bluuebunny/crossref_metadata_2025 huggingface dataset:
(A194) “Displaced Voices”: Are those Displaced by War Satisfied with the Provision and Quality of Health Care they Received?
Authors: Wickramage K. , Surentrikumaran R.
Published: May 2011

Research into how war-displaced communities value or prioritize aid response is limited. A clearer conceptualization of what affected populations seek from the international humanitarian response to their needs would be valuable in planning for emergencies.

Aim

Exploring internally displaced person's (IDP) experiences and perceptions of the humanitarian response, with a focus on health risks, resources, and health services received during their displacement.

Method

A mixed-method approach using both quantitative and qualitative methods was used. This study assessed the perceptions of IDPs on provision of health and other services using an interviewer-administered-questionnaire (survey) using a sample frame that included the entire displaced population of 150,000 IDPs living in 97 camps. Findings from the survey were synthesized with the key themes that emerged through the qualitative methodology. In-depth interviews were conducted with health cluster actors. An innovative child-to-child (CTC) based research methodology was used to ascertain the insights and perceptions of displaced children and adolescents.

Results

The survey revealed community satisfaction with health care services immediately after displacement (within IDP camps) improved considerably from 63% to 80% (6 months after the acute phase). Significant gains also were registered for shelter (54.2% to 81.4%), and sanitation (47.4% to 62%). Satisfaction of services rendered by primary healthcare workers also were high; 81.7% for public health midwife (who provided maternal and child health care), and 76.8% for public health inspectors (who provided environmental health and disease control). However, CTC workshops revealed inequalities in access to food based on ‘caste’ and occupation. Protection issues relating to violence from community and militant groups were reported.

Conclusions

Despite IDP satisfaction with healthcare services, there were gaps in food security and violence/protection activities. Recognizing of the role/impact community health volunteers play in health care is an important factor in enhancing primary health care services in IDP camps.
(A195) Planning for Special Needs and Vulnerable Populations in Disaster Care
Authors: Mace S.E. , Doyle C.T.J.
Published: May 2011

Caring for special-needs patients is challenging in disasters. They cannot be triaged, treated or discharged without consideration of their disabilities, including caregivers and social situations. The US Government's response to all hazards requires planning for challenges to communication, medical care, independence, and supervision (CMIST) for vulnerable populations. Vulnerable patients, by lack of any other plan or unavailability of an alternate caregiver, may converge on the emergency department, whether or not there is a medical problem. Language, hearing, seeing, and understanding must be included in patient care and discharge in an expedited manner during a disaster situation. Patients with powered devices and/or underlying medical problems may need access to services such as dialysis or electricity. Vulnerable populations have higher risk for injury and recovery from traumatic disasters. Patients with rotating caregivers, whether in an institution or independent, need alternative caregiver plans. Those patients with service animals will need to have animals included in their plans. Supervised nursing home patients, group home patients, psychiatric patients, minors, and high security patients cannot be released to shelters or other venues without adequate supervision. Before being released from medical care, one must ensure that supervision needs for vulnerable persons are met. Vulnerable casualties must also be protected from abuse and fraud. Individuals dependent on handicap access or public transportation or mobility aids will need plans for alternate transportation prior to a disaster. If the patient is not able to return to their normal community setting, discharge planning to alternate facilities will be part of the planning to prevent unnecessary admission to a hospital that may already be over capacity. Central repositories of information must be available to emergency department and social service personnel to allow caregivers and family to reconnect with patients, and to help with expedited care and discharge.
(A198) Bringing H1N1 Vaccinations to Vulnerable Populations
Authors: Bollinger P. , Baird S. , Giard D. , Higginson G.
Published: May 2011

Background

Populations that participated in this project represented > 46% of the total H1N1 patients hospitalized and 34% of deaths in the state of Oregon.

Methods

A committee was convened by the Oregon Health Authority to increase access to vulnerable populations. The committee determined the project must be supported by: (1) a local advocacy group; (2) a local Health Department; and (3) an emergency medical services (EMS) provider agency to provide immunization. This project involved outreach to a vulnerable population that may not be able to utilize mass vaccination clinics and may have limited access to medical services. Outreach was accomplished using three models: (1) volunteers delivering meals; (2) mailings to those receiving in-home meals; and (3) a community organization that conducted a flu clinic frequented by people with disabilities. Three models were developed for receiving calls and scheduling appointments. All projects followed the same procedure for vaccine administration.

Results

Seventy home-bound individuals met the criteria for vaccination. Post-survey results indicated: 55.2% lived alone and were homebound. Over 70% had previously received their vaccinations from their healthcare provider and 38.9% were not previously vaccinated due to vaccine availability. Fifty-eight individuals were vaccinated. Partner organizations were surveyed after their efforts were completed. Findings indicated that relationships between the EMS agencies and providers were greatly enhanced.

Conclusions

Outreach using nontraditional partners was an effective method to reach a vulnerable population. The project demonstrated that qualified vaccinators can be mobilized quickly. However, because this resource-intensive effort is more costly than providing mass vaccination, similar projects should only be utilized when less costly means are not effective, or when the risk level of the vulnerable population being served warrants it.
(A207) Resuscitation of Casualties Following Exposure to Toxic Chemicals: What is New?
Authors: Baker D.J.
Published: May 2011

Injury following exposure to toxic chemical agents has potential life–threatening effects, particularly on the respiratory system. Antidotes alone often are not sufficient to reverse this situation, and the need to provide early and effective advanced life support for chemical casualties increasingly has been accepted by emergency services around the world. Although the principles of life support are the same for toxic as for conventional casualties, the requirement for responders to wear personal protective equipment makes airway and ventilation management more difficult. Special training and familiarity with devices and equipment used are essential to ensure effectiveness. Recent studies have indicated both the limitations and the possibilities for resuscitation of casualties in a contaminated environment before decontamination. Ventilation of patients with respiratory failure or arrest requires the use of devices which are able to operate and be used by responders wearing protective equipment. The laryngeal mask airway has been shown to be an easier and viable alternative to intubation in this situation. Portable automatic ventilators have been developed which can be used to provide controlled ventilation in a contaminated zone. The ideal mode of ventilation for potentially damaged lungs, following exposure to agents such as chlorine and phosgene has yet to be established. There may be a case for early application of the protective lung ventilation strategies that are now common in intensive care units. This presentation will review recent human and animal studies related to resuscitation in a contaminated zone and provide illustrations of the practical approaches currently used by emergency medical services.
(A209) Developing Medical Facility Preparedness for Radiological Hazmat Emergencies: Applying Surge Science
Authors: Lim H.C.S. , Cheong A. , Cai Y.L.
Published: May 2011

Introduction

Singapore is considered a prime target for transnational terrorism. Perpetrators may select an explosive radiation dispersal device or “dirty bomb” as their weapon of choice. Additional risks of a local radiological emergency may arise from mishaps involving visiting marine nuclear-powered vessels. Strategies and methods used to enhance preparedness to respond to radiological mass-casualty incidents (MCIs) will be described.

Methods

A core group comprising hospital emergency managers and radiology and emergency department staff spearheaded preparedness efforts. The Ministry of Health Guiding Document on managing radiological MCIs provides the principles and operational concepts to anchor the development of local protocols. Discussion sessions, site visits, drills, and exercises are conducted to improve organization performance. Expert opinion and feedback from various stakeholders and partners help shaped the overall plan.

Results

Preparedness activities focused on improving surge response capability through broad categories include: 1. Staff—Radiation response teams were developed and assigned roles and responsibilities. Training and education programs were created for different staff positions, e.g., on correct usage of electronic personal dosimeters and acute radiation syndrome. 2. Stuff—Material resources such as antidotes, and expendables like floor covering were procured and stored. 3. System—These areas include: (a) activation procedures; (b) communication plans; (c) safety measures; (d) casualty transfer protocols; and (e) handling radiologically contaminated waste and materials. 4. Space—Potential care areas, such as radiation isolation rooms were designated. An algorithm was devised to guide casualty management.

Conclusions

Facility preparedness for radiological MCIs requires multidisciplinary involvement and the creation of trusting partnerships. More research is needed to identify the metrics to measure success objectively and aid protocol revisions.
(A210) Chemical Sensor Trial for Nerve Agent Differentiation: Impact of Hydrogen Bonds on Detection
Authors: Oztuna A. , Nazir H.
Published: May 2011

Chemical warfare agents (CWAs) are a growing concern for many countries. The uses of CWAs as they can be synthesized by simple chemical reactions, and often have an extremely high toxicity. Conventional, analytical techniques for the detection of nerve agents from environmental and biological samples include gas chromatography, liquid chromatography, gas chromatography– mass spectrometry, ion chromatography, atomic emission detection, capillary electrophoresis, etc. These methods have very high sensitivity, reliability, and precision. However, in spite of these advantages, these techniques require expensive instrumentation and highly trained personnel. They also are time-consuming and unsuitable for field analysis. To meet these prerequisites of rapid warning and field deployment, more compact, low-cost instruments are highly desirable for facilitating the task of on-site monitoring of nerve agents. a quartz crystal microbalance (QCM) sensors could be a reliable and promising alternative to routine methods because of their simplicity, ease of use and high sensitivity and selectivity.1,2 In this study, we prepared QCM sensors functionalized with –NH2 and –COOH groups for differentiate diethyl ester phosphonic acid (DEHP) from diethyl phthalate (DEP), which are known as G and VX agent stimulants respectively. Infrared spectroscopy (FT-IR) was performed in order to characterize the surface of the sensor after modification and the detection. Furthermore, impact of hydrogen bonds on detection will be discussed.
(A213) Review of the Mass Casualty Incident after a Bomb Explosion in a Crowded Restaurant
Authors: Shettar S.S. , Kelkar K.V. , Jamkar A.V. , Gawali Y.V. , Kapil V. , Sasser S. , Hunt R. , Basavaraju S. , Galwankar S.
Published: May 2011

Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.

Materials and Methods

The CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.

Results

Of the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.

Discussion

The occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns.

Strengths

Highlights the importance of being able to recognize the blast injury patterns and their management.

Limitations

Inability to compare with other blast injuries due to several missing data.

Conclusion

Blast injury sustained in a small, enclosed space is one of the most serious and complicated forms of multiple trauma. Hospitals and civic authorities must be prepared to counter this menace of modem times. Not everything that is faced can be changed, but nothing can be changed until it is faced.
(A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children
Authors: Reilly M.
Published: May 2011

Introduction

Recent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.

Methods

A nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.

Results

Very few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.

Conclusions

Out study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.
(A252) Impact of Protracted, Intrastate Conflict on Population Health in Manipur, India
Authors: Kaushik V. , Nair S. , Tanwar Y. , Sinha S. , Roy N.
Published: May 2011

Introduction

Manipur is a state in northeastern India and in civil war for > 45 years. Healthcare delivery and access is affected due to poor security, restricted accessibility, and the incapacity of this fragile state.

Methods

The burden of morbidity and mortality in the conflict area of Manipur was estimated using data sources (hospital attendance, hospital inpatient, and death registries, national family and health registries, and in-depth interviews of healthcare providers) and compared to national averages. These findings were co-related with violent events reported in the local newspaper.

Results

Excess mortality was observed in the 21–50 year age group, but not in females or the elderly. The major causes of deaths were non-communicable diseases, cerebrovascular accidents, and chronic pulmonary disease. Chronic conflict increased the burden of alcohol liver disease and of mental health diseases. Suicidal deaths were common in the mid-twenty age group and usually due to agricultural pesticide consumption. These deaths were higher in men, and suicide attempts were higher in women. The prevalence of intravenous drug users and of HIV was reported to be five times as higher than the national average. High rates of disappearances, mutilation, torture, kidnapping, and hostage-taking, spousal physical violence and attacks on healthcare facilities and medical personnel were events of concern. There were no reported events of suicide bombers.

Conclusions

Protracted conflict dramatically changes the demographics and disease burden. Humanitarian space constantly is under threat of attack and the insecurity interferes with the provision of sustained preventive and curative services. Recommendations to be implemented would measures to continue treatment in the insecure environment through telephonic or online medical helplines, vaccination, and drug supplies during negotiated ceasefires or curfew times and protecting humanitarian spaces. However, militarization of healthcare may not be favorable solution.
(A254) The Dutch Post-Disaster Response Strategy
Authors: Hall E.F. , Van Der Ree J. , Stom C. , Greven F.
Published: May 2011

The post-disaster response strategy in The Netherlands is unique in that it links scientific institutes, national government and local emergency response organizations. The lynch pin is the Centre for Environmental Health which was founded by the Ministry of Health to improve post-disaster care in The Netherlands. The recently refined Dutch strategy for post-disaster response will be presented and illustrated with a few examples from recent disasters. We will focus on both the role of the Centre and the role of public health Hazmat advisors who are part of the local emergency response organization. The latter advise on the health risks of exposure to CBRN agents. One of the main objectives of the Centre is to prepare guidelines and a structure to ensure transparent and authoritative advice is given to local governments and public health services on the need and value of post-disaster care. The Centre operates a front office, available 24/7, to deliver integrated advice on public health and psychosocial care to local emergency response organizations. A network of experts with a wide range of expertise is on stand-by, whereby the characteristics of the disaster determine which experts compile the advice. The Centre also works closely with several other advisory organizations within the national emergency response organization. Three kinds of advice are delivered. Firstly, as an immediate response (usually within an hour), advice is given on the registration of victims. Secondly, usually within 24 hours, advice is given on the need and value of a health outcome assessment (HOA). Thirdly, if a HOA is decided on, detailed advice is given on its implementation. Another objective of the Centre is strengthening the unique position of regional public health services to deal with post-disaster care. The Centre produces guidelines, tools and training on demand to achieve harmonization and uniformity among these services.
(A262) Use of Portable Ultrasound in Triage in Field Settings
Authors: Yuen H.Y. , Chan E.Y.Y. , Ahuja A.T.
Published: May 2011

Speed and accuracy are major considerations in triage in emergency field settings. Traditional physical examination techniques often are limited in detecting the true nature and full extent of internal visceral injuries, for which delayed recognition and treatment may lead to catastrophic results. Ultrasound has a well-established role in the rapid initial assessment of intra-abdominal pathologies, including trauma, and contemporary portable ultrasound machines are available for use in the field. This presentation will introduce the basic principles of diagnostic ultrasound and its use in emergency settings. Common clinical applications and pathologies and potential limitations and pitfalls also will be discussed with image illustrations.
(A263) Electronic Triage System
Authors: Bajow N.A. , Alkhalil S.M.
Published: May 2011

Most emergency medical response systems rely on paper triage tags and clipboards to share information during mass-causality incidents (MCIs). However, this procedure has proven labor-intensive, time-consuming, and susceptible to human error. Previous research about electronic triage depend on a small movable device, which can be costly. Therefore, an electronic triage system was developed to facilitate effective patient care during an emergency. In this paper, the design, development, and deployment of an electronic triage system for use by rescuers responding to MCIs and disasters will be discussed. The electronic triage software runs on a small, embedded system with limited memory and computational power that efficiently saves patient records. The software system is easy, user-friendly, can be used with any computer, laptop, or iPhone, and it is applicable in all hospitals. This system includes three interfaces: (1) electronic triage tags depending on the Simple Triage And Rapid Treatment (START) triage protocol; (2) the Sort Triage interface; and (3) the Evacuation interface, which includes hospital information such as the Hospital Treatment Capacity (HTC) and the Hospital Surgical Capacity (HSC). It also includes doctors information and hospitals and doctors can be alerted via e-mail. The system also has a database records file for patients that can be saved then immediately sent to hospitals and rescue centers. The electronic triage system will lay the foundation for reliable and continuously updated network coverage during a MCI. It also will help technologists develop future emergency response systems.
(A267) Factors Influencing the Diarrheal Outbreak in the 2010 Pakistan Flood
Authors: Gupta S. , Kumar A.
Published: May 2011

Floods are among the most common hazards in the world and can result in a devastating impact on human life and property. The impact of floods on humans can be traced directly to factors such as the location and topography of the area, as well as demographics and characteristics of the existing environment. Pakistan is currently facing the worst humanitarian crisis in history. It is faced with daunting challenges of reviving and reconstructing almost one fourth of the population. Latest government figures indicate that over 14 million people have been affected by the floods. More than 1.5 million cases of diarrheal diseases have been reported so far. Over 235,000 people have been treated at the diarrhea treatment centers set up in the aftermath of the floods. Floods are unique in their nature since every region is characterized by diverse factors. This paper examines closely the diarrheal outbreak in the flood-ravaged provinces of Pakistan. The study looks at the extent of spread of diarrhea across different time periods through a comparative analysis of different provinces affected. There are many direct factors that affect the severity and scale of floods and, in turn, impact human health like contaminated water, cramped living conditions and lack of sanitation facilities. The paper explores the pre-existing indirect factors responsible for the spread of outbreak in the provinces. These range from geography, socio-economic conditions, demographic features, topography, and community infrastructure. These factors play an extremely pivotal role in determining the nature of response required to control the diarrheal outbreak.
(A273) Mass Gatherings and the Application of the New International Risk Management Standard ISO3100
Authors: Hills M.W.
Published: May 2011

Background

Early involvement by health services in the planning, preparation, operations and post-event analysis of mass gatherings provides one of the best opportunities to engage with other agencies and to develop a real sense of your agency's capabilities. The establishment of the new ISO Standards on Risk Management provide the best opportunity in a decade to structure this work in a manner that will develop true capacity to manage the multitude of risks health services face this century.

Discussion

Rather than ad hoc and sometimes conflicting approaches we now have the “lingua franca” on which to build our policy, capacity development, budgets and response. The evolution of risk management standards has seen the release of ISO 31000: 2009, Risk management - Principles and guidelines and ISO 31010: 2009, Risk management – Risk assessment techniques. Largely based on the earlier Australian Standard 4360 and work of the IEC these standards have the potential to embed critical aspects of the responsibilities of health agencies worldwide into a universal singular policy framework. Translating this into other areas of health agencies work includes communicable disease management and emergency management, in general, which will allow other agencies to understand the “health” perspective and vice versa.

Conclusions

Drawing on personal experiences from mass gatherings since 1997, the author will demonstrate the utility of the ISO Standards as the framework for health emergency management including mass gatherings. Examples will include mass gatherings at the international level within the Asia- Pacific Region to the local level within Sydney, Australia from 1997 to 2010.
(A276) Young People at Mass Gathering Events: Data Collection Tools and Findings
Authors: Hutton A.
Published: May 2011

Background

During the summer months in Australia, school leavers celebrate their end of school life at Schoolies festivals around the nation. These events are typically described as a mass gathering as they are an organised event taking place within a defined space, which is attended by a large number of people.

Discussion and Observations

Two research projects were undertaken to understand the Schoolies phenomenon. The first project was to understand the event as a mass gathering. The second to determine what was important to stay safe and healthy at this event from a young person's perspective. To understand the Schoolies event as a mass gathering Arbons conceptual framework was used which considers the psychosocial, environmental and biomedical aspects of the event. This study found that the crowd mood of the Schoolies were expressive, social and participatory. The environment was bounded, ticketed and dry. The bio-medical data showed a high patient presentation rate when compared to the Australian average. However most of the presentations were minor. What was of concern to the researchers were the high level of risky drinking that took part a this event. The second study used postcards to understand what young people perceived to be important to their health and safety whilst at Schoolies. 3 lead questions were used, and 9 items placed underneath each question to be ranked by participants. Data collected showed that exposure to illicit drugs and violent behaviour where of concern to them. The results from these studies highlights the need to re focus the Schoolies event to be inclusive of strategies that not only support young people to party safely, such as dry zones, but to support young people to feel safe from exposure to drugs, and to violence (physical and sexual) that can occur for many reasons.
(A278) Providing Medical Coverage for an Unfamiliar Sport Event: Tent-Pegging and the 2nd Asian Beach Games
Authors: Al-Qusimy H.N.
Published: May 2011

Background

The addition of Tent-pegging to the 2nd Asian Beach games as one of its 14 Competition events was a welcomed step, especially to the equestrian community of the games' host country, Oman. An equestrian sport of ancient military origin with a long history in Asia, Tent-pegging It a fast-paced sport in which a lance or sword is used to pick pegs off the ground while riding a horse at full gallop. The sport is gaining popularity especially in a number of countries around the world, including Oman.

Discussion and Observations

The hazards inherent in equestrian sports and specifically in Tent –pegging, furthermore, the mass gathering created by the equine presence, the participants, as well as the spectators, required a well planned medical coverage to safely conduct the games. Taking into account that Tent-pegging events normally receive limited medical support, the presentation will discuss the concepts and methods that are commonly followed by the host country on planning and implementing the medical care to sport events of Olympic standards, along with an illustration on how exclusively these concepts were applied to the Tent -pegging events during the 2nd Asian Beach Games. In addition, the presentation will elaborate on the challenges that were dealt with by the medical care providers, and the outcome following a 1st major sporting event of such a scale to be conducted by the host country, Oman. As more countries bid to host major sport events for their first time, suggestion for improving the methodology of providing medical coverage to a sport event will be discussed in the presentation.
(A279) Evidence-Based Decision-Making in Triage
Authors: Mirhaghi A. , Sajjadi M. , Golafshani A.
Published: May 2011

Background and Aims

Decision-making is the major component in triaging emergency department patients. Influencing factors on decision-making have been identified but it`s not clear how much of the decision is based upon scientific criteria. The objective of this study was to determine frequency of using reliable and valid guidelines by nurses in emergency departments.

Methods

It was a descriptive survey study. The questionnaire was composed of demographic data, evidence-based triage questions (15) and triage decision-making questions (10). The questionnaire reliability was 0.87 using the test-retest method. Content validity was considered based upon Canadian Triage and Acuity Scale.

Results

70 nurses from 10 emergency departments participated. 40 % of nurses` responses to evidence-based questions was correct. The percentage of inter-rater agreement between nurses was moderate (0.56) related to decision-making questions. No valid and reliable guideline was utilized in emergency departments.

Conclusion

Nurses` decision-making was poorly based on evidence-based criteria. Low level of nurses` knowledge about triage may be derived from lack of official and specialized triage training courses. Academic triage courses establishment and development of national triage scale are recommended.
(A282) Comparison of Safety Index in Iranian Hospitals
Authors: Djalali A. , Massumi A. , Öhlen G. , Castren M. , Kurland L.
Published: May 2011

Introduction

Hospitals are highly complex facilities that play a key role in the medical response to disasters. However, they are susceptible to the impact of disasters with respect to their structural, non-structural and functional elements. Many hospitals have collapsed or been damaged and rendered nonfunctional as a consequence of disasters. The resilience of a hospital along with the capability of effective medical response to disasters is a key part of a community based disaster plan.

Objective

The objective of this study was to evaluate and compare hospitals in Iran with respect to safety.

Methods

This study was performed as a survey in four hospitals in Iran. The Hospital Safety Index package from WHO was used as an evaluation tool. The evaluation team consisted of: a PhD in structural engineering, an architect with a Master's degree, a specialist in electrical and mechanical maintenance, a medical doctor, a specialist in disaster management, and an expert in health care planning. The hospitals were evaluated in three elements; structural, non-structural, and organizational. The hospital safety calculator was used.

Results

The most important hazard for these hospitals was earthquakes. The structural safety at three hospitals was inadequate or at risk; and consequently needs intervention in a near future. Also, the administrative and organizational element of these hospitals was inadequate or at risk. All hospitals need intervention in the near future due to non-structural safety being inadequate. The overall safety index at one hospital was A (functional); in two hospitals B (at risk); and in one hospital C (inadequate).

Conclusions

The Iranian hospitals which had been assessed were on the whole unsafe. Also, these hospitals do not have a disaster management plan. Implementing a comprehensive disaster plan, including mitigation and a preparedness plan, would most likely enhance the safety of these hospitals.
(A297) Psychosocial Care for Children Survivors of Tsunami Disaster - Pondicherry Response, India
Authors: Sinu E. , Sekar K. , Dhanasekarapandian R.
Published: May 2011

Tsunami left 7997 people dead in Tamil Nadu. Nagapattinam, Cuddalore and Kanyakumari districts were worst affected in terms of human and property loss.. Highest number of children death (1776) were reported in Nagai District. In Project Area, Totally 522 children died due to tsunami in Pondicherry (152), Cuddalore (222), Chennai (48) respectively. Considering massive death of Children in Tsunami Disaster, Rural Development Integrated organization (RIDO) along with partnership of Plan International and Technical Support from National Institute of Mental Health and Neuroscience (NIMHANS) provided psychosocial care for tsunami affected children in the regions of Union territory of Pondicherry, Cuddalore and Chennai. Totally 150 community level workers; 50 from each region were selected and trained for a period of 1 week on psychosocial care for children affected in Disaster through using different mediums by master trainers who underwent intensive Training of Trainers program on psychosocial care for tsunami affected children at National Institute of Mental Health and Neurosciences, Bangalore which is a nodal agency in India on psychosocial care in Disaster management. Psychosocial care program for tsunami affected children was carried out over a period of 2 years in afore said regions and handholding support was given to the community level workers periodically in the field. The psychosocial care program was provided for children in their own community by their own community volunteers through group based activities using different mediums. Mediums used to provide psychosocial care were unique in their own way which brought out the underlying emotions of children related to tsunami. Emotional perceptions differed among children across the age groups. Involving the community level workers in providing the psychosocial care for children survivors of tsunami disaster showed encouraging results. Challenges, limitations and lessons learnt in providing psychosocial care for tsunami affected children through community level workers will be discussed.
(A298) Assessment of Psychosocial Impact of Flood on Children - Indian Experience
Authors: Vranda M.N. , Sekar K.
Published: May 2011

A Disaster is the tragedy of a natural or human made hazard that negatively affects society or environment. Disaster impacts physical, psychological, social and economic areas of the individual and family and community. Most of the time these are interlinked to each other and its total impact on the survivors is substantial. Children are more susceptible to disaster suffering, and it is noticeable in many complex psychological and behavioral symptoms. On the other hand, the post-disaster psychological effects on children are not recognized and underestimated by the mental health professionals. India is highly prone to natural disasters such as floods, droughts, cyclones, earthquakes and landslides have been recurrent phenomenon in India. Out of 602 districts in the country, 125 districts have been identified as most hazard prone areas. The recent heavy rainfall and flood between 28th September to 2nd October 2009 in the Northern region of Karnataka State caused several deaths and massive destructions. This was the first time that North Karnataka received highest rainfall. The incessant rainfall that poured for four days caused the flood and devastated and destroyed the entire social fabric of the community. Floods carry greater risks to psychological as well as physical health of children. The psychological impact of the floods on children has been carried out both qualitatively and quantitatively. The quantitative assessment was done to assess the severity of floods impact on children using the Impact of Event Scale (Dyregrov and Yule, 1995). The results showed the children showed higher level of intrusion and avoidance aftermath of floods. Boys had significantly higher psychological impact than girls. However, both boys and girls showed moderate to severe level of psychological impact on the domains of intrusion, avoidance and hypervegilence. The implication of the findings are discussed in the context of framing psychosocial programmes.
(A278) Preliminary Successes and Challenges in the Creation of an Emergency Medical Care Training Program in the Wake of the 2010 Earthquake
Authors: Sacks E. , Mastroianni M. , Hanselman K. , Cange V.
Published: May 2011

Background

The earthquake in January 2010 killed more than 250,000 Haitians and caused traumatic injury to tens of thousands of survivors. In the aftermath of the earthquake, Haitian civilians assisted in various medical roles. Many of the civilians requested training, and 8 months after the earthquake, a team of American clinicians, EMTs and health educators returned to Haiti to teach a course in basic lifesaving and emergency care.

Methods

Using a modified French-language EMS training curriculum, 60 community members with no previous medical experience were trained during an intense 2-month period. Trainings were held to teach basic lifesaving and stabilization skills. The Gwoup Ayisyen pou Ijans was formed and is preparing to take the French-language EMS exam. A follow-up study is being conducted to assess the capabilities of the students.

Discussion

Preliminary challenges included securing safe places for training and teaching in both French and Kreyol. Successes were the willingness of trainers to volunteer time and equipment, and the high motivation of the students, despite the inability of the government to promise consistent work for an EMT force.
(A312) Evaluation of a Continuing Education Intervention to Improve Management of Mass-Casualty Incidents
Authors: Jaffe E.
Published: May 2011

Introduction

Emergency medical services (EMS) personnel must continuously educate themselves on mass-casualty management. Emergency medical services personnel in Israel are provided with continuing education programs aimed at maintaining knowledge and skills to manage different types of mass-casualty incidents (MCIs). There are 11 Magen David Adom (MDA) regions that have different incidences and experience with MCIs.

Objective

The purpose of this study was to evaluate the effectiveness of an intervention for the management of conventional and mega MCIs.

Methods

A 17-item, multiple choice question pre-test (n = 640) and post-test (n = 536) were administered after a brief continuing education intervention based on lectures and discussion in all 11 EMS regions. The MCI and mega MCI scores were combined to provide an overall MCI score. An independent t-test and ANOVA were used to examine for differences by age, seniority, role, and area of employment of EMS personnel. (p = 0.05)

Results

Reliability of the pre- and post-tests was 0.70. The overall mean score and standard deviation for the pre- and post-test was 64.31% Â ± 14.2% and 75.0% Â ± 14.0%) respectively (p = 0.000). Distribution of scores on the pre- and post-tests were: 80%, 11.8% pre-test, 42.7% post-test. No significant differences were found in pre-/post-test scores by area. Older personnel (> 50 years of age), and those who had been working in EMS for longer periods were found to have significantly lower scores (p = 0.05). Overall scores of paramedics was significantly higher than driver/medics. (p = 0.05).

Conclusions

Both pre- and post-tests were reliable. Post-test scores improved significantly after the intervention. Age and seniority are factors that must be considered when developing continuing education interventions. Possibility should be given to implementing role specific continuing education interventions. Attrition of knowledge must be investigated.
(A313) Integrating Paramedics into the Health System — Israel as a Case Study
Authors: Wacht O. , Dopelt K. , Davidovitch N. , Schwartz D. , Goldberg A.
Published: May 2011

Background

Since its development in the 1970s, the paramedic profession has tried to expend its traditional role of providing prehospital emergency care in ambulances into new fields of practice (e.g. community care). Paramedics in Israel are employed almost exclusively in the emergency medical services (EMS). Similar to other countries, the manpower shortage in the Israeli health system forced policy-makers to consider the expansion of traditional roles of various healthcare professions including paramedics.

Objectives

This presentation seeks to: (1) map the current situation and challenges facing paramedics in Israel; (2) examine paramedics' professional status among policy-makers; and (3) examine the best way to integrate paramedics in the Israeli health-system.

Methods

Qualitative interviews were conducted with 20 senior policy-makers in the Israeli EMS system, Academia, Health Ministry, and military. A policy analysis of documents, laws, regulations, and public media was conducted.

Results

The Ministry of Health in Israel did not play a significant role in the regulation of the profession. Nevertheless, according to the interviewees, paramedics have gained considerable professional recognition among policy-makers, healthcare professionals, and the general public. Following the medical manpower crisis that is evolving in Israel, and the trends that are common in many western countries of expanding the traditional roles of allied health professions, most policy-makers in Israel see the paramedic role evolving into new field of practice. According to policy-makers, legislators, and EMS officials, the major challenges that the paramedic profession faces deal with legislative and professional (mainly academization) issues.

Conclusions

The paramedic profession must adapt itself to the new medical environment. More research should be conducted to build a model, adapted for different local national context, to expand the traditional role of paramedics. This will influence training, research and policy-making regarding the paramedic profession, and will change the traditional professional medical borders.
(A325) Educational and Technical Considerations of Veterinary Personnel Involved in Animal Welfare during Disasters
Authors: Squance H.
Published: May 2011

Training and education of healthcare and government workers has long been accepted as integral to disaster preparedness, although, up until recently, veterinarians and veterinary paraprofessionals have not participated in such practices. It is well documented that when disasters occur, there are dramatic increases in the occurrence and spread of zoonotic diseases, significant contamination of food, water and soil, and reductions in food supply for both humans and animals. These effects reflect the interdependence of humans, animals and their environment, and the importance of managing animal health and welfare after such disasters. Currently, animal welfare emergency management (AWEM) is neither evidence-based nor standardized. Most veterinary schools do not include AWEM in their curriculum, even though AWEM is an essential part of the veterinary professions obligations to both animals and humans. With this gap identified, research was undertaken to derive educational competencies and objectives in criteria-based preparedness and responses that were relevant to veterinarians and veterinary paraprofessionals involved in AWEM. The results have been used to inform the development of Animal Emergency Response training for inclusion in both veterinary and veterinary paraprofessional curriculums. A systematic evidence-based consensus building method was used to derive the educational competences and objectives. This included the following steps: (1) review of peer-reviewed literature on relevant content areas and educational theory; (2)a review of existing competences and training objectives within other sectors involved in disaster management; (3) a survey of international experts and responders which produced qualitative and (4) quantative results development of competencies and testable objectives. The qualitative results showed that veterinarians and veterinary paraprofessionals require core competencies in all three groups and the four basic components of disaster management: mitigation, preparedness, response/emergency relief and recovery. A curriculum should cover all animals, companion, production and wild.
(A331) Simulation of Mobile Hospital Team for Mass Gathering and Mass Casualty in Iraq: Korean Experience
Authors: Wang S.J.
Published: May 2011

Introduction

From 2007, it is decided officially to provide and support mobile hospital team for Iraqi people to enhance access to quality healthcare not only for primary healthcare but also for religious mass gathering and mass casualty situation. Multiple special vehicles were donated to two provincial governments in Iraq and Iraqui experts were invited to Korea for mobile hospital team training including field simulation.

Methods

The simulation was based on computer aided initially, and table top simulation was done and real field drills were performed twice. This process was performed for 2 years to different teams from different province in Iraq. The arrangement of mobile hospital vehicles differed between the first and second year field simulation for finding more efficient arrangement. All the table top simulation and real field drills were recorded by writing and camcoders, after the simulations the video was analyzed and discussed with experts and participants.

Results

Table top simulation has highest number of right decisions in individual simulation situation. The second field drill has more right decisions than the first field drill. The second year field simulation has less duration of drill, highest number of right decisions, and was more comfortable to trainees.

Conclusions

The necessity of mobile hospital team is increasing especially in some region and situation, however, the effort is not enough to seek the appropriate preparedness and method of operation academically. Specific knowledge and guideline for mobile hospital will be necessary as well as the up-to-date facilities and technologies.