bluuebunny/crossref_metadata_2025 huggingface dataset:
(A121) Relation of Dopamine Dependent Hypotension with Outcome in Cervical Spine Injury Patients
Authors: T. D. Agarwal A.
Published: May 2011

Background

It is believed that dopamine resistance sets in within 72–92 hours following therapy. However, in the authors' experience, spinal cord injury patients may require dopamine to maintain blood pressure over several weeks.

Objectives

This study aims to: (1) assess the incidence and duration of of dopamine dependence in cervical cord injury patients; and (2) find the relation (if any) of dopamine dependent hypotension with outcome of spinal cord injured patients.

Methods

This was a prospective, observational study carried out over 2-month period in the neurosurgery intensive care unit (ICU) at JPN Apex Trauma Centre, AIIMS. All cervical spine injury patients who had hypotension during the hospital stay were included in the study. History, clinical findings, requirement of ionotropic support, management, and outcome were recorded for all enrolled subjects.

Results

During the study period 48 patients were admitted with cervical spine injury in the ICU. Of these, 26 patients (54%) had hypotension and were constituted the study group. Eleven patients had complete spinal cord injury (power 0/5) and 15 patients had incomplete spinal cord injury. Twenty-four patients were on ventilator support and two were on oxygen masks. The mean dose of dopamine which the patient receives during the treatment was 7.5 mcg/kg/min with the maximum and minimum doses of 20mcg/kg/min and 2 mcg/kg/min. The mean duration of dopamine support was 17 days (Range 6–48 days). Eight patients (31%) required intermittent dopamine support and 18 patients (70%) required continuous support. The in-hospital mortality was 61% (n = 16). Mortality was significantly lower in patients who received intermittent ionotropic support as compared to those who required continuous ionotropic support (p < 0.01).

Conclusion

The patients with spinal cord injury are dependent on dopamine throughout their recovery period. The patients who required intermittent ionotropic support had significant better outcome compared to those who required continuous ionotropic support.
(A123) Developing World Disaster Health Research - Present Evidence and Future Priorities
Authors: Ralte H. , Roy N. , Chatterjee K. , More V.
Published: May 2011

Developing world disaster Health research - Present Evidence & future priorities

Introduction

Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. The existing & available evidence on disasters in peer-reviewed journals about the developing world, was examined for quality and quantity in this systematic review.

Methods

The free PubMed database was searched using the MeSH (Medical Subject Heading) terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ and ‘conflict’ and then refined using the MeSH terms ‘developing country’. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation & region of the study.

Results

Citations using MeSH search terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ & ‘conflict’ yielded 63,196 results. After these results were refined using the second MeSH term “developing country”, 438 articles were retained. Less than 1% (0.69%) citations in PubMed dealt with developing country disasters. Half of the manuscripts (46.5%) were found to be original research articles (36.1%) or reviews (10.4%), while more than a quarter (29.5%) were commentaries. 97.4% (149/153) of all ‘original research articles’ were Level IV or V evidence. A fifth (20.3%) of the authors of all manuscripts on developing world disasters were from the developing world (82/404); Predominant themes (29.1%) were missions, healthcare provision and humanitarian aid during the acute phase of developing world disasters.

Conclusion

Less than 1% of all disaster-related publications are about developing world disasters. Also, the developed world, authors four-fifths of the articles about developing world disasters, and contributes the predominant perspective. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters, than short-term humanitarian aid missions to the developing world.
(A127) Major Trauma in a Swedish Paediatric Population – A Survey of Children Admitted to a Neuro Intensive Care Unit (NICU)
Authors: Franzén L.E.
Published: May 2011

Purpose

To describe the demographics, mechanism, pattern, and severity of injury, prehospital and hospital care (first 24 hours) and the patient outcome in severely injured children in a NICU. This study was made to complete the study of Swedish children admitted to a paediatric intensive care unit (PICU) due to major trauma in the same region and during the same period.

Method

The medical records of 124 traumatized children (0–16 years of age), admitted to the NICU in Gothenburg 1992–2001, were retrospectively examined. The Injury Severity Score (ISS), Glasgow Paediatric Coma Scale (GSC), Revised Trauma Score (T-RTS/RTS), Paediatric Trauma Score (PTS), Trauma Score Injury Severity Score (TRISS) and Paediatric Risk of Mortality Score (PRISM) estimated the severity of injury.

Results

About 7/100 000 children with severe injuries were admitted to the NICU each year from 1992–2001 inclusive. Epidemiology showed a similar pattern as in other OECD countries. Severity of injury was recorded as an ISS median of 17. Mortality rate in our series was 6%.

Conclusion

Major trauma with admission to a NICU is rare in Swedish children. With management in conjunction with a pediatric centre, these children have a good survival rate.
(A132) Animals and Refugees
Authors: Vroegindewey G.V.
Published: May 2011

Disasters caused by natural and human-made hazards often result in mass-movement of populations. Within these movements, companion and production animals can have significant impacts on the internally displaced persons, refugees, and disaster managers. The humanitarian agency Sphere recently identified and highlighted the fact that animal welfare and protecting the livestock of rural communities (before and after disasters) is crucial to the survival of those disaster-impacted communities. Those who are faced with the decision to move will consider the impact and risk/benefit evaluation of housing, losing companion animals, or the loss of production animals necessary for food security and economic survival. Animal impacts also include the potential to spread zoonotic or animal transboundary diseases, raise security concerns within camps, loss of future breeding stock, feeding, housing, and maintaining accountability. Issues involved with animals and refugees in the evacuation decision process, during movement, and in ad hoc, developing, and mature refugee camps will be discussed.
(A136) Eldery in Emergency
Authors: Saenz M.C.
Published: May 2011

Elderly in emergency -

Presentation

Psychosocial support is essential to prevent mental health disorders in the elders subjected to trauma in emergencies that induces to isolation as well as risks or vulnerability for them and their environment. Financial crisis, natural disasters, attacks, poverty, violence and loneliness in the social environment turn threatening for them. Reality becomes hard and produces disorganization in mental health.

Objectives

Elder people who have gone through one or more of the following situations are the ones who are prone to develop intense or immediate character disorder. With strategies that increase the existing psychosocial protection factors stress at different intervention levels is lowered. Those who have gone through one or more violent experiences are the ones who are prone to develop intense or immediate character disorder. Cultural transferring (between adults and between adults and children) and mutual help between adults and children is held.

Methodology

Cognitive processing factors associated to each individual's anxiety: stress, depression, loneliness, panic attacks etc. Some techniques have been developed to understand emotions and learn how to manage them: songs, classic tales, puppets, advertisements and anagrams, Kessen cards, etc. All the material and the results were evaluated with clinic tests and professional help.

Conclusion

Additionally, a good cultural understanding of the situation and the adult's feelings are needed in order to provide assistance. The one providing help as well as the one receiving bio-psychosocial help are both part of the link created to overcome the impact of violence, committed to build bridges in the adversity. To prevent post-traumatic stress they are trained in facing disturbing anxiety when facing catastrophes produced by nature or men.
(A145) Simulation for the Assessment and Optimization of Medical Disaster Management
Authors: Dhondt E.L. , Van utterbeek F. , Ullrich C. , Debacker M.
Published: May 2011

Background

The ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.

Objective

The aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.

Methods and Results

A system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.

Conclusions

Simulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.
(A147) Pediatric Medical Surge: An Exercise Evaluation Guide
Authors: Weber E.K.
Published: May 2011

A guide was created by the Chicago Healthcare System Coalition for Preparedness and Response to help hospitals and health facilities design, implement, and evaluate emergency exercises following the US Homeland Security Exercise and Evaluation Program (HSEEP) format. The HSEEP provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. As a part of a toolkit for hospital use, the pediatric at-risk population is represented with an Exercise Evaluation Guide titled “Pediatric Medical Surge”. Pediatric Medical Surge is defined as the rapid expansion of the capacity of the existing healthcare system in response to an event that results in an influx of children and an increased need for personnel (clinical and non-clinical), support functions (laboratory and radiological), physical space (beds, alternate care facilities), and logistical support (clinical and non-clinical equipment and supplies). The Exercise Evaluation Guide is fully customizable and includes the following activity sections: (1) Pediatric Pre-Event Mitigation and Preparedness; (2) Incident Command; (3) Pediatric Bed Surge Capacity; (4) Pediatric Surge Staffing Procedure; (5) Pediatric Decontamination; (6) Receive, Evaluate, and Treat Pediatric Surge Casualties; (7) Provide Pediatric Surge Capacity for Behavioral Health Issues; and (8) Demobilization. Each of these sections includes a number of exercise tasks and details the potential tasks/observation keys that are completely modifiable in an electronic format. All or a limited number of these activity sections can be used in an exercise. Following the Activity and Tasks, a section for Observations is provided, and includes Strengths and Areas for Improvement. Upon completion of the Exercise Evaluation Guide, the findings are then utilized to complete the After Action Report for the exercise. This planning document is one tool to assure that children are not neglected in health care based exercises.
(A141) Contingency Planning for Veterinary Public Health Emergencies
Authors: Rantsios A.T.
Published: May 2011

In the cycle of dealing with emergencies one can distinguish four periods, that is planning, diagnosing, responding and recovering. Contingency planning is a prerequisite for emergency management in general. The principles of this planning, for Veterinary Public Health (VPH), does not differ from other cases. However, here will be seen from the point of view of VPH. VPH emergencies include zoonotic diseases and food safety aspects. Emergencies in VPH appear suddenly or expand gradually. Need to define responsibilities for proclaiming an emergency by rating the severity and ranking the situation in steps before deciding that an emergency is in place. One can suggest that surveillance is significant in relation to zoonotic diseases. In food safety, preventative Food Safety Management Systems, in which crisis management and consequent possible product recall actions are part of it, serve the same purpose. In both activities VPH is related with other professionals, a reality expressed, also, in government administrations with different services and/or agencies. Therefore, partnerships and interoperability between veterinarians and physicians on the one hand and other food professionals on the other should be established, for the purpose of efficiently serving the general public. These actions should be developed, as appropriate, in business, region or country level. In order to effectively mobilise the appropriate personnel training and simulation exercises should be part of preparedness. In preparedness, planning for early warning and early reaction should be considered as part of the overall contingency planning. In the various steps in dealing with emergencies the key tool for decision making is risk analysis, served through its three components, that is risk assessment, risk management and risk communication. This last one is very important in relation to communicating with the general public, so that a balanced informing will allow for general public diligent actions without panic.
(A163a) Gold-Medal Performance: “Operational Readiness Assessments” for High-Risk Workplaces
Authors: Mcdonald J.M.
Published: May 2011

This presentation will demonstrate that the use of an “Operational Readiness Assessment” was successful in identifying high-performance strategies for frontline-responders, namely surgeons, air traffic controllers, police, and world-class athletes. This research-based approach confirms that best performers in high-risk situations prepare similarly to elite athlete, specifically relating to their emphasis on mental readiness. A framework (Orlick's “Model of Excellence”) developed by researchers who worked with Olympic athletes has a proven replication within very different high-risk disciplines. Both quantitative and qualitative analysis of mental readiness was provided based on in-depth interviews with exceptional professionals regarding their best and less-than-best performances. These findings were assessed to determine the presence of common success elements, including: (1) commitment; (2) confidence; (3) mental preparedness; (4) focus/refocus; and (5) seeking and accepting feedback. This refined assessment tool combines the methodological rigour of academic research with a highly readable and practical analysis of specific techniques that increase effectiveness. Challenges were defined from a frontline-perspective. The balance between technical, physical, and mental readiness were compared. Success skills, performance blocks and influencing factors for optimal performance were detailed. Ten practical recommendations are discussed relating how preparedness of frontline-operations strengthens performance, productivity, and morale. An “Operational Readiness Assessment” is a powerful tool with proven value in hospital, paramilitary, corporate, and industrial settings in which there is a need to be well prepared for, risks of injury or death, large equipment/financial expenditures, complacency, fatigue, and significant consequences of errors. It has been described as an indispensable addition to current work in recruitment, career development, e-learning, role-modeling and future research benchmarks. For example, new performance-indicators for mental readiness were incorporated into surgical-resident evaluations, national situational-awareness training was instituted for seasoned air-traffic controllers, and mental-survival e-modules now enhance police coach-officer programs. Ultimately, a “winning” strategy for managing risk is promoting a healthy, prepared workforce resulting in a safer community.
(A165) Red Cross Health Erus, a Modular Approach to the Challenge of Evolving Emergencies
Authors: Meagher R.C. , Tingberg T.
Published: May 2011

Emergency Response Units (ERUs) were pioneered over a decade ago by the International Federation of Red Cross and Red Crescent Societies (IFRC), with the intention of providing a standardized, rapid global tool for response in disasters. Health ERUs are one example of several types of ERUs on stand-by in various countries around the world. Their tented infrastructure, basic medical equipment, and pre-trained personnel allow for the provision of surge medical capacity where it is needed. Commonly used set-ups include a Basic Health Care Unit and a Referral Hospital. The recently-introduced Rapid Deployment Emergency Hospital allows for a lighter, highly mobile infrastructure, with surgical and emergency medical capacity. The modular design of these ERUs allows for deployment with materials “tailored” to the disaster. Their flexibility has been demonstrated in public health emergencies such as the nation-wide cholera epidemic that occurred in Zimbabwe (2008) and more recently in earthquake-damaged Haiti (2010) and flood-affected Pakistan (2010). Health ERUs already on the ground in post-earthquake Haiti were able to re-organize equipment for use in cholera treatment units and centers, and additional ERUs were deployed specifically to set-up treatment centers. In Pakistan, a mobile clinic set-up was used to deliver primary health services to displaced populations, including psychosocial support initiatives and community health messages to minimize the emergence of communicable diseases. The Community Health module (CHM) is a new module in development since 2009. Experience has shown that disrupted health systems, combined with displaced populations can create a fertile environment for communicable disease outbreaks. The CHM addresses primary, secondary and tertiary prevention early in emergencies by engaging communities and more specifically National Society volunteers in epidemic control. The modular design of Health ERUs allow for a rapid and comprehensive approach to delivery of health care in a disaster, with a longitudinal perspective of population needs.
(A151) The Situation of Reporting Road Traffic Accidents Resulting In Injury and Death in a Suburban Roadway: A Cohort Study
Authors: Hatamabadi H. , Soori H. , Hadadi M. , Vafaii R.
Published: May 2011

Introduction

The prerequisite of improving the situation of traffic accidents and injury prevention is to set up a “Road Traffic Accident and Victim Information System (RTAVIS)” which does not exist in Iran. The objective of this study was to compare the three major sources information including police, emergency medical service and hospitals to show the necessity of integrated road traffic injury surveillance system.

Method

This prospective cohort study has been done by pursuing each road traffic accident (RTA) case within 30 days of its occurrence by a draft questionnaire and data pooling from participating sources during one year.

Results

In this study, after aggregating/ pooling the data from all organizations, it was finally revealed that during one year 254 injury crashes happened in Tehran–Abali road (with 45 Kilometer distance) in which 434 people were injured or died. Out of these injury crashes, Police and Emergency Medical Services (EMS) stated to be unaware of 67 and 51 cases, respectively. In other words, Police, pre- hospital emergency service and hospital have reported 56.2% 82.9% and 76.4% of the entire number of injuries or deaths respectively.

Conclusion

None of the information sources including police, EMS and health care facilities has complete information about injuries and deaths caused by traffic accidents. It seems that formulating and implementing a centralized and multidisciplinary data collection system of national traffic accidents with the collaboration of police, Ministry of health and medical education (EMS and medical centers), forensic medicine, and Iranian Red Crescent is necessary.
(A153) Does Prehospital Delay Change Trauma Outcomes in Mumbai?
Authors: Kumar V. , Suryawanshi P. , Dharap S.B. , Roy N.
Published: May 2011

Introduction

Prehospital delay in trauma victims has been associated with worsened trauma outcomes, and forms the basis of emergency medical services (EMS). Survival rates of severely injured patients with life and limb threatening trauma were studied and corrlated with prehospital delays in Mumbai, India, where there is no central EMS system.

Methods

From October 2010 to March 2011, a researcher collected Injury Severity Score and prehospital time delay data in all severely injured patients arriving at the Trauma Centre. The time of injury, and time and mode of transport to the Trauma Centre were recorded, along with the details of the injury and the physiological parameters upon admission. Information regarding time and place of the crash, arrival to a trauma care facility, injuries, and survival were noted.

Results

A taxicab was the most common mode of transport followed by a police van, private ambulances, and government ambulances. Patients reached the Trauma Centre more quickly when accompanied by relatives or police, and took longer if they were examined at peripheral centers, were unknown victims, or arrived by Government ambulances. Better outcomes were observed in patients with informal carers. The majority of the victims presented within three hours of trauma.

Conclusions

Prehospital delay did not correlate well with poorer outcomes. Further research is needed to determine how many injured die on the way to the hospital in countries without a formal EMS system. Implementation of a high-cost, state-funded EMS system in a congested, resource-poor, urban setting must be balanced with the insufficient evidence about whether prehospital field interventions actually improve survival outcomes.
(A154) Overcrowding of Ambulances at the Scene of a Disaster: Pitfalls and Implications
Authors: Waseem H. , Shahbaz S. , Razzak J.
Published: May 2011

Introduction

Pakistan is a developing country with a basic prehospital system in some cities. The prehospital services are a mixture of government and private ambulances.There is no central regulatory body for them and no central command to control the influx and out flux of ambulances from the scene.

Objective

In this paper, five episodes of terrorist incidents in the country and will try to estimate the number of ambulances on the scene.

Methods

Retrospective data was collected and triangulation was done by three sources: (1) ambulance records; (2) visual estimation; and (3) print media. An estimate of total ambulances was reached along with dead and injured. Furthermore medical transport capacity was calculated where possible.

Results

In majority of the incidents, it was found that there was a huge influx of ambulances beyond the need. This further adds to the chaos and confusion already present on the scene of disaster.

Conclusions

A Command and Control Center should be established to direct all ambulance control and movements.
(A179) A Survey of Rapid Sequence Intubation (RSI) Complications in Immam Hossein Medical Center Carried Out by Emergency Residents
Authors: Hatamabadi H. , Golkhatir I. , Amini A. , Alavi Moghadam M.
Published: May 2011

Introduction

Critically ill patients in emergency department frequently require emergency airway management. This procedure in our ED is carried out by emergency medicine resident with rapid sequence intubation (RSI). This study investigates complications of tracheal intubation carried out in critically ill patients including: (1) hypoxemia and hypotension (2) aspiration and esophageal displacement (3) pneumothorax and right bronchus intubation.

Methods

Data were collected on consecutive intubations carried out by EM residents over a 29 months period. Between 195 patients only 100 patients had including criteria to enter this study. Also we compare the complications and success rate among three level of personnel carrying on the procedure.(first to third year of emergency medicine residency).

Results

109 consecutive intubations were carried on in 100 patients. Oral translaryngeal intubation was done in all patients. Three intubations required more than 2 attempts and hypoxia occurred in 34 cases. Aspiration was diagnosed by direct vision in 5 cases. Hypotension was found in 5 cases causing death in 3 of them during the intubation or in 30 minutes following the procedure. Esophageal displacement occurred in 10 of the attempts but all were recognized and reintubated. Success rate between three personnel levels are as follow: in first year residency 82% and in second year residency 94% and in third year residency is 100% (p = 0.014).There was not a statistically significant difference among these three groups considering the complications but the success rate should a difference between level 1 and 3 (p = 0.936). Multiple attempts did not increase the rate of complications. Mortality were dependent to hypotension (p = 0.019) and age (p = 0.001).

Conclusion

In our study we did not find the results of RSI to be operator dependent as long as it was done by emergency residents. It is recommended to compare the results of RSI and non- RSI methods in a future.
(A196) Psychological Distress, Quality of Life and Post-Traumatic Stress among Tsunami Affected People with Disabilities
Authors: Satapathy S. , Kasi S.
Published: May 2011

The study investigated psychological impact of tsunami of men and women with disabilities two years after the tsunami disaster. A total of 248 tsunami affected people with disabilities aged between 16 to 85 years were included in the final sample. And the sample consisted of 132 males with the men age 37.9 years, and 116 females with the men age 40.6 years. SRQ (psychological distress), IES (post-traumatic stress), WHO- DAS (psychosocial disability functioning) and QOL (quality of life) were administered. In addition to scale administration to 248 people, formal discussions were held with 27 mentally retarded people and their guardians/parents, thus making the total sample of 275. Main effects of gender were found significant on IES i.e. post-traumatic stress and main effects of type of disability was found significant on physical QOL, psychological QOL, and post-traumatic stress. Main effects of severity of disability was found significant on all variables. t-tests have been found out to study the inter group differences. All findings have been discussed in the light of supporting studies and theories. Long-term psychosocial and psychiatric interventions are suggested to be provided till the reconstruction and rebuilding phase continues, however, the challenge still remains for the strategy of mainstreaming disabled specific designed interventions within the community based psychosocial care services framework.
(A206) Simulation of an Emergency Situation Caused by Biochemical Incident
Authors: Čech P. , Bures V. , Otcenaskova T. , Antos K. , Vaněk J.
Published: May 2011

Emergency situations such as biological or chemical incidents require prompt decision making. The problem is that the authorized personnel responsible for conduction the response operations might lack the knowledge about the agent's biological, chemical and epidemiological characteristics that would influence the impact of the incident. Thus the effect of response operations on lives and assets could hardly be anticipated. The paper suggests simulation based approach to provide appropriate decision making support in such situations. The simulation would imitate the development of an emergency situation under various scenarios and help to determine the proper response operations by which the casualties and loss of assets would be minimized. The aim of the paper is to present the simulation of a spread of an agent in an environment and the corresponding impact on population. The simulation is based on a model with incorporated knowledge about environmental and agent characteristics such as weather conditions, transmission, fatality, incubation period combined also with demographic information. The provided simulation forms a part of the proposed non-military decision support framework for emergency response operations during biochemical incidents.
(A215) Delayed Diagnosis of Injury in Survivors of the February 2009 Crash of Flight TK 1951
Authors: Postma I.L.E. , Winkelhagen J. , Bijlsma T. , Bloemers F. , Heetveld M. , Goslings J.C.
Published: May 2011

Introduction

In 2009, a Boeing 737 crashed near Amsterdam, traumatically injuring 126 people. In trauma patients, some injuries initially escape detection. The aim of this study is to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the effects of tertiary survey on the victims of a plane crash.

Methods

Data collected included documentations of DDI, tertiary surveys, Injury Severity Scale (ISS) score, Glasgow Coma Scale score, number and type of injuries, and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. Comparison was made to a crash in the UK (1989), before advanced trauma life support became practiced widely.

Results

All 126 victims were evaluated in a hospital emergency department; 66 were admitted with a total of 171 clinically significant injuries. Twelve clinically significant DDIs were found in eight patients (12%). In 65%, a tertiary survey was documented. The DDI incidences differed for several risk factors. Eighty-one survivors of the UK crash had a total of 332 injuries. Of those with > 5 injuries, 5% had a DDI, versus 8% of those with ≤ 5 injuries.

Conclusions

The DDI incidence in this study was 7% of the injuries in 12% of the population. A tertiary survey was documented in 65%; ideally this should be 100%. In this study, a high ISS score, head injury, > 5 injuries, and emergency intervention were associated with DDI. The DDI incidence in the current study was lower than in the UK crash.
(A191) The Challenge of the Mexican Oil SPILL (MC252)
Authors: Wu Y.
Published: May 2011

This proposal considers the recent events in the Gulf of Mexico during the British Petroleum MC 252 explosion and subsequent spill. It will discuss the challenges and innovative solutions applied by those involved in the Safety and Pre-hospital medical branch of the Deepwater Horizon spill response. First, it examines the logistical and practical challenges faced by emergency medicine planners working with a large temporary workforce on a HAZMAT scene for many months. It will also discuss the geographic challenges with working on dock sites that existed in local communities with mostly a rural medicine and hospital system, while also considering the potential for ambulance and further pre-hospital support. Impacts resulting from the public/private Incident Command Structure (ICS) will also be discussed liberally throughout the presentation. The author is the former Emergency Response Coordinator for one of BP's largest contractors in charge of the Vessels of Opportunity (VOO) and Near-Shore Skimming (NSS) programs. He was in charge of coordinating all emergency medicine in multiple US states throughout the response. It will analyze the multi-layered approach taken by on-site contractors in addressing these issues from a planning and operational perspective. Planners discovered that a uniform, one-size-fits-all approach applied by the Unified Area Command in New Orleans was virtually inapplicable to sites that had unique geographic and personnel characteristics. Furthermore those who involved in cleanup work in the Gulf had very different requirements than those on-shore. Therefore, site-specific personnel had to adapt to conditions while working within the framework established in New Orleans in order to satisfy ICS guidelines and ensure that emergency medicine in local communities was not overwhelmed. Lessons for future responses will be discussed, as there will be an examination of both the land-based NSS and the water-borne VOO programs.
(A227) Tension between Emergency Management Policy Decisions and Aged Care Facilities in Australia: A Case Study
Authors: Cusack L. , Siegloff L. , Arbon P. , Hutton A. , Mayner L.
Published: May 2011

This paper considers the impact that a number of Australian emergency management policy and operational decisions are having on residential aged care facilities located in the community. For example, all residential aged care facilities applying for new federal government funded aged care places are required to demonstrate a plan for environmental disaster threats such as bushfires and floods. Another example is the adoption of new fire danger rating scale, with the inclusion of an extreme level called “catastrophic”-code red. This inclusion requires all services and community members, living in bushfire-prone areas to decide whether or not to evacuate the day before or morning of a Bureau of Meteorology fire danger index indicating a code red. There is evidence that these policy and operational decisions have been made without fully examining the practical implications, particularly for aged care facilities. While many of the facilities on which these decisions impact see the rational for such decisions, they argue that these decisions have serious implications for their services and patients. Many residential aged care facilities, which are privately operated, historically have not been involved in any state or local government emergency management planning. Therefore, the whole concept of risk assessment, preparation, and planning to increase the absorbing, buffering, and response capacity of their facilities against extreme weather events has become quite overwhelming for some. This paper presents a case study that demonstrates the tension between emergency management policy decisions on an aged care facility, and outlines their issues and response.
(A228) Evaluation of the “Health Legal Preparedness” Model in the Context of Emergency Response in Israel
Authors: Cohen O. , Feder-Bubis P. , Bar-Dayan Y.
Published: May 2011

Background

The “Health Legal Preparedness Model” developed in the US aims to provide better health-related responses in times of emergency. It includes four components: (1) law; (2) competencies; (3) information; and (4) coordination.

Objective

The aim of this study is to examine the usefulness of the “Health Legal Preparedness Model” in the present state of affairs in the field of emergency preparedness in Israel.

Methods

A qualitative study was conducted. In-depth interviews were performed with leading experts in the past or at present in the Israeli emergency health system.

Results

The Israeli healthcare system already has elements of the model in place at various levels. The relative perceived importance of each of the four aspects of the model varied between the experts. Of the four components, law and coordination were perceived as a major system concern. Training of specialists in emergency legislation was controversial. In addition, differences were found in the experts' perceptions as of the optimal way to operate the health system during an emergency. Variability also was found in the perception of the private sector growth and in the importance of its incorporation into emergency response plans. The study found that the emergency preparedness system resembles military practices in its conduct. Nevertheless, there is willingness toward mutual emergency systems drills, including aspects of legal preparedness.

Conclusions

The model already is applied partially in the Israeli emergency healthcare system. Results indicate that the Health Legal Preparedness Model might be useful in identifying gaps in emergency response plans. It also crystallized gaps related to optimal operation during emergencies in the country. Therefore, it is important to reach agreement upon solutions that will incorporate a regulatory guideline in order to improve the function of the emergency healthcare system.
(A232) Volcanic Eruptions: Health Consequences and Preventive Health Measures — An Overview
Authors: Rossodivita A.
Published: May 2011

The 2010 eruptions in Iceland, and on Mount Merapi in Indonesia, caused enormous disruption and opened a new chapter in the history of volcanic eruptions, emerging hazards, and disaster crisis management. A volcanic eruption can be devastating for the local wildlife as well as for the human population. Volcanic eruptions represent a different kind of hazard compared with floods, hurricanes, and earthquakes. Their onset also may be sudden, but they differ in that the danger does not necessarily decline rapidly with time, and actually may increase because of the unpredictability of the eruptive behavior and desire of a willing population to believe that the danger has passed and they can resume normal living. Volcanoes and their eruptions can result in a wide range of health impacts and kill people in a remarkably large number of ways. At least 500 million people worldwide live within potential exposure range of volcanic activity and possible eruption. The range of adverse health effects is quite broad and extensive. This presentation will provide an overview of the main causes of death and injury caused by a volcanic eruptions and the preventive health measures and public health interventions to be adopted during a volcanic eruption. Information on the causes of death and injury in eruptions is sparse, but the available literature is summarized in this report for the benefit of volcanologists and emergency planners. Healthcare workers and physicians responding to the volcanic events might find themselves involved in scenarios as varied as disaster planning, epidemiological surveillance, treating the injured, or advising on the health hazards associated with long range transport of volcanic emissions. Medical treatment only has a small role during severe volcanic eruptions. The preventive measures are paramount if injuries and loss of life are to be reduced.
(A234) Disasters as an Opportunity to Train and Prepare for Future Disasters
Authors: Ranasinghe T. , Vithana E.K. , Herath H. , Pattuwage L.
Published: May 2011

Asian tsunami in 2004 had a tremendous impact on the health system of Sri Lanka leaving many healthcare institutions damaged in the costal provinces and destabilizing the healthcare delivery network. Immediately after the tsunami, health authorities in Sri Lanka realized, health workers should be prepared well if they are to face any future disasters successfully. In this background, the Ministry of Health set its agenda to train all levels of health cadres on disaster preparedness and mitigation whenever there are opportunities. Ministry of Health established the Tsunami Rehabilitation Unit (TRU), later renamed as Disaster Preparedness and Response Unit (DPRU) and mandated it to prepare the health sector for future disasters. During a disaster, well trained health cadre is an asset to any health manager facing the burden of the emergency at the ground level. Trained health personnel on disaster management become a human resource multiplier to fill the gaps of scarce skilled health staff in the field operations. We reviewed the Ministry of Health reports, plans, meeting minutes, reports of training institutions, routine reporting from Ministry of Health departments and reports from health sector partners to compile and then analyze to construct this case study. We provide an overview of how DPRU coordinated and used the opportunities following Tsunami 2004 and then during the humanitarian crisis at the end of 30 years of armed conflict in 2009 to train the health staff. This case study also describes how DPRU networked with government and non governmental organizations to train the different categories of government health staff.
(A238) Optimizing Medical Response to Large-Scale Disasters: The Ad Hoc Collaborative Healthcare System
Authors: Peleg K. , Lipski A. , Kreiss Y. , Ash N.
Published: May 2011

During the authors' recent experience in Haiti during the early aftermath of a major earthquake, it was discovered that more optimal use of field hospitals could be achieved through increased coordination across the deployed medical resources. Moreover, if it were possible to standardize both the capabilities of these resources and their inter-operational guidelines, further improvement in resource utilization could be achieved. Resolving the bottleneck particularly was crucial as the impact on mortality that specialized field hospitals may affect in disasters is observed primarily early on. Confronted with tremendous need in the face of massive devastation, a solution was improvised: For every patient requiring a higher level of care sent by a light hospital, it would have to take a patient being cared for by the authors' in exchange. This arrangement allowed the admission patients who had been screened by other health professionals as requiring an acute intervention that the authors were in a unique position to provide, and ensured that patients would remain under medical care until they were stable enough to be discharged. Additionally, senior medical staff to light hospitals to help identify which patients would most likely benefit from being transferred to the authors' facility. With the other hospital teams' cooperation, surgeons performed needed morbidity and mortality reducing operations on more patients than would have otherwise been possible. Implementing a collaborative healthcare system would help achieve more optimal use of all the medical resources available in a disaster. Further optimization could likely be achieved if participating countries and organizations adhered to a standardized classification and coordination system. Both levels of coordination, at the preparatory and deployment stages, would likely lead to decreased mortality, morbidity, and disability among the devastated population.
(A242) Evaluación De Emergencia Sobre Agua Y Saneamiento En Brote Epidémico De Cólera (Artibonite, Haití Octubre 2010)
Authors: Baena Izquierdo J. , García Pulido K. , Cabello Sanabria F. , Muñoz Martínez P. , Sevillano Borowski D. , Reyes Remedios J.
Published: May 2011

Introducción

En la actuación de Cruz Roja Haitiana/ Cruz Roja Española en la emergencia de Artibonite (Haití), se evaluaron posibles puntos de intervención para el tratamiento de agua dentro de hospitales regionales convertidos en Centros de Tratamiento de Cólera (CTC) improvisados.

Objetivo

Evaluar las capacidades de Agua y Saneamiento del Centro Hospitalario de L'Estere, así como su respuesta de emergencia ante el brote epidémico de cólera a finales de Octubre de 2010.

Metodología

Tras la confirmación de los primeros casos de cólera en la zona de Artibonite, se desplazó a la zona un equipo especializado de delegados en Agua y Saneamiento de la Cruz Roja Haitiana/Española que realizaron una valoración y evaluación de emergencia en la región, identificando el Centro Hospitalario de L'Estere, donde una brigada médica cubana ya ofrecía atención médica a la población previo al brote epidémico de cólera. Las tareas de apoyo a dicho centro fueron principalmente de potabilización y distribución de agua de diversas fuentes (aljibe propio y río), mantenimiento de niveles altos de cloración del agua, fabricación de letrinas y drenajes, así como capacitación en promoción de la higiene a usuarios y familiares de pacientes del Centro Hospitalario de L'Esfere y comunidades cercanas al mismo.

Resultados

Del 21 de Octubre de 2010 al 26 de Octubre de 2010 se valoraron un total de 1966 pacientes; (424 hombres, 374 mujeres, 229 menores de 15 años, 596 de 5 a 10 años y 370 menores de 5 años), de los cuales 798 fueron diagnosticados de cólera. El número total de fallecidos en este periodo fue de 16.

Conclusiones

Una evaluación y respuesta rápida de apoyo en Agua y Saneamiento a estructuras sanitarias regionales permite capacitar y mejorar la respuesta de los mismos ante enfermedades epidémicas como el cólera.

Palabras clave: Cólera, potabilización, saneamiento.
(A243) Características De Estudios De Posgrado En El Area De La Salud
Authors: Ruiz R.B. , Ramírez G.P. , López F.S.
Published: May 2011

Objetivo

Describir las Características de estudios de posgrado en el área de la salud como preparativos para la realización de Planes en caso de Desastres y la asistencia de las principales patologías de Nuestro País.

Método

Se realizó un estudio descriptivo del seguimiento de 92 Diplomados en el área de la salud durante 8 años, realizados en el “Centro Nacional de Capacitación y Educación Ernesto Giovanni Porras”, con participantes médicos, enfermeras y paramédicos de más 75 % de estados de la República Mexicana.

Desarrollo

El 12 de junio del 2002 se constituye una Asociación Civil sin fines de Lucro denominada “Desarrollo Educativo de Posgrado en el Área de la Salud e Investigación AC”, con el objetivo principal de Capacitar y Actualizar al Personal de la Salud en las principales causas de morbilidad y mortalidad, como una respuesta de mejorar la atención de estas patologías. Tres Universidades Avalan estos Diplomados.

Resultados

El diplomado con más participantes es el de Urgencias Médicoquirúrgicas (75%). La profesión más interesada corresponde a los médicos (95%), seguida por personal de Enfermería (4%), El tiempo destinado de capacitación corresponde a 250 hrs. mínimo por cada nivel. El financiamiento de los Diplomados es absorbido por el propio participante (98%), El Índice de deserción es del 20%, siendo la principal Causa por cuestiones económicas (85%) y en segundo lugar por cambio de adscripción o de jornada laboral. Lo más atractivo para el proceso de enseñanza aprendizaje corresponde a la práctica más que a la teoría (95%). La realización de estos planes mejora la capacidad funcional hospitalaria dentro del programa Hospital Seguro, y se evalúan y mejoran mediante la realización de simulacros.

Conclusiones

Los estudios de posgrado son elementos indispensables en la atención de las principales causas de morbimortalidad y en la realización de planes de Emergencia de un Hospital.