network belong to groups at risk to undergo wounds, to die or develop post-disaster health problems. Considering this, several researchers and national or international government and private as well as non-profit organizations such as World Health Organization, the International Red Cross or HelpAge International produced several guides on intervention aiming to support workers caring for the elderly during a disaster. The purpose of this communication is to present the main outstanding facts and recommendations of these various documents in order to heighten the participants' awareness of the importance to take into account the specificities of older people during the application of emergency measures and the recovery period of a community.
(A134) Special Needs of the Elderly During Disasters – Suggested Strategies and Lessons Learned from the 2007 Tulsa, Oklahoma Ice Storm
Authors: Gulden J. , Stewart M.K. , Stewart C.E.
Published: May 2011

Special Needs of the Elderly During Disasters – Suggested Strategies and Lessons Learned from the 2007 Tulsa, Oklahoma Ice Storm. On the evening of December 7, 2007 an ice storm occurred in the south central United States causing severe power outages in Tulsa, Oklahoma. In Oklahoma alone, 900,000 people were without power for periods of up to 3 weeks. Approximately 13.2% of the population in Oklahoma aged 65 + live in institutional care (2000 US Census Report). There are 498 nursing home facilities in Oklahoma serving this majority of this population (a small percentage live in other types of care facilities). Of these facilities 143 lost electrical power for up to six days, 88 lost power but had generators available within 24 hours or less, and 55 had no alternative source of power. Of the 55 without power, 42 relocated residents. Critical infrastructure failures during natural disasters can create a cascade of direct and indirect losses due to a number of physical, social and economic interdependencies that exist (Rinaldi, Peerenboom & Kelly 2001). The elderly present some unique characteristics that make them more vulnerable during natural disasters. Chronic health problems, physical mobility and cognitive limitations make them unable to adequately prepare for disasters (Aldrich & Benson 2008) making them entirely dependent on the facilities. In the three years since the storm the Oklahoma Disaster Institute has focused its efforts on developing and implementing mitigation strategies to address power loss in nursing homes. These strategies included discussions with the Department of Health, Emergency Medical Services Authority and local hospital officials. As a result of these discussions, table-top exercises were conducted in multiple venues, and speakers from the Department of Health, EMSA, and emergency management were arranged in an Extended Care Facility Workshop. This paper will look at lessons learned, mitigation strategies and successes in protecting the elderly in nursing homes during natural disasters.
(A139) Profile of Likely Needs in a Disaster Alternate Site Care in Honolulu, Hawaii
Authors: Qureshi K.
Published: May 2011

Background

In the US, a system has been developed to provide disaster sheltering for persons with special needs in what are now termed alternate care sites (ACS). As in many other developed countries, as the population ages, the rates of people with chronic diseases that require complex health care management in the home setting has increased. The aim of this study was to identify the key chronic diseases, conditions, and therapies that should be planned for in ACS operations.

Methods

A convenience sample (n = 402) of senior citizens (≥ 65) who resided in Honolulu, Hawaii were interviewed and completed a 15-item survey that asked about demographics, existing health conditions, activities of daily living abilities (ADL), and requirements for ongoing care.

Results

The mean age was 68 years; 56% were female. The most common health issues included: hypertension (53.4%), heart disease (24.6%), diabetes mellitus (23.3%), and asthma (15.1%); while 11% (n = 47) reported they required daily physical assistance ADLs, including: getting up from a chair (15.1%), walking (8.1%), taking medications (8.1%), dressing (5.2%), and toileting (4.2%). Of these 47 people, most (81%) had someone who would help them in a disaster shelter, while nine (19% of the total who required assistance) had no one to help them. On average, of the respondents who reported they took medication daily, 14% had less than a seven-day supply of medication for their chronic disease.

Conclusions

As the population ages, the burden of chronic disease in the population increases. During a disaster with large numbers of displaced persons, accommodations for such persons must be accounted for in order to prevent a second disaster related to de-compensation of those with chronic health problems in the ACS shelter. Understanding the population needs beforehand can mitigate the effects of displacement on this population.
(A146) Disaster Patient Tracking – Local, State and Federal Interoperability during a Multi-Hospital Evacuation Exercise
Authors: Andress K. , Downey E.
Published: May 2011

Introduction

Associated with hospital evacuation is the need to track multiple patient evacuees from point of origination to final hospital reception. Patient tracking, a component of the hospital emergency operations plan, is vital to patient care; family association, resource management, financial reimbursement, risk management, and repatriation. Tracking strategies and plans can include a variety of vendors, hardware, software, and coordination issues. Hospital evacuee tracking plans and platforms exist at multiple jurisdictional levels but may not be interoperable.

Methods

Three patient tracking platforms representing a local, state and federal application were used during a multi-hospital evacuation exercise, initiated in New Orleans, Louisiana, May 2010. Simulated patients were flown and tracked to multiple patient reception centers in the southern United States, including the Federal Coordinating Center in Shreveport, Louisiana, and receiving National Disaster Medical System hospitals. This review summarizes tracking operations, patient data characteristics captured and interoperability at the Shreveport reception location.

Results

7 New Orleans hospitals entered 51 patients for evacuation into Louisiana's web-based, At-Risk-Registry (ARR) database including 8 patient identifiers each. ARR data was shared with federal and Louisiana Region 7 patient evacuee receivers for flight manifest construction and reception planning. 34 ARR evacuee patients were indicated for the Shreveport, Louisiana, reception site. 34 patients with 6 identifying characteristics were entered from ARR into EMTrack, the local patient tracking system. A C130 arrived with a TRAC2ES manifest of 20 simulated patients with 6 patient data characteristics. The local tracking system was reconfigured for the hardcopy manifest; simulated patients were received at the airport; transported and received at local hospitals.

Conclusions

Tracking system interoperability may be challenged by tracking technologies, jurisdictional requirements and degree of implementation at the local, state and federal level. Tracking should be standardized based on national recommendations with local systems remaining flexible for just-in-time requirements.
(A153) Analysis of Chest Compressions: Measured Using the Quality Compression Index and Performance Disparities among Demographic Characteristics
Authors: Schwab J.H. , Williams A.L. , Birnbaum M.L. , Emberts Z.T. , Padjen P.D. , Bhattacharya A. , Olson S.K.
Published: May 2011

Introduction

Cardiopulmonary resuscitation (CPR) guidelines throughout the world stress the importance of high quality chest compressions soon after cardiac arrest as the most significant factor in determining survival. Little evidence exists, internationally, documenting the quality of compressions provided by healthcare providers. In this study investigators sought to determine the quality of chest compressions delivered by rescuers. It was hypothesized that greater variably in compression quality exists between rescuers than variability in individual rescuers over time.

Methods

In this observational pilot study, basic life support (BLS) providers from prehospital and in-hospital settings were invited to participate in the investigation. Ten minutes of continuous chest compressions were recorded on the Resusci Anne and the Laerdal PC Skillreporting System. An adequate compression was defined as a compression with depth > 38mm, full chest recoil, and correct hand position. The Quality Compression Index (QCI) was developed to factor rate into the characteristics of an adequate compression. QCI is a scaled performance index calculated every 30 seconds.

Results

Providers came from a variety of clinical backgrounds, aged 35.5 ± 11.0 years. Of the 103 total participants, 94 (91.3%) completed 10 minutes of compressions. The most significant degradation in the quality of compressions occurred within the first two minutes. There was greater variability between different rescuers than the variability over time. Mean Square Error (MSE) due to subjects was comparatively greater than the MSE due to time (63.2 vs. 7.68). Performance of CPR, male sex, < 45 years of age, and prehospital background, correlated with higher quality. Time since last BLS certification and the number of times a rescuer completed a BLS class did not correlate with the quality.

Conclusions

Greater variability in the quality of compressions exists between different rescuers than a rescuer over time. Some participants were not able to deliver ideal compressions from the start, when the effects of fatigue were minimal.