bluuebunny/crossref_metadata_2025 huggingface dataset:
First-aid Training and Bystander Actions at Traffic Crashes — A Population Study
Authors: Larsson Eva M. , Mártensson Niklas L. , Alexanderson Kristina A.E.
Published: August 2016

Introduction:

Traffic crashes constitute a major, worldwide public-health problem that cause disabilities, life-long suffering, and huge economic losses. When a person is injured in a traffic crash, actions taken by bystanders often are of crucial importance. To perform first-aid actions in a correct manner, bystanders, often lay persons, need both the courage and the knowledge to do so. For preventive purposes, society spends large resources to inform and educate the public in order to enhance people's ability to take correct actions. However, there only is little information on the rate in a population of persons who have had first-aid training, have been bystanders at a traffic crash, on the actions taken by such persons, and on effects of first-aid training on patient care.

Objective:

The aim of this study was to acquire knowledge about: (1) the prevalence of first-aid training; (2) the incidence of being a bystander and of the first aid provided at traffic crashes and other emergencies; and (3) the impact of first-aid training on the risks people take in road traffic.

Methods:

A questionnaire was administered to 2,800 randomly selected persons aged 18–74 years.

Results:

The response rate was 67.5%. During the previous five years, 39% of the population had received first-aid training, with a higher rate among younger individuals and those with a higher education. After training, 30% of the respondents had used their skills, and 41% took fewer risks in traffic, particularly those who were older or had a lower level of education. Fourteen percent of those with training (significantly more men) had been bystanders at a traffic crash. At 20% of the crashes, a bystander had administered first aid, and one-third of those who provided such assistance had had use of their training. Conclusion: Intensified first-aid training of the general public could lead to citizens who are more cautious in traffic and to bystanders who provide more immediate and adequate first aid at traffic crashes and other emergencies.
Effectiveness of a Glasgow Coma Scale Instructional Video for EMS Providers
Authors: Lane Peter L. , Báez Amado Alejandro , Brabson Thomas , Burmeister David D. , Kelly John J.
Published: August 2016

Introduction:

The Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness of patients who have sustained head injuries. Rapid and accurate GCS scoring is essential.

Objective:

To evaluate the effectiveness of a GCS teaching video shown to prehospital emergency medical services (EMS) providers.

Methods:

Participants and setting—United States, Mid-Atlantic region EMS providers. Intervention—Each participant scored all of the three components of the GCS for each of four scenarios provided before and after viewing a video-tape recording containing four scenarios. Design—Before-and-after single (Phase I) and parallel Cohort (Phase II). Analysis— Proportions of correct scores were compared using chi-square, and relative risk was calculated to measure the strength of the association.

Results:

75 participants were included in Phase I. In Phase II, 46 participants participated in a parallel cohort design: 20 used GCS reference cards and 26 did not use the cards. Before observing the instructional video, only 14.7% score all of the scenarios correctly, where as after viewing the video, 64.0% scored the scenarios results were observed after viewing the video for those who used the GCS cards (p = 0.001; RR = 2.0; 95% CI = 1.29 to 3.10) than for those not using the cards (p <0.0001; RR = 10.0; 95% CI = 2.60 to 38.50).

Conclusions:

Post-video viewing scores were better than those observed before the video presentation. Ongoing evaluations include analysis of longterm skill retention and scoring accuracy in the clinical environment.
Effects on Local Emergency Departments of Large-Scale Urban Chemical Fire
With Hazardous Materials Spill
Authors: Hsu Edbert B. , Grabowski Jurek G. , Chotani Rashid A. , Winslow Jason A. , Alves Donald W. , VanRooyen Michael J.
Published: August 2016

Introduction:

On 18 July 2001, a train hauling hazardous materials, including
hydrochloric acid, hydrofluoric acid, and acetic acid, derailed in the
city of Baltimore, Maryland, resulting in a fire that burned under a
downtown street for five days. Firefighters were stymied in their
efforts to extinguish the fire, and the city was subjected to thick
smoke for several days.

Objectives:

To determine whether an urban chemical fire with a hazardous
materials spill resulted in a detectable public health impact, and to
demo-graphically describe the at-risk population for potential smoke and
chemical exposure.

Methods:

The United States Centers for Disease Control and Prevention (CDC)
was consulted about possible side effects from chemical exposure. Total
numbers of emergency department (ED) patients and admissions from 15:00
hours (h), 15 July 2001 to 15:00 h, 21 July 2001 were collected from
five local hospitals. Patient encounters citing specified chief
complaints from 15:00 h, 15 July to 15:00 h, 18 July (pre-accident) were
compared with the period from 15:00 h, July 18 to 15:00 h, 21 July
(post-accident). Data were analyzed using Fisher's exact test. The
United States Census Bureau's Topologically Integrated Geographic
Encoding and Referencing (TIGER) digital database of geographic features
and ArcView Geographic Information Systems (GIS) were used to create
maps of Baltimore and to identify populations at-risk using attribute
census data. Results: There were 62,808 people residing in the
immediate, affected area. The mean of the values for age was 33.7 ±3.2
years (standard deviation; range = 16 yrs) with 49% (30,927) males and
51% (31,881) females. A total of 2,922 ED patient encounters were
screened. Chief complaints included shortness of breath, pre-event = 109
vs. post-event = 148; chest complaints = 90 vs. 113; burns and/or skin
irritation = 45 vs. 42; eye irritation 26 vs. 34; throat irritation = 33
vs. 27; and smoke exposure = 0 vs. 15. There was a statistically
significant increase (p <0.05) for
shortness of breath and smoke exposure-related complaints. No
statistically significant increase in numbers of admitted patients with
these complaints was found.

Conclusions:

In the setting of a large-scale urban chemical fire, local EDs can
expect a significant increase in the number of patients presenting to
EDs with shortness of breath and/or smoke inhalation. Most do not
require inpatient hospitalization. Careful assessment of impact on local
EDs should be considered in future city-accident planning. Some official
warnings were widely misinterpreted or ignored. Public education on
potential hazards and disaster preparedness targeted to populations
at-risk should receive a high priority. Geographic information systems
(GIS) may serve as useful tools for identifying demographics of
populations at-risk for disaster planning and responses.
Multimodal Assessment of the Primary Healthcare System of Serbia: A Model for Evaluating Post-Conflict Health Systems
Authors: Nelson Brett D. , Simic Snezana , Beste Lauren , Vukovic Dejana , Bjegovic Vesna , VanRooyen Michael J.
Published: August 2016

Introduction:

Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia.

Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.

Methods:

Integrated quantitative and qualitative methodologies—system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology—were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.

Results:

Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.

Conclusions:

This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings.
Cost: Benefit of Point-of-Care Blood Gas Analysis vs. Laboratory Measurement During Stabilization Prior to Transport
Authors: Macnab Andrew J , Grant Greg , Stevens Kyle , Gagnon Faith , Noble Robert , Sun Charles
Published: August 2016

Introduction:

This study was conducted to determine whether point-of-care testing, using the iSTAT Portable Clinical Analyzer, would reduce time at the referring hospital required to stabilize ventilated pediatric patients prior to interfacility, air-medical transport.

Methods:

The following data were collected prospectively: (1) When a blood gas analysis was ordered; (2) If it was necessary to call in a technician; (3) Waiting time for blood to be drawn; and (4) Waiting time for results. The cost-efficacy of point-of-care testing was calculated based on: (1) Three minutes for a transport team member to draw a sample and obtain a result using the iSTAT (unit cost $CDN8,000); (2) Lab technician call-back (minimum two hours at $90); (3) Paramedic overtime (by the minute at $49/hour); and (4) Cost of charter aircraft wait time ($200 per hour) for every hour beyond four hours.

Results:

Data were collected on 46 ventilated patients over a three month period. A blood gas analysis was ordered on 35 patients. Laboratory technicians were called in for 17 (49%). For 12 (34%) patients, there was a wait for the sample to be drawn, and for 23 (66%), there was a wait for results to become available. Total time waiting to obtain laboratory gases was 526 minutes compared with a calculated 105 minutes using point-of-care testing. An iSTAT cartridge cost of $420 would not have been different from laboratory costs. Cost-saving on technician callback ($1,530), paramedic overtime ($690) and aircraft time waiting charges ($2,000) would have totaled ($4,220). From this study, the cost of point-of-care equipment could be recouped in 101 patients if aircraft charges apply or 192 patients if no aircraft costs are involved. For 11 cases, ventilator adjustments were made subsequently during transport, and for six patients, point-of-care testing, if in place, would have been used to optimize transport care.

Conclusion:

The data from the present study indicate significant cost-efficacy from use of this technology to reduce stabilization times, and support the potential to improve quality of care during air medical interfacility transport.
Terrorism in Colombia
Authors: Zapata Gabriel Darío Paredes
Published: August 2016

Colombia is a poor country that has been plagued by ongoing violence for
more than 120 years. During the 1940s, subversive terrorist groups emerged
in rural areas of the country when criminal groups came under the influence
of Communism, and were later transformed into contemporary groups, such as
the Ejercito de Liberacion Nacional (ELN) or
National Liberation Army and Fuerzas Armadas Revolucionares de
Colombia (FARC) or Revolutionary Armed Forces of
Colombia). Paramilitary terrorist groups emerged in response to subversive
groups and were later transformed into contemporary groups, such as the
Autodefensas Unidas de Colombia (AUC) or
United Self-Defense Forces of Colombia.

Terrorism has placed an enormous burden on modern Colombia. From 1995 to
2002, 9,435 people were killed by terrorism-related events, of which 5,864
were killed by subversive terrorist activities and 3,571 were killed by
paramilitary terrorist activities. In 2002, at least nineteen attacks
produced 10 or more casualties, of which 18 were bombings. In 2002,
terrorists killed at least 12 mayors, 71 legislators, and internally
displaced 300,000 persons from their homes. Since terrorist groups in
Colombia are typically supported by drug manufacturing and trafficking, it
has been difficult at times to distinguish violence due to terrorism from
violence due to illicit drug trafficking. Terrorism has also had a major
adverse effect on the economy, with restricted travel, loss of economic
resources, and lack of economic investment. In addition to political,
military, and commercial targets, terrorists have specifically targeted
healthcare infrastructure and personnel.

At the national and local levels, much emergency planning and
preparedness has taken place for terrorism-related events. The Centro
Regulador de Urgencias (CRU) or Emergency Regulation Center in Bogota plays
a major role in coordinating local prehospital and hospital emergency
response in the capital city and the national level where
necessary.
Terrorism in France
Authors: Carli Pierre , Telion Caroline , Baker David
Published: August 2016

France has experienced two waves of major terrorist bombings since 1980.
In the first wave (1985–1986), eight bombings occurred in Paris, killing 13
and injuring 281. In the second wave (1995–1996), six bombings occurred in
Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during
these events, France has developed and improved a sophisticated national
system for prehospital emergency response to conventional terrorist attacks
based on its national emergency medical services (EMS) system,
Service d' Aide Medicale Urgente (SAMU).
According to the national plan for the emergency medical response to
mass-casualty events (White Plan), the major phases of EMS response are: (1)
alert; (2) search and rescue; (3) triage of victims and provision of
critical care to first priority victims; (4) regulated dispatch of victims
to hospitals; and (5) psychological assistance.

Following the 1995 Tokyo subway sarin attack, a national plan for the
emergency response to chemical and biological events (PIRATOX) was
implemented. In 2002, the Ministries of Health and the Interior collaborated
to produce a comprehensive national plan (BIOTOX) for the emergency response
to chemical, biological, radiological, and nuclear events. Key aspects of
BIOTOX are the prehospital provision of specialized advance life support for
toxic injuries and the protection of responders in contaminated
environments. BIOTOX was successfully used during the 2003 Severe Acute
Respiratory Syndrome (SARS) outbreak in France.
Terrorism in Mexico
Authors: Nordin Yannick , Cruz-Vega Felipe , Roman Fernando
Published: August 2016

Even though Mexico is considered internationally as a pacifist country,
its economic, social, and geopolitical characteristics during the last half
of the 20th century have resulted in internal events that can be considered
acts of terrorism.

Most of the acts of terrorism during the last 15 years have had to do
either with political movements or drug-dealing actions. After the 11
September 2001 attacks in the United States, Mexican Health Authorities have
strengthened the epidemiological surveillance system. More than 1,372 calls
asking for information or reporting suspicious envelopes were received
between 16 October and 21 October 2001.

Following the earthquake in 1985 that caused great damage and many
deaths in Mexico, the National Civil Protection System was created in 1986.
This protection system is led by the President and the Secretary of
Government. It was developed to improve preparedness for disaster
coordination more than for terrorism responses. In addition, the emergency
medical systems continue to lack organization, even though some states have
shown significant progress in their emergency medical system.
Terrorism in Taiwan, Republic of China
Authors: Tsai Ming-Che , Chuang Chia-Chang , Arnold Jeffrey , Lee Mau-Hwa , Hsu Sun-Chieh , Chi Chih-Hsien
Published: August 2016

The Republic of China on the island of Taiwan has experienced at least
20 terrorist events since 1979, including 13 aircraft hijackings and five
bombings. Factors responsible for the relatively small burden of terrorism
on Taiwan in the past include tight military control over political dissent
until 1987, a warming relationship with the People's Republic of China in
the 1990s, political inclusion of major internal cultural groups, geographic
isolation, and a lack of other significant international enemies.
Nevertheless, today Taiwan faces a new prospect of terrorism by adversaries
of the United States and its allies and by an international paradigm shift
in the types of weapons used by terrorists.

National emergency management has been enhanced significantly since the
Ji Ji earthquake in 1999, including the assignment of lead government
agencies to the planning and preparedness for specific types of terrorist
events involving nuclear, biological, and/or chemical releases. Other
significant improvements at the operations level, include the establishment
of two national disaster medical assistance teams, four urban search and
rescue teams, 13 local disaster medical assistance teams, and eight chemical
emergency response hospitals. Future challenges include improving the
coordination of inter-agency response at the national level and the quantity
and quality of local disaster response assets.
Terrorism in South Africa
Authors: MacFarlane Campbell
Published: August 2016

The Republic of South Africa lies at the southern tip of the African
continent. The population encompasses a variety of races, ethnic groups,
religions, and cultural identities. The country has had a turbulent history
from early tribal conflicts, colonialisation, the apartheid period, and
postapartheid readjustment.

Modern terrorism developed mainly during the apartheid period, both by
activities of the state and by the liberation movements that continued to
the time of the first democratic elections in 1994, which saw South Africa
evolve into a fully representative democratic state with equal rights for
all.

Since 1994, terrorist acts have been criminal-based, evolving in the
Cape Town area to political acts, largely laid at the feet of a
predominantly Muslim organisation, People against Gangsterism and Drugs, a
vigilant organisation allegedly infiltrated by Muslim fundamentalists. Along
with this, has been terrorist activities, mainly bombings by disaffected
members of white, right-wing groups.

In the apartheid era, a Draconian series of laws was enacted to suppress
liberation activities. After 1994, most of these were repealed and new
legislation was enacted, particularly after the events of 11 September 2001;
this legislation allows the government to act against terrorism within the
constraints of a democratic system. Disaster management in South Africa has
been largely local authority-based, with input from provincial authorities
and Civil Defence. After 1994, attempts were made to improve this situation,
and national direction was provided. After 11 September 2001, activity was
increased and the Disaster Management Act 2002 was brought into effect. This
standardized disaster management system at national, provincial, and local
levels, also facilites risk assessment and limitation as well as disaster
mitigation.

The potential still exists for terrorism, mainly from right wing and
Muslim fundamentalist groups, but the new legislation should stimulate
disaster management in South Africa to new and improved levels.
Introduction: Consequences of Terrorism
Authors: Noji Eric K.
Published: August 2016

Recent acts of terrorism have ranged from the dissemination of anthrax spores to intentional contamination of food to the release of chemical weapons to suicide attacks using explosives. The prediction of such events is difficult, if not impossible. The recent attacks that have generated massive numbers of injured and dead may signal the crossing of a new threshold from multi-casualty events to the use of weapons of mass destruction. Consequently, the medical and healthcare infrastructure must be able to prevent and treat illness and injury resulting from such events. Thus, a first step in improving the preparation for and responses to such events must include a sustained commitment to training physicians, nurses, identification specialists, pathologists, and other first responders. The rapid spread of SARS gives reason to believe that the distribution of such agents has potential advantages over the use of other weapons. Investments in the public health and healthcare systems provide the best defense against terrorism.
Terrorism, Disasters, and Security
Authors: Alexander David
Published: August 2016

The purpose of this editorial is to explore the relationship between the new global emphasis on terrorism and the developing academic and practical fields of disaster management. It includes an appraisal of the place of terrorism among the various forms of disaster, a consideration of its relationship to risk assessment and its place in the practical handling of risks and incidents, and some reflections on the role of the private sector in security management. The influence on the current attitude toward managing the terrorism threat by the evolution of the disaster management field is considered and some of the problems with defining scenarios for counter-terrorism planning also are discussed.
Lack of Hospital Preparedness for Chemical Terrorism in a Major US City: 1996–2000
Authors: Keim Mark E. , Pesik Nicki , Twum-Danso Nana A.Y.
Published: August 2016

Introduction:

The [US] Nunn-Lugar-Domenici Defense Against Weapons of Mass Destruction (WMD) Act (the WMD Act of 1996) heralded a new wave of spending by the federal government on counter-terrorism efforts. Between 1996 and 2000, the United States of America (US) federal government allocated large sums of funding to the States for bioterrorism preparedness. Distribution of these funds between institutions involved in first-responder care (e.g., fire and safety departments) and hospitals was uneven. It is unknown whether these additional funds had an impact on the level of hospital preparedness for managing mass casualties involving hazardous materials at the local level, including potential terrorist attacks with chemical agents.

Objectives:

(1) To compare 1996 and 2000 measures of preparedness among hospitals of a major US metropolitan area for dealing with hazardous material casualties, including terrorism that involved the use of weapons of mass destruction; and (2) To provide guidance for the improvement of emergency preparedness and response in US hospitals.

Methods:

In July 1996 and again in July 2000, 21 hospitals in one major US city were surveyed by questionnaire. A survey was used to assess the amounts of antidote stocks held available for treatment of casualties caused by toxic chemical agents and institutional response capabilities including the number of showers for decontaminating patients, the level of worker protection, and the number of staff trained to decontaminate patients.

Results:

Hospital preparedness for treating and decontaminating patients exposed to toxic chemical agents was inadequate in 1996 and in 2000. From 1996 to 2000, there was no statistically significant change in the lack of hospital preparedness for stocking of nerve agent and cyanide antidotes. Capacity for decontamination of patients, which included appropriate hazardous material infrastructure and trained staff, generally was unimproved from 1996 to 2000 with the exception of an increase of nearly 30% in hospitals with at least one decontamination shower facility.

Conclusion:

Hospitals surveyed in this study were poorly prepared to manage chemical emergency incidents, including terrorism. This lack of hospital preparedness did not change significantly between 1996 and 2000 despite increased funds allocated to bioterrorism preparedness at the local level.
Public Health Response Actions and the Use of Emergency Operations Centers
Authors: Mignone A. Thomas , Davidson Robert
Published: August 2016

In the wake of 11 September 2001, many public health agencies are reassessing their institutional capabilities and procedures to respond to mass-casualty incidents involving weapons of mass destruction. Prior to the fall of 2001, planning by the public health and other sectors addressed more conventional or naturally occurring events such as earthquakes, hurricanes, tornados, and chemical spills, although attacks with weapons of mass destruction were a growing concern. While the nature of natural versus intentional events differs, the management and coordination of response activities to them follows the same incident command system.

A major lesson learned during the response operations to the 11 September 2001 attacks in New York City was the value of disaster planning, conducting exercises, and developing relationships among the various response agencies. Although New York City's physical Emergency Operations Center (EOC) at 7 World Trade Center was destroyed in the attack, the medical and health response community was able to react effectively to the possibility of mass casualties as well as to the more usual needs. This was enabled by the pre-existing relationships that had been developed between city, state, federal, and non-governmental agencies while planning and exercising for such events and their aftermaths.
Mass-Casualty, Terrorist Bombings: Implications for Emergency Department and Hospital Emergency Response (Part II)
Authors: Halpern Pinchas , Tsai Ming-Che , Arnold Jeffrey L. , Stok Edita , Ersoy Gurkan
Published: August 2016

This article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.
Planning for Resilience in Hospital Internal Disaster
Authors: Sternberg Ernest
Published: August 2016

This article seeks to clarify the terminology and methods of planning to
avert hospital internal disaster. It differentiates “crisis” from “disaster”
in the in-hospital setting. Preparedness, as contrasted with mitigation, is
meant to reduce the likelihood that a crisis will turn into a disaster.
Though there are some recurring features of crises, allowing for
preparedness through the identification of a few high-likelihood
contingencies, crises are subject to numerous, overwhelming uncertainties.
These include hazard uncertainty, incident uncertainty, sequential
uncertainty, informational uncertainty, consequential uncertainty, cascade
uncertainty, organizational uncertainty, and background uncertainty. In view
of the uncertainties, the primary aim of planners should not be to try to
create plans for ever more contingencies, since contingencies are far too
numerous and perhapsapproach infinity, but rather to create capabilities
(through proper preparedness) for resilience during crisis. Resilience can
be cultivated through improvements in information acquisition and
dissemination, communication systems, resource management, mobility
management, design for resilience, incident command, and staff
versatility.
Preventing After-Effects of Disaster Trauma: The Information and Support Centre
Authors: Weisæth Lars
Published: August 2016

This paper describes the establishment and activities of the Information and Support Centres developed in Norway in the aftermath of large-scale accidents and disasters between 1980 and 1990. The function of these Centres is to provide rapid, authoritative information and psychosocial support services for the next-of-kin of disaster victims, including the families of those missing. By gathering together those affected by a particular event, the Centres provide a setting in which individuals and families can support each other. The activities of the psychosocial team include triage for mental-health emergencies, orienting survivors to immediately available local services, communication with family, friends, and community, and other forms of psychological first aid. The psychosocial team also provides linkages to local health, clergy, and other local resources that are near to the family's home and could provide continued care if necessary.
A New Opportunity for Public Health Development: Athens 2004
Authors: Levett Jeffrey
Published: August 2016

A number of organized and universally publicized, large-scale events take place each year in many parts of the world that involve a population at greater risk. Large gatherings provide a theater of operations for public health and more thought now is being given to these issues. The Olympic Games is the largest, single event that is concentrated into one significant geographical space that unfolds over a period of weeks and involves a transient population. From Atlanta to Sydney, a growing awareness of public health issues has occurred, and there is a clear recognition that much more preparation is necessary for all future events. Therefore, it is mandatory that we recognize that the Olympic Games, Athens 2004 is a potential venue for accidents as well as for purposefully precipitated acts leading to suffering, disability, and death. The organization and management of public health is a major hurdle for Athens 2004. At a minimum, hospital and emergency medical services must be in an optimal state of readiness, a network of public health laboratory services must be deployed, and human resources must be retooled.
Challenges of Major Incident Management When Excess Resources are Allocated: Experiences from a Mass Casualty Incident after Roof Collapse of a Military Command Center
Authors: Romundstad Luis , Sundnes Knut Ole , Pillgram-Larsen Johan , Røste Geir K. , Gilbert Mads
Published: August 2016

During a military exercise in northern Norway in March 2000, the snowladen roof of a command center collapsed with 76 persons inside. Twentyfive persons were entrapped and/or buried under snow masses. There were three deaths. Seven patients had serious injuries, three had moderate injuries, and 16 had minor injuries.

A military Convalescence Camp that had been set up in a Sports Hall 125 meters from the scene was reorganized as a causality clearing station. Officers from the Convalescence Camp initially organized search and rescue. In all, 417 persons took part in the rescue work with 36 ambulances, 17 helicopters, three ambulance airplanes and one transport plane available. Two ambulances, five helicopters and one transport aircraft were used. Four patients were evacuated to a civilian hospital and six to a field hospital.

The stretcher and treatment teams initially could have been more effectively organized. As resources were ample, this was a mass casualty, not a disaster. Firm incident command prevented the influx of excess resources.
Information-Sharing in Out-of-Hospital Disaster Response: The Future Role of Information Technology
Authors: Arnold Jeffrey L. , Levine Brian Neil , Manmatha R. , Lee Francis , Shenoy Prashant , Tsai Ming-Che , Ibrahim Taha K. , O'Brien Daniel J. , Walsh Donald A.
Published: August 2016

Numerous examples exist of the benefits of the timely access to information in emergencies and disasters. Information technology (IT) is playing an increasingly important role in information-sharing during emergencies and disasters.

The effective use of IT in out-of-hospital (OOH) disaster response is accompanied by numerous challenges at the human, applications, communication, and security levels.Most reports of IT applications to emergencies or disasters to date, concern applications that are hospital-based or occur during non-response phases of events (i.e., mitigation, planning and preparedness, or recovery phases). Few reports address the application of IT to OOH disaster response.

Wireless peer networks that involve ad hoc wireless routing networks and peer-to-peer application architectures offer a promising solution to the many challenges of information-sharing in OOH disaster response. These networks offer several services that are likely to improve information-sharing in OOH emergency response, including needs and capacity assessment databases, victim tracking, event logging, information retrieval, and overall incident management system support.
Hazardous Substances Releases Causing Fatalities and/or People Transported to Hospitals: Rural/Agricultural vs. Other Areas
Authors: Berkowitz Zahava , Horton D. Kevin , Kaye Wendy E.
Published: August 2016

Introduction:

Mass-casualty and hospital preparedness has been analyzed widely. However, information regarding the types of areas where these events occur is limited. Therefore, the characteristics of acute hazardous substances releases resulting in death/multiple-victim events occuring in rural/agricultural areas and in all other areas were studied and compared. Methods: Data reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system from 16 state health departments during 1993–2000 were used to examine factors associated with events with death/multiple victims involving acute release of hazardous substances. A death/multiple-victim event is defined as any event resulting in a death and/or at least five people being transported to a hospital.

Results:

Of a total of 43,133 events, 6,661 occurred in rural/agricultural areas. Of these, 107 were death/multiple-victim events with 632 victims, of whom 91 died and 77 were hospitalized. All other areas had 472 death/multiple-victim events with 7,981 victims, of whom 116 died and 413 were hospitalized. Death/multiple-victim events in rural/agricultural areas were more likely to be associated with transportation (Proportional Ratio (PR) = 4.1, 95% CI = 3.1–5.4) and fires and/or explosions (PR = 1.4, 95% CI = 0.95–2.0) than were death/multiple-victim events in all other areas. Among transportation-related events in rural/agricultural areas, 19 were associated with air transport—mainly crop dusters—and resulted in 18 deaths. Responders were three times more likely to be injured in rural/agricultural areas. Of responders, volunteer firefighters constituted 52% compared with 6.7% in all other areas. The most frequently released chemicals in rural/agricultural areas were ammonia, chlorine, and pesticides. In all other areas, ammonia, chlorine, hydrochloric acid, carbon monoxide, and 0-chlorobenzylidene malononitrile, a tearing agent often associated with an illegal or unauthorized act, were released most frequently.

Conclusions:

Findings from this analysis suggest that remedial actions should address safety measures in both transportation and fixed facilities containing acute hazardous substances. These include regular maintenance of equipment, education of workers about the substances used in their facility, rigorous training and licensing of drivers and crop duster operators, and education and training of employees and first responders in the use of protective equipment. These activities may reduce the number of events, casualties, and costs associated with hazardous substance events.
Health Indicators for Mothers and Children in Rural Herat Province, Afghanistan
Authors: Ahmed Ayan , Edward Anbrasi , Burnham Gilbert
Published: August 2016

Introduction:

Following years of conflict and neglect, major efforts now are underway to develop health policy and rehabilitate the health facilities in Afghanistan. As part of these efforts, there is a need to better understand the health status and health-seeking behaviors. As part of an effort to assist local non-governmental organizations (NGOs), a household survey of mothers with children under the age of five years was conducted in two rural districts of Herat Province, Karokh and Chesht-e-Sharif.

Methods:

A two-stage, 30-cluster approach was used for each district. This included 622 mothers of 926 children under the age of five years living in the two districts. Outcome measures included demographic characteristics, antenatal services, immunization coverage, hemoglobin levels of the mothers, nutritional status and practices, environmental health indicators, recent illness, and health seeking behaviors.

Results:

The mean value of ages of the mothers was 27 years with an average parity of 6.1. Less than 5% of mothers ever had attended school. Half of women had lost at least one child before the child reached the age of five years. Under-five-year mortality was estimated at 325. Only 29% of the women had attended an antenatal clinic during their last pregnancy. Virtually all deliveries occurred at home. Only 7.6% of women had received three doses of tetanus toxoid. Less than 9% of the children 12–59 months of age were fully immunized. According to the measurements of mid-upperarm circumference (MUAC), 11% of children were malnourished. Although breastfeeding almost was universal, greater than one-third of the women did not start breastfeeding until the second day after delivery. Protected water sources and appropriate control of feces were lacking in both districts. In the previous two weeks, 45.7% of children had experienced diarrhea, and dysentery had occurred in 10%. Fever had been present in one-quarter of the children.

Conclusions:

Household health indicators indicate serious maternal and child health concerns in these two districts. Of particular concern is the poor immunization coverage, lack of reproductive health service, and the prevalence of common childhood illness in these populations. The feeding practices for children and the anemia among mothers also raised concerns. Poor environmental health contributes substantially to childhood illness.Without special emphasis, efforts to rebuild the health sector are likely to reach the household level only late in the process. An aggressive program to integrate community development and promotion of sound health practices is needed to improve the health of the Afghanistan people.
Making A Difference
Authors: Birnbaum Marvin L.
Published: August 2016

All of us hope that our life will make a difference. But, how and what we wish to accomplish is highly individual. Our goals may be personal, global, or a combination of both. If any portion of the “difference” you wish to accomplish is in the realm ofhumanitarianism, you are in the right place.
Seismic Intensity and Risk of Cerebrovascular Stroke: 1995 Hanshin-Awaji Earthquake
Authors: Sokejima Shigeru , Nakatani Yoshimi , Kario Kazuomi , Kayaba Kazunori , Minowa Masumi , Kagamimori Sadanobu
Published: August 2016

Introduction:No epidemiological data exist concerning the influence of an earthquake on the risk of stroke. Whether the incidence of cerebrovascular stroke increased after the 1995 Hanshin-Awaji earthquake (EQ) in Japan and whether seismic intensity affected stroke risk dose-dependently was examined.

Methods:A retrospective cohort study was conducted among residents, who were living in two towns on the island of Awaji and were participants of the National Health Insurance (NHI) program. The two towns were divided into 11 districts and their respective damage and socioeconomic states were investigated. Reviewing the NHI documents issued before and after the EQ, people who had strokes (9th International Classification of Diseases, codes 430–431 or 433–434.9) were identified. Risk of stroke in relation to the seismic intensities, was assessed with the Cox proportional hazard model.

Results:Among subjects aged 40 to 99 years, 45 of 8,758 (0.514%) had a stroke the year before the EQ, 72 of 8,893 (0.810%) had a stroke in the first year following the EQ, and 49 of 8,710 (0.566%) had a stroke in the second year following the EQ. In districts where the earthquake's intensity was ≤9.5 on the modified Mercalli intensity (MMI), compared with the year prior to the EQ, the relative risk (RR) of stroke was 2.4 (95% confidence interval (CI) 1.1, 5.0) in the first year following the EQ, after adjusting for age, gender, and income. In that year, compared with MMI of <8.5–9.0, RRs for 9.0–9.5 and ≥9.5 were 1.6 (CI 0.9, 2.1) and 2.0 (CI 1.1, 3.7), respectively (pfor trend 0.02). No trend for the RR was observed in the year before the EQ or in the second year following the EQ.

Conclusion Stroke increased in the first year following the EQ. The increase was associated with seismic intensity in a dose-response manner. Results suggest a potential threshold for RR of >2.0 in areas near 9.5 on the MMI scale.
Prehospital Spirituality: How Well Do We Know Ambulance Patients?
Authors: Jang Timothy , Kryder George D. , Char Douglas , Howell Randy , Primrose Joseph , Tan David
Published: August 2016

Objective:

To assess the religious spirituality of EMS personnel and their perception of the spiritual needs of ambulance patients.

Methods:

Emergency medical technicians (EMTs) and paramedics presenting to an urban, academic emergency department (ED) were asked to complete a three-part survey relating to demographics, personal practices, and perceived patient needs. Their responses were compared to those of ambulance patients presenting to an ED during a previous study period and administered a similar survey.

Results:

A total of 143 EMTs and 89 paramedics returned the surveys. There were 161 (69.4%) male and 71 (30.6%) female respondents with a median age range of 26–35 years old. Eighty-seven percent believed in God, 82% practiced prayer or meditation, 62% attended religious services occasionally, 55% belonged to a religious organization, 39% felt that their beliefs affected their job, and 18% regularly read religious material. This was similar to the characteristics of ambulance patients.

However, only 43% felt that occasionally ambulance patients presented with spiritual concerns and 78% reported never or rarely discussing spiritual issues with patients. Contrastingly, >40% of ambulance patients reported spiritual needs or concerns at the time of ED presentation, and >50% wanted their providers to discuss their beliefs. Twenty-six percent of respondents reported praying or meditating with patients, while 50% reported praying or meditating for patients.

Females were no more religious or spiritual than males, but were more likely to engage in prayer with (OR = 2.38,p= 0.0049) or for (OR = 6.45,p<0.0001) patients than their male counterparts.

Conclusion:

EMTs and paramedics did not perceive spiritual concerns as often as reported by ambulance patients, nor did they commonly inquire about the religious/spiritual needs of patients.
Public Hospital Preparations for SARS Outbreak: Experience of Alexandra Hospital
Authors: Lee Francis Chun Yue , Wee Wei Keong , Johan Azman
Published: August 2016

Alexandra Hospital (AH) was one of the public hospitals in Singapore that responded to the severe acute respiratory syndrome (SARS) crisis. Being the only public hospital that remained “SARS-free”, i.e., with no documented intra-institutional spread of disease, AH had to tackle a sudden, two-fold surge in hospital attendances and patient volume. Being the oldest hospital with a traditional open ward design and lack of proper isolation facilities, tough command and control policies had to be implemented to reduce the risk of a SARS outbreak. Stringent infection control measures, screening and triage, clinical procedures, and administrative policies all were important factors in helping the hospital balance the need to run routine operations while “fighting” SARS. Staff and people management also were crucial in keeping the workforce healthy and maintaining their morale and confidence during this difficult period.
Effects of Prehospital Spinal Immobilization: A Systematic Review of Randomized Trials on Healthy Subjects
Authors: Kwan Irene , Bunn Frances
Published: August 2016

Objective:

To evaluate the effects of spinal immobilization on healthy participants.

Methods:

A systematic review of randomized, controlled trials of spinal immobilization on healthy participants.

Results:

Seventeen randomized, controlled trials compared different types of immobilization devices, including collars, backboards, splints, and body strapping. For immobilization efficacy, collars, spine boards, vacuum splints, and abdominal/torso strapping provided a significant reduction in spinal movement. Adverse effects of spinal immobilization included a significant increase in respiratory effort, skin ischemia, pain, and discomfort.

Conclusions:

Data from this review provide the best available evidence to support the well-recognized efficacy and potential adverse effects of spinal immobilization. However, comparisons of different immobilization strategies on trauma victims must be considered in order to establish an evidence base for this practice.
Information Technology and Public Health Management of Disasters—A Model for South Asian Countries
Authors: Mathew Dolly
Published: August 2016

This paper highlights the use of information technology (IT) in disaster management and public health management of disasters. Effective health response to disasters will depend on three important lines of action: (1) disaster preparedness; (2) emergency relief; and (3) management of disasters. This is facilitated by the presence of modern communication and space technology, especially the Internet and remote sensing satellites. This has made the use of databases, knowledge bases, geographic information systems (GIS), management information systems (MIS), information transfer, and online connectivity possible in the area of disaster management and medicine.

This paper suggests a conceptual model called, “The Model for Public Health Management of Disasters for South Asia”. This Model visualizes the use of IT in the public health management of disasters by setting up the Health and Disaster Information Network and Internet Community Centers, which will facilitate cooperation among all those in the areas of disaster management and emergency medicine. The suggested infrastructure would benefit the governments, non-government organizations, and institutions working in the areas of disaster and emergency medicine, professionals, the community, and all others associated with disaster management and emergency medicine. The creation of such an infrastructure will enable the rapid transfer of information, data, knowledge, and online connectivity from top officials to the grassroots organizations, and also among these countries regionally. This Model may be debated, modified, and tested further in the field to suit the national and local conditions. It is hoped that this exercise will result in a viable and practical model for use in public health management of disasters by South Asian countries.