bluuebunny/crossref_metadata_2025 huggingface dataset:
(A338) Time for Order In Chaos! A New Model to Capture the Role of Foreign Field Hospitals after Disasters
Authors: Lind K. , Westman L. , Gerdin M. , Wladis A. , Von Schreeb J.
Published: May 2011

There is a paucity of reliable data on the healthcare needs over time after sudden onset disasters (SOD). There also are no widely acknowledged definitions and data on deployment, use, staffing, and management of foreign field hospitals (FFH) after such disasters. Further, the efficiency, relevance, timing and cost-effectiveness of FFHs in the aftermath of SODs have been questioned. This was again highlighted after the 2010 Haiti earthquake, when the situation, to a large extent, was chaotic, uncoordinated, and care was not adapted to needs. These shortcomings create severe difficulties with respect to studying the real impact of medical aid after a SOD and optimizing the international medical relief efforts to be applied afterward. This article aims to present a health system approach to the deployment of FFHs after a SOD, here applied to an earthquake. By reviewing the literature and drawing on field experiences from SODs, a conceptual framework was developed that capture the essential dimensions in such a model, including: (1) classification standardization of levels of care in FFH (1–4); (2) time-phases after the event (1–5); and (3) the need for health care based on the assumed burden of disease and, hence, need for medical care in relation to the socio-economic context. The model currently is being tested on a number of international experts in the field. By using this framework, the authors hope to create: (1) a common platform for research within this area; and (2) a tool for international actors that will facilitate a development toward an international coordination body in the future. As such, the framework hopefully will offer an opening to a structural approach to the above mentioned difficulties, support international actors in their SOD preparations and deployments, and put them in a better position to optimize the resources available to the targeted population.
(A341) Disaster! What about Me?
Authors: Al-Qusimy H.N.
Published: May 2011

Background

There is one important aspect of hospital preparedness for disaster that has so far received minimum attention. It has been taken for granted that medical staff know best how to take care of themselves and are well prepared personally when there is a call for disaster. However, the reality is far from what is expected, and many staff tend to keep their personal needs as a second priority when it comes to patient care, especially during disasters and mass casualties. They may not show it, however, while attending to their duties and managing casualties of disasters.

Discussion

Medical staff continue to have personal concern regarding their family, properties, personal safety and in some instances their own health as well. The medical staff are not the only one to blame, as other parties, including their employers are involved. This presentation will discuss causes and consequences of ill prepared medical staff personnel to disaster or Mass casualty, including a brief illustration of a mini survey that was conducted immediately following a hospital disaster drill. The presentation will also elaborate on developing staff personal response plans and kits that will contribute in reducing the burden of concern for their own family and them and indirectly may help increase their performance and productivity during disaster or mass casualty situations.
(A313) Role of Physiatrists in Post Disaster Scenarios - Lessons Learned from Pakistan, China and Haiti Earthquakes
Authors: Rathore F.A. , O'connell C. , Li J.
Published: May 2011

Introduction

Physical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.

Methodology

Authors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.

Results

In these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.

Conclusion

Physiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.
(P1-2) Incidence and Pre-Hospital Care of Acute Coronary Syndrome in Emergency Department Banja Luka
Authors: Banjac N. , Maravic-oplakan G. , Kovacevic B. , Jelovac L. , Mihajlovic D. , Burgic-radmanovic M. , Kovacevic D.
Published: May 2011

Introduction

The acute coronary syndrome is a leading cause of heart death among adults. The treatment of such patients begins during the first contact with the doctor who is in most cases neither an internist or cardiologist, but an emergency medicine specialist or general practitioner working in the emergency department. For that reason it is of great importance to educate doctors who will be able to establish a fast and precise diagnosis, start therapy and organize quick transport to the nearest catheterization room or coronary unit.

Objective

The primary objective was to measure frequency of patient's visits to the Emergency Department because of an acute coronary syndrome. The Secondary objective was to examine the choice of treatment in pre-hospital conditions.

Methodology

Through the statistical retrospective analysis we collected the data from the Emergency Department protocols for the period between June 1, 2008 and December 31, 2008.

Results

In 14,986 patients during the six-month period, 343 of them had acute coronary syndrome. Men were more affected ((59.5%) than women (40.5%). Most cases belonged to the age group from 65 to 80 years (39.6%) and prevalence after 50 years shows abrupt growth. According to the diagnoses, most patients had unstable pectoral angina (42%) and then followed stenocardia (31%) and AIM (27%). Other therapy included NTG (22%), antihypertensives (21%), acetyl-salicylic acid (20%), analgesics (13%), antiarrhythmics (4%). Fifty-seven percent of the patients had complications. STEMI was diagnosed in 69% of patients, and most often the anterior wall was involved (35%).

Conclusion

The diagnosis of acute coronary syndrome was established in 343 patients based on the clinical image, electrocardiographic changes and level of cardiospecific enzymes (troponin T).
(P1-6) Community-Based Disaster Management: An Effective Approach in Bangladesh
Authors: Chanda S.K.
Published: May 2011

Natural disaster like cyclone, tidal bore, flood, tornado etc. is a common phenomenon in Bangladesh. Tropical cyclones associated with tidal surges occur at the rate of 1.3 a year in the coastal districts, cyclone in 1970 and 1991 claimed over 500,000 and 138,000 lives respectively in the coastal districts and offshore islands. The vulnerability is so miserable that they have to go and settle in the newly accreted land in Bay of Bengal and its surrounding areas which is occasionally hit by tidal bore or devastating cyclone. The main susceptibility comes from weak social and economic structures of the country. Housing quality, preexisting poor health and nutritional status, social welfare infrastructure, and economic resilience determine the magnitude of a disaster's effect and its long term consequences. In recent years, improved early warning systems and preparedness measures have helped reduce mortality, but no significant change in morbidity. However the effective disaster preparedness systems and capabilities for post-disaster emergency phase usually provides through volunteer contributions and local authority at the neighborhood level. The government's relief team, NGOs and foreign teams took couple of days to few weeks to start operation properly after devastating disasters like Sidr in 2007. However the basic survival and emergency assistance like clothes, shelter, food and medicine which saved thousand of lives were managed by community people themselves. Active participation of local communities, those have rich experience of coping with natural disaster both in preparedness and emergencies are essential for successful disaster reduction policy and practice, also putting value on our traditional social and cultural bondage. So strategies for disaster preparedness should be focused at family and community levels, support to community-based low-cost technology, promotion and development of human resources and integration disaster management components into development policies and empower the people to face the challenges of disasters.
(P1-11) Psychosocial Impact of Russian Invasion of Georgia in 2008
Authors: Migline V. , Shultz J.M.
Published: May 2011

In August 2008, Georgia was subjected to a brutal Russian military invasion and occupation of some its territories. A total of 364 citizens of Georgia were killed, another 2,234 were injured, and 127,589 were internally displaced. This historic military act of a superpower nuclear state invading a small, neighboring country produced population-wide psychological distress and debilitating psychopathology. The key features of the Russian invasion for Georgia were examined, and the consequences of this particular event were defined. Casualty figures, ethnic cleansing facts, numbers of refugees and displaced persons, impact on Georgia's education, damage to cultural heritage, the role of mass media, economic loss, and environmental destruction also were examined. Data suggest that exposure to hazards, loss, change, human causation/culpability, information as a stressor, multiple traumatic events contributed significantly to the mental health outcomes of the population in Georgia. Mental health, psychological trauma, post-traumatic stress disorder (PTSD), resilience, suicide risk, and secondary trauma were highly prevalent among impacted persons. There is an urgent need to focus on the protective nature of preserving and restoring psychosocial and material resources in the prevention and treatment of PTSD and major depressive disorder following traumatic events.
(P1-13) Initial Experience with Mobile Computed Tomography in the Neurosurgery Intensive Care Unit in a Level-1 Trauma Center in India
Authors: Chauhan S. , Agarwal D.
Published: May 2011

Background

Neurosurgical patients require frequent Computed Tomographies (CTs) of the head, usually at short notice. A mobile CT may prove to be invaluable for these patients.

Objectives

To review the usefulness of mobile CT in intensive care unit (ICU).

Methods

This review was carried out over a 14 month period (18 July 2009 till 31 August 2010). Administrative and clinical data were reviewed and analyzed. For the first 6 months, only the number of CT's done was available. However, data were collected prospectively starting 01 Jan 2010 to include variables such as Glasgow Coma Scale (GSC) ventilator status and pressor support at the time of CT scan. The average time to do a CT was 150 minutes (range 60–240 minutes). The mean number of people required for shifting the patient was 4(range 3–6). For, mobile CT the average time to do a CT was 27.4 minutes (range 7.8–47 minutes) and mean for manpower was 3 (range 3–4).

Observations

The mobile CT was installed and became functional in the neurosurgery ICU on 18 July 2009. A total of 1,752 head CTs were performed during the study period, with an average of 4.8 CTs daily. Detailed prospective data were available (since 01 January 2010) on 1,023 patients. Of these patients, 75.9% (n = 776) were on ventilator, 72.3% (n = 740) were on sedation, and 5.6% (n = 57) were on pressor support at the time of CT. The mean GCS at the time of CT was 8.1 (range 3–15).

Conclusions

Mobile CT was found to be easy to use, with fast scanning time and excellent image quality. It proves to be beneficial for nurses as it requires less time, energy and manpower. The mobile CT is strongly recommended for any high volume neurosurgery department in the country.
(P1-18) Experience of IMSS Medical Equipment in Rescue Efforts in Haiti
Authors: LorÍa-castellanos J. , Cruz-vega F. , Gomez-zarate E.
Published: May 2011

Has been a tradition of the Mexican Social Security Institute (IMSS) have a great spirit of solidarity with any type of disaster. That is why the early hours of the earthquake in Haiti was appointed to a group of specialists trained in emergency care who participated in the first acts of rescue and stabilization of multiple victims. The first group of six specialists arrived Port au Prince on January 15 fieldwork being allocated in coordination with the rest of the Mexican aid mission in the sector 8 of the city, preferably at the University of Saint Gerard. Among the actions taken by this group were:

•

Application of 300 doses of immunization.

•

Tracking and signaling a radius of 3 km in search of survivors and bodies.

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Working in conjunction with the group of Topos, the Federal Police and the Navy in the initial care, resuscitation and transfer of 9 people rescued from the rubble.

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More than 60 dressings and sutures.

•

Monitoring and maintenance of health of mission personnel.

The second group, consisting of specialists in trauma, reconstructive surgery, anesthesiology, surgical and intensive care nurses, was part of a Field Hospital was established in conjunction with the United States at the place called “Killi Point”, involving a network trauma care in which our doctors surgically intervened the hospital ship “Comfort”. Were to a large number of cases of traumatic amputation, children and adults burned, fractures, crushing limbs and carrying large infections for obvious reasons IMSS staff recognizes the professionalism and capacity of the entire Mexican mission of humanitarian aid to Haiti and the opportunity offered to us to help a sister nation, we reiterate that we are engaged, if required again to respond with the same promptly and sense of humanity shown so far.
(P1-40) Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital
Authors: Plani F.
Published: May 2011

Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital F. Plani1, E Degiannis, P Lingham No disaster training had ever been carried out at the CHBH, the biggest hospital in the world with over 2900 beds and over 5000 staff members. The 2010 Disaster Plan required that all clinical staff undergo the appropriate training. Basic Interprofessional Training for Trauma Disasters 411 staff members attended a half day course during May/June 2010, presented and sponsored by CHBH Trauma Directorate consultants. The aims of the course were to disseminate the trauma disaster plan in interdisciplinary and interprofessional fashion, clarify hospital triage, familiarize staff with Trauma Unit equipment, and practice resuscitations in mass casualty incidents. The course started with presentations on CHBH Disaster Plans and Protocols and Principles of Triage and Standard of Care in Disasters. This was followed by 3 multiple patient scenarios with rotating groups, over a whole hospital floor with: 1) 50 mixed patients outside the hospital; 2) 10 serious patients in the ER; 3) 10 patients deteriorating later in a ward or ICU. Next were individual patient resuscitations, Primary, Secondary, Tertiary Survey and “hand-over”, patient resuscitations in a disaster, using the contents from “Disaster Bags” and questionnaires to assess confidence and suitable treatment areas (Red, Yellow, Green, OT) for allocation in a disaster. The course was wrapped up by a familiarization visit to ED and the colour coded areas.

Results

Final questionnaires demonstrated that all participants were a lot more confident in the triage of patients and the initial resuscitation using the implements found in the resuscitation room and the “Disaster Bags”. The course has been adopted as part of staff orientation at all professional levels from 2011 onwards, and is in the process to be extended to secondary level hospitals in Gauteng, RSA.
(P1-43) Standardized Full-Scale Exercises using Indicators Related to Patient Outcome: A Method to Increase Knowledge Coping with Aircrafts Incidents
Authors: Rådestad M.E.A. , Nilsson H. , Rüter A. , Castren M. , Svensson L. , Gryth D.
Published: May 2011

Introduction

Disaster medicine is a young discipline and there is a need for the development of methods for evaluation and research. This includes full-scale disaster exercises that are quite costly. Within each organization these exercises are seldom conducted. If there was a standardized concept on how to conduct as well as evaluate these exercises, this could lead to better knowledge and cost effectiveness. The aim of this study was to increase awareness of the possibility to develop and conduct full-scale exercises in different settings using performance indicators combined with indicators related to patient outcome serving as a basis for comparison and evaluation process.

Methods

Two full-scale exercises in different organizations were studied. Identical panorama with the same number and type of casualties was used. Sets of performance indicators combined with indicators for unfavorable patient outcome, according to the Emergo Train System®, were recorded as well as all transportation times and the patient distribution to selected hospitals. Qualified observers scored the results on predetermined locations; on the scene, hospital and strategic command and control.

Results

The lowest scored performance indicators were “first report to dispatch”, “second report from scene” and “first patient evacuated”. Due to insufficient response and evacuation times of victims to the receiving hospitals the unfavourable patient outcome, regarding preventable deaths and preventable complications were 28% (n = 18) and 41% (n = 17), respectively.

Conclusions

Standardized full-scale exercises where the same type of results is recorded can be conducted. This combination of performance indicators and Emergo Train System® leads to probabilities of development and better command and control response. Future use of the same concept may demonstrate important results that will lead to new and better knowledge that can be applied during real incidents.
(P1-45) Harvard Humanitarian Initiative (HHI) and Federal University of Paraiba (UFP) Joint Emergency Medicine and Disaster Preparedness Training Center A Model for Academic and Clinical Exchange of Expertise
Authors: Morris S.C.
Published: May 2011

Introduction

Evolving health systems frequently seek guidance with emergency medicine related topics. This has lead to countless international collaboration between organizations attempting to meet this need.

Background

Paraiba, a state of 3.6 million, ranks near the bottom in Brazil for per capita income. The medical establishment has private, public and military systems without emergency medicine training and no disaster plans. HHI and Harvard International Emergency Medicine Fellowship are academic research and service oriented organizations with an emergency medicine and disaster preparedness focus. In 2009 a request for technical assistance was made to HHI from Paraiba, concerning disaster preparedness, clinical emergency medicine and pre-hospital training.

Methods

Exchange of correspondence surrounding needs and expectations of the partner organizations was conducted until the August 2010. During August a series of meetings was conducted among the civilian, military and federal representatives and a collaborating body was formed under the guidance of UFP consisting of SAMU (prehospital care), the medical school and the five main hospitals of the city. In September HHI staff conducted a series of meetings and assessments in Paraiba. Plan Evaluation, educational and programmatic steps were decided on to be conducted over the several year project. Space and resources for the training center at the UFP was allocated. Establishment of 8–12 teaching modules for practicing physicians and nurses, built and taught by local staff with HHI support will be implemented and become a requirement to work in emergency areas. An assessment of disaster risks and emergency metrics will be conducted concomitantly. Exchange of staff between Brazil and USA will occur throughout the project.

Conclusion

No standard model of collaboration exists regarding international emergency medicine and disaster planning but ours demonstrates that exchange of information can evolve to match the abilities and expectations of both parties.
(P1-51) Learning from a Cohort of Emergency Technicians & Doctors in Patient Assessment - A Survey in Secondary Hospital, Ningbo Area, China
Authors: Wang X.W. , Xu J. , Zhou W.
Published: May 2011

Background

Patient assessment (PA) is one of the key points to Emergency Technicians and Doctors (ETD) in Emergency cases. Objective of this study is to investigate the general level of PA skill in ETD in a secondary hospital Ningbo and how ETD practice in different scenarios during PA process.

Methods

A retrospective study was carried out by using a questionnaire .33 ETD which includes 3 Emergency Technicians and 30 Emergency Doctors (Male: Female = 2:1) were taken into the study. Thus the analysis of position dependent PA skill variation is difficult to carry out. Mean age of the subject was 28.2 years. Average working experience was 3.91 years.

Analysis

12% ETD did not carryout scene size-up before approaching victims.The same proportion (12%) of ETD didn't call Police /Fire Agency in risk situations. 1/3 doctors insisted in entering the dangerous spot. Almost 30% doctors ignored bystanders safety when assessing patients.10% doctors did not collect patient history during transferring. Only 30% of the doctors practice complete physical examination, others (70%) were inclined to assess main parts. 84% of the ETD would not carry cervical collar when approaching the injured. During assessment, 69.9% ETD neglected patient's medical tag. 94.1% ETD accepted Emergency Training with only once or twice a year.

Conclusion

Awareness on safety of scene and self protection is weak in ETD in PA. Less doctors examine patient completely. Most of ETD does not look for medical tag which is considered an important element in PA although it is not prevailed yet in Ningbo. No significant differences are perceived upon the gender of the worker. Systematic education programs and ongoing trainings with identified shortcomings in patient assessment skill of ETD in Secondary hospitals in Nigbo area are highly recommended.
(P1-59) Atom Course in Japan
Authors: Nagata T. , Hashizume M. , Lefore A.
Published: May 2011

Introduction

Trauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.

Methods

The ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.

Results

Participants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value < 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value < 0.001), with all groups reaching statistical significance.

Discussion

This course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.
(P1-61) Nursing Education for Disaster Management
Authors: Boone J. , Moore D.
Published: May 2011

In Southern California in 2010, there were 76 declared disasters of which the majority were in Southern California, for this reason and at the request of our clinical partners, when West Coast University (WCU) started its nursing program in 2008, it recognized the need to have a course in disaster management. With nursing being the largest of the health professions, the American Association of Colleges of Nursing (AACN) recognized the need to incorporate disaster nursing in its new Baccalaureate Nursing standards. The Disaster Management course was developed in concert with other parts of the curriculum such as Leadership, Physical Assessment, Critical Care courses to help students focus their assessment and intervention skills to prepare them to be future responders. The disaster management course is delivered in both didactic and hands on format including online Federal Emergency Management Agency (FEMA) modules, disaster drills, guest lecturers and field trips. Students are also introduced to many volunteer opportunities and are trained to be disaster ready once they are needed. Students are excited and ready to volunteer at various organizations before graduation such as the American Red Cross, the Medical Volunteer Program and the Disaster Medical Assistance Teams. Since WCU has new campuses, the students have been instrumental in implementing a new disaster plan for our facilities, including developing flyers, videos and conducting disaster drills. We have received feedback from our clinical partners that our students are better prepared than their current emergency staff in regards to disaster management and to that end we plan to work with our clinical partners to translate our class into an online course so their staff can be trained on disaster management.
(P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study
Authors: Hsu C.
Published: May 2011

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper management

of difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.
(P1-66) Operating a Field Hospital after the Earthquake at Haiti - The Israeli Experience
Authors: Bader T. , Kreiss Y.
Published: May 2011

Introduction

On January 12th 2010 an earthquake of 7.0 magnitude struck Haiti. The region suffered an estimated 230,000 fatalities with approximately 250,000 injured and more than one million people who lost their houses. The government of Israel dispatched a military task force consisting of 230 people. 121 of them were medical personnel from the IDF Medical Corps. The force's primary mission was to establish a field hospital in Haiti and to give medical support to as many people as possible. We left Israel about 50 hours after the Earthquake and the field hospital started operating at Porte-Au-Prince 89 hours after the earthquake.

Materials and Methods

During our 10 days of operating, 1111 patients were treated at our hospital. 363 of them were pediatric patients (younger than 18 years). 272 pediatric patients were treated by the pediatric division, 79 (29%) were hospitalized and 57 (21%) required surgery.

Results

There were 16 deliveries, 5 Neonates, 244 Operations and 17 Intra-hospital deaths. We noticed a change of pattern of the hospital activity, regarding the cause of the admission after the sixth day. On the ninth day most of the patients who came to our hospital were due to a non-traumatic cause. At the pediatric department, the common treatments included wound debridement and dressing, I.V. rehydration and antibiotic treatment, and a neonatal unit, the sole one in the inflicted area. Operations when needed were done by the orthopedic team and the pediatric surgeon.

Conclusions

Operating a field hospital for a population inflicted by natural disaster is a complex mission and since pediatric care has its own unique, challenging characteristics, operating a pediatric division in such a field hospital is a continuous challenge, which includes preparedness in uncertainty and the necessity to have dynamic treatment strategy according to the unique circumstances.
(P1-67) Collaboration of Military and Civil EMS during Russian Georgian War 2008
Authors: Chikhradze K. , Kereselidze T. , Zhorzholiani T. , Oshkhereli D. , Utiashvili Z. , Jibladze C. , Canava G. , Tevzadze N.
Published: May 2011

Introduction

During 2008 Russian Federation realized major aggression against its direct neighbor, the sovereign republic of Georgia. It was Russia's attempt to crown its long time aggressive politics by force, using military forces. EMS physicians from Tbilisi went to the Gori district on August 8 at first light, 14 brigades were sent. At noontime of August 8, their number was increased up to 40. 6 brigades of disaster medicine experts joined them as well.

Results

Destination site for the beginning was the village Tkviavi, where a military field hospital was assembled and a Military Hospital in Gori. Later 6 brigades were withdrawn towards the village Avnevi. During fighting, wounded victims were evacuated from the battlefield, where initial triage was done. Evacuated victims were brought to the military hospital where the medical triage, emergency medical care and transportation to Gori military hospital or to Tbilisi hospitals was done. A portion of the wounded was directly taken to Gori military hospital and later to different civil hospitals in Tbilisi. Corpses were transported to Gori morgue as well. On August 9, the emergency care brigades and field hospital left Tkviavi and moved to the village Karaleti, then to Gori. On August 12, the occupied territory was totally evacuated by civil and military medical personnel. Although withdrawal of wounded was done on following days. Up to 2232 military and civil persons were assisted by EMS brigades during war period (8–12 August), from them 721 patients were transported among which 120 were severely injured.

Conclusion

Close collaboration between military and civil EMS gave the system opportunity to work in an organized manner. On the battlefield prepared military rescuers were active taking out wounded victims to the field or front-line hospitals from which civil emergency care brigades transported them to Tbilisi hospitals. Only 3 fatalities occurred during transportation.
(P1-74) Introduction of the Portable Decontamination Unit of Gulhane Military Medical Academy
Authors: Bayir A. , Eyi Y.E. , Durusu M. , Oztuna A. , Eryilmaz M.
Published: May 2011

Introduction

Chemical, biological, radiological and nuclear (CBRN) cases are seen as an increasing risk because of the increasing threat of international terrorism. Decontamination is one of the basic components of the intervention for CBRN exposure. The introduction portable decontamination unit in the hospital setting is described in this presentation.

Method

The general properties, facilities, and capabilities of the portable decontamination unit, which is present in the GATA CBRN Department of the Turkish Armed Force's Health Command, were evaluated.

Results

The portable decontamination unit in the hospital has a metal frame that is 54 m2 wide. It is composed of two tents that weigh about 300 kg. The metal frame, metal legs, and tent cloth are stored in carrying bags. Four people can construct the tents in 10 minutes. An educated squad of four people can prepare the decontamination system and instructions in 25–30 minutes. The unit consists of two lines: one for outpatients and another for inpatient decontamination, which includes a rail system. Each decontamination line contains an undressing, shower, and dressing section.

Discussion

Along with metal-framed decontamination tents, there also are inflatable tents. The inflatable decontamination units can be pitched in 5–7 minutes by an electrical air compressor. Metal-framed tents are easy to carry, as the frame, metal legs, and tent cloth are stored in carrying bags. By pitching the decontamination tent on a smooth ground in front of the hospital entrance, decontamination of patients can be completed before they reach the hospital. Another decontamination unit is in place next to the emergency department.

Conclusion

Terrorist attacks that result in mass casualties demonstrate the importance of CBRN preparedness. A decontamination unit and an appropriate CBRN preparedness plan should be constituted into the basic treatment system.
(P1-81) Differences between Radiation Dosages to Which the Radiology Department Staff and the Public were Exposed
Authors: Ortatatli M. , Kenar L. , Gumral R. , Bayir A. , Arziman I. , Durusu M.
Published: May 2011

Introduction

In this study, the mean daily and annual radiation exposure of the radiology department staff, other hospital health staff, and public volunteers was compared at Maresal Cakmak Military Hospital in Erzurum, Turkey.

Methods

The NEB.211 Dose–Rate Meter with a Gaiger–Müller counter was used to measure the amount of radiation. Six radiology department health staff carried the NEB.211 device during seven working hours. At the end of the day, total absorbed dosages were noted. The same measurements were also done for the six health staff of the other departments and six non-hospital volunteers. Seventeen additional hours were noted for the non-hospital volunteers. The mean value of 17 hours of daily measurements (3.31 mSv) was added to the both group's working hours measurements and the total daily radiation amounts were calculated.

Results

There was no statistical difference between each three groups in working hours (p = 0.087), daily and annual equivalent dosages (for both p = 0.099).

Discussion

The radiology department health staff was exposed to radiation under the border of equivalent dosage which is determined by Turkish Automic Energy Authority. Public volunteers were seen as they were exposed the radiation over the determined border of equivalent dosage. Nonetheless, with changes depending on living standards, the physical properties of living spaces and geographical circumstances per capita exposed annual dosage is about 2.4–2.8 mSv throughout the world. There was no significant statistical difference between the amounts of equivalent dosage which were exposed to the radiology department health staff, the other hospital staff and public members.
(P1-85) Health Seeking Behavior Post-Unintentional Household Injury in Hong Kong
Authors: Chan E.Y.Y. , Lee P.P.Y. , Leung J.M.S.
Published: May 2011

Background

Unintentional household injuries are a major public health problem that affects large numbers of people. Various population-based surveys from the literature showed > 40% of households reporting an injury that required medical attention. However, there is a general lack in comprehensive population surveys to highlight the risk of post-injury, help-seeking behavior and its associated financial cost. This study is part of the urban, home-based injury epidemiological study series (2007–2010) in Hong Kong.

Methods

A population-based, cross-sectional, random telephone survey was conducted using the last birthday method in 2009. A study instrument was developed and validated based on the modified Chinese World Health Organization guidelines for injury and violence surveys.

Results

The study population comprised of non-institutionalized, Cantonese-speaking Hong Kong residents (n = 6,570). Among the 39.4% self-reported injuries within the past 12 months, only 8.6% of injured people had sought medical care. Respondents tended to seek medical care from the private setting in the first episode of post-injury treatment. Among health seekers, 70% of the injured participants reported having to seek a second treatment and the care-seeking pattern shifted from private to public medical service delivery setting. Predictors of service preferences were identified and discussed.

Conclusions

Medical care seeking patterns post-unintentional household injury was identified. Medical and emergency services providers may wish to consider health service implications.
(P1-86) Socioeconomic Impact of Natural Disasters in China
Authors: Zhang W.
Published: May 2011

Introduction

China is one of the countries most affected by disasters caused by natural hazards. Disasters comprise an important restricting factor for economic and social development.

Methods

Retrospective analysis was performed based on the epidemiological data of disasters caused by natural hazards in recent two decades.

Results

The deadliest disaster that was reviewed was the Sichuan, Wenchuan earthquake on 12 May 2008 with a death toll of 88,928. Floods were the the primary natural hazard resulting in disaster in China. The economic loss caused by natural disasters was huge, the Sichuan earthquake alone resulted in an economic loss of 845.1 billion Chinese Yuan. However, psychosocial factors did not receive attention by Chinese Government and academics.

Conclusions

The characteristics and impact of disasters should be analyzed to scientifically provide useful information for natural disaster mitigation in China.
(P1-91) Beyond Emergency Care and Compensation: A Study on the Long Term Implications of Firearm Injuries for Psychosocial Well Being
Authors: Joseph J. , Jaswal S.
Published: May 2011

The field ‘Public Health in Disasters and Complex Emergencies’ is replete with either epidemiological studies or studies in the area of hospital preparedness and emergency care. The field is dominated by hospital based or emergency phase related literature. The social science perspective to public health is largely missing. It is in this context that the study of 26/11 Mumbai Terror Attack Survivors, was carried out. The study is an outcome of the ongoing work with the survivors over a period of two years following the attack. The qualitative study uses a case study approach and focuses on lived experiences of the 26/11 Mumbai Terror Attack Survivors who had firearm injuries. The paper highlights the special health issues faced by the survivors, issues of professional competence, hospital preparedness as perceived by the survivors, issues with disability assessments and issues of ill informed care and compensation policies. The paper also explores the interface between health and psychosocial well being two years after the attack and proposes a conceptual framework for understanding psychosocial well being of survivors within a public health perspective.
(P1-95) Clinical Effectiveness of Psychological First Aid Training among Emergency Responders in Chinese Population: Preliminary Results of 3-Month Follow-Up
Authors: Cheung E.Y.L. , Chan E.Y.Y. , Lin C.L.Y. , Lee P.P.Y.
Published: May 2011

Background

Psychological First Aid (PFA) has become the choice of mental health intervention and integration with the current disaster relief protocols during emergencies by the Institute of Medicine, NIMH and the WHO. It can be used during or immediately after disaster. People without mental health specialized training, including public health practitioners and emergency responders can learn and apply to everyone in need. Whilst being used extensively, few studies have evaluated the effectiveness of PFA and its field applicability.

Methods

A prospective randomized controlled study. 800 emergency medical responders were recruited. Participants were randomly assigned to the control/intervention arms to receive a one-day training of PFA based on the protocol developed by the National Child Traumatic Stress Network (2006). A pilot study was conducted to evaluate the screening tools and training material and all training was provided by trained clinical psychologist. Repeated measures analysis of covariance was used to evaluate the efficacy of PFA program in changes in various outcome measures between PFA intervention and control group. All analyses were conducted on the intent-to-treat and completer groups. Ethical approval was approved by the CUHK-NTEC Clinical Research Ethics Committee.

Results

Preliminary results from the post-training and 3 month follow-up data indicated participants in the training group have reported a significantly more substantial knowledge in disaster mental health, improve self-efficacy in delivering help in times of emergencies, high frequency of actual helping behavior as well as better self-reported psychological well-being when compared with waitlist control group.

Conclusion

This study examines and reports findings of clinical effectiveness of PFA 3 months post training in Chinese emergency responders. Preliminary results provided empirical evidences on the effectiveness of the approach.
(P1-109) Violence, Health and Human Rights: Analysis of the Right to Health for Conflict Displaced Persons Living In IDP Camps in Northern Sri Lanka
Authors: Wickramage K. , Zwi A.
Published: May 2011

This presentation explores the nexus between collective violence (in the form of violent civil conflict) and health and human rights in Sri Lanka, focusing specifically on persons displaced during the most recent conflict in Northern Sri Lanka beginning in November 2008. After exploring the normative framework in relation to the right to health, the local legal framework governing internal displacement, and the related component on healthcare access, service provision, and standards will be described. By examining health cluster reports, health surveys, and case-studies, this presentation describes how the health sector responded in providing healthcare services to those war displaced living in internally displaced people (IDP) camps in Vavuniya District. The “rights based approach to health” is examined in relation to the health sector response, and key issues and challenges in meeting health protection needs are highlighted. A conceptual framework on the right to health for IDPs in Northern Sri Lanka is presented. This presentation also explores how some health interventions in the post-conflict Sri Lankan context may have acted as a bridge for peace building and reconciliation.
(P1-111) Japan Medical Association Team (JMAT)
Authors: Nagata T. , Ishihara T. , Inasaka H. , Sakamoto T. , Akashi M. , Otomo Y. , Koriyama K. , Kobayashi H. , Ido T. , Ishi S.
Published: May 2011

Disaster preparedness is one of the national priorities. In Japan, disaster medicine is defined as a part of the national medical plan initiated by Ministry of Health, Welfare and Labor. The Japan Medical Association is the largest professional physicians' group in Japan, and has contributed to all kinds of disaster relief work regionally and nation-wide for years. Based on past successes, the Japan Medical Association proposes a new disaster action plan named Japan Medical Association Team (JMAT). The primary mission of JMAT is to deploy to the disaster scene requested and work for disaster relief. JMAT covers the acute to sub-acute phase of disaster response, and also collaborate with other agencies. In the preparation and mitigation phases, the Japan Medical Association work for establishing mutual disaster aid partnerships, disaster plans, networks with other agencies, team building, disaster medicine training and education, etc. In Japan, the Disaster Medical Assistant Team (DMAT) has been established based on the experience of the 1995 Kobe Earthquake, when lots of preventable trauma deaths occurred because of delayed medical response. The mission of DMAT is to deploy to the scene immediately and triage/transfer the most serious disaster victims outside the scene for advanced medical care. DMAT covers the first 48 hours of disaster response phase, and then JMAT takes charge of the work. JMAT will also respond to chemical, biological, radiological and nuclear disasters, and international humanitarian work. The present issues of establishing JMAT are 1.training and education for Japan Medical Association members, 2.establising cooperation with other agencies, and 3.having presence at the Central Disaster Committee, Cabinet Office, Government of Japan.