bluuebunny/crossref_metadata_2025 huggingface dataset:
International Disaster Medical Relief of China: Lessons and Practices
Authors: Bibo Peng
Published: May 2019

Aim:

This descriptive study explored barriers and difficulties faced by an international disaster relief team from China, which took part in two types of international disaster relief missions.

Methods:

Data was collected since the founding of the Chinese international disaster relief team, including information on team composition, operational hours, and average number of patients rescued and treated by staff per day, etc.

Results:

Overall, thirteen disaster relief missions utilizing the Chinese disaster relief team occurred in eight countries. All the operations were divided into two kinds of models: Urban Search and Rescue mission, and Emergency Medical service. The first model consisted of search, rescue, and emergency medical services on site. The ratio of medical staff on the team accounted for 18.8%. According to the six international health-based operations, the team was deployed ten days following the disaster, with an average working time of 17.8 days, and benefiting around 6,812 wounded and sick persons per operation. Compared with these two models, medical-based operations deployed more staff after the disaster and had a longer window of operation. The beneficiaries of medical-based operations are ten times greater than those of rescue-based operations. The differences are distinct.

Discussion:

Missions will better meet the needs of international relief by enhancing organizational coordination among medical teams around the world, and by contributing to the communication between teams. They will further benefit from technical capacity building, regional coordination trainings, formatting the standard of teaming building, and evaluation of the work.
Research on the Design of a Training Course for an International Emergency Medical Team
Authors: Hu Hai
Published: May 2019

Introduction:

Currently, Technical Advisors of the World Health Organization’s (WHO) Emergency Medical Teams (EMT) Secretariat are conducting standardized verification work for international emergency medical teams in various countries and organizations. However, a uniform and standard training course for an International EMT is lacking.

Aim:

To design a training course model based on knowledge structure, teaching, and evaluation methods for an International EMT.

Methods:

The first and second level catalogue defined as chapters and sections for the International EMT training curriculum were drafted based on literature and summaries of fragmentary experience. The teaching syllabus with the method of teaching and evaluation was initially outlined. The expert consultation form was designed and validated. Experts from International EMTs from various countries were consulted and investigated. The Delphi method was used, and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts.

Results:

A total of 25 experts were consulted. By 2 rounds of consultation with a Kendall coordination coefficient W value of 0.210 and chi-square value of 78.61 (p<0.05), consensus about the knowledge structure for the curriculum was achieved, which consisted of 6 chapters: (1) introduction of International EMT, (2) Disaster medicine, (3) Global health, (4) Care in austere condition, (5) Medical technology, (6) Field training, with the weights of 0.1415, 0.1584, 0.1536, 0.1827, 0.1728, and 0.1909, respectively, and 32 sections. Teaching methods for different knowledge modules were determined, which included lecture, demonstration, discussion, drills, and tabletop simulation. The evaluation methods were affirmed via a quiz, written examination, skill test, and teamwork test assessed by intra-group and inter-group evaluation.

Discussions:

Through scientific investigation of experts from International EMTs, a training course model for International EMT was established.
What About Us? Addressing the Needs of First Responders in Behavioral Health Disaster Planning in Chicago
Authors: Hebert Charles
Published: May 2019

Introduction:

Behavioral health needs of first responders often receive less attention than those of survivors. Fire, police, medical, and other personnel frequently witness direct loss of life, assaultive violence, and other stressors during disasters. Evidence indicates a greater incidence of psychiatric sequelae among disaster workers. What role do emergency management authorities have in addressing the needs of such personnel?

Aim:

To evaluate integration of first responder behavioral health needs among a metropolitan healthcare coalition, the Chicago Healthcare System Coalition for Preparedness and Response (CHSCPR).

Methods:

CHSCPR developed a Behavioral Health Annex providing uniform guidance on behavioral health integration into emergency operations with attention to first responders. An electronic Behavioral Health Capability Survey of coalition members was performed in March 2017 to assess implementation of these recommendations. Qualitative and quantitative responses were recorded.

Results:

Fifteen of thirty-five institutions responded, including academic and private community hospitals. Many reported no services. Where services existed, most facilities endorsed use of employee assistance programs or external vendors for staff support. 4/15 (26.7%) reported proactive strategies to mitigate stress such as information sheets on healthy coping. Measures for family support of affected emergency personnel were varied and typically outsourced to online resources, or reported as “in development.”

Discussion:

Findings suggest that recognition of emergency personnel behavioral health needs is lacking in city-wide disaster planning with greater emphasis on post-disaster needs than preventative efforts. Increased awareness of risk for psychological decompensation among first responders, and inclusive efforts to mitigate this risk, are warranted in future disaster planning.
Surveillance and Control of Threats in the Public Health System in Brazil: Mapping Managers’ Competencies
Authors: Silva Marcio Haubert Da , Albini Alessandro , Witt Regina Rigatto
Published: May 2019

Introduction:

With the increase in the number and intensity of disasters, integrated risk management has been a subject of discussion in Brazilian health system, in which the local level plays an important role. Competency Mapping of Managers working at a Municipal Health Office from a Metropolitan Area of Curitiba, Southern Brazil was developed.

Aim:

To describe gaps in core competencies identified for Surveillance and Control of Risks and Threats.

Methods:

The Public Health Core Competencies contained in the booklet: A Regional Framework for the Americas, of the Pan American Health Organization, originated a semi-structured self-assessment questionnaire. A Likert scale with levels of proficiency (from one to five) was aggregated to the 56 specific core competencies. It was applied to a sample of 78 managers between the months of October 2017 and January 2018. The data obtained were submitted to quantitative analysis. Gaps (Training Priority Degree) were defined according to the grade of importance and expression by means of a arithmetic mean and standard deviation.

Results:

Gaps were identified for the competencies: Design disaster risk management plans for natural, technological and biological threats so as to mitigate their impact on health (2.82 ± 1.16); Design investment projects for reducing the health risks of disasters (2.8 ±1.07); Provide an immediate response to threats, risks and damage from disasters based on the risk assessment, in order to protect health (2.89 ± 1.13); Plan and execute post-disaster reconstruction, based on the damage identified for the immediate restoration and protection of the population’s health (2.81 ± 1.11).

Discussion:

The degree of expression for these competencies indicate the need of preparing public health managers for surveillance, by monitoring the exposure of people or population groups to environmental agents, or their effects with an integrated approach to injuries and the etiology of emergencies and disasters.
Anatomy of a “Mass” Mass Gathering
Authors: Molloy Michael , Browne Ciaran , Horwell Tom , VanDeVelde Jason , Plunkett Patrick
Published: May 2019

Introduction:

Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.

Aim:

To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.

Methods:

A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.

Results:

One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.

Discussion:

A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.
Prediction Modeling Studies for Medical Usage Rates in Mass Gatherings: A Systematic Review
Authors: Van Remoortel Hans , Scheers Hans , De Buck Emmy , Lauwers Karen , Vandekerckhove Philippe
Published: May 2019

Introduction:

Mass gatherings attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted to identify those variables that are associated with increased medical usage rates.

Aim:

To identify studies that developed and/or validated a statistical regression model predicting patient presentation rate (PPR) or transfer to hospital rate (TTHR) at mass gatherings.

Methods:

Prediction modeling studies from 6 databases were retained following systematic searching. Predictors for PPR and/or TTHR that were included in a multivariate regression model were selected for analysis. The GRADE methodology (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence.

Results:

We identified 11 prediction modeling studies with a combined audience of >32 million people in >1500 mass gatherings. Eight cross-sectional studies developed a prediction model in a mixed audience of (spectator) sports events, music concerts, and public exhibitions. Statistically significant variables (p<0.05) to predict PPR and/or TTHR were as follows: accommodation (seated, boundaries, indoor/outdoor, maximum capacity, venue access), type of event, weather conditions (humidity, dew point, heat index), crowd size, day vs night, demographic variables (age/gender), sports event distance, level of competition, free water availability, and specific TTHR-predictive factors (injury status: number of patient presentations, type of injury). The quality of the evidence was considered as low. Three studies externally validated their model against existing models. Two validation studies showed a large underestimation of the predicted patients presentations or transports to hospital (67-81%) whereas one study overestimated these outcomes by 10-28%.

Discussion:

This systematic review identified a comprehensive list of relevant predictors which should be measured to develop and validate future models to predict medical usage at mass gatherings. This will further scientifically underpin more effective pre-event planning and resource provision.
Effectiveness of Children’s Disaster Risk Reduction (DRR) Program on Earthquake Preparedness in Jordan
Authors: Issa Fadi S , Molloy Michael , Hart Alexander , Issa Mahmoud S , AlFalasi Reem , Alhadhira Abdullah A , Sarin Ritu R , Voskanyan Amalia , Ciottone Gregory R
Published: May 2019

Introduction:

Children represent a particularly vulnerable population in disasters. Disaster Risk Reduction refers to a systematic approach to identifying, assessing, and reducing risks of disaster through sets of interventions towards disaster causes and population vulnerabilities. Disaster Risk Reduction through the education of the population, and especially children, is an emerging field requiring further study.

Aim:

To test the hypothesis that an educational program on Disaster Risk Reduction can induce a sustained improvement in knowledge, risk perception, awareness, and attitudes toward preparedness behavior of children.

Methods:

A Disaster Risk Reduction educational program for students aged 10-12 was completed in an earthquake-prone region of Jordan (Madaba). Subject students (A) and control groups of similarly aged untrained children in public (B) and private (C) schools were surveyed one year after the program. Surveys focused on disaster knowledge, risk perception, awareness, and preparedness behavior. Likert scales were used for some questions and binary yes/no for others. Results were collated and total scores averaged for each section. Average scores were compared between groups and analyzed using SPSS.

Results:

Students who had completed the Disaster Risk Reduction program were found through Levene’s test to have statistically significant improvement in earthquake knowledge (5.921 vs. 4.55 vs. 5.125), enhanced risk perception (3.966 vs. 3.580 vs. 3.789), and improved awareness of earthquakes (4.652 vs. 3.293 vs. 4.060) with heightened attitudes toward preparedness behavior (8.008 vs. 6.517 vs. 7.597) when compared to untrained public and private school control groups, respectively.

Discussion:

Disaster Risk Reduction education programs can have lasting impacts when applied to children. They can improve students’ knowledge, risk perception, awareness, and attitudes towards preparedness. Further work is required to determine the frequency of re-education required and appropriate age groups for educational interventions.
“Operation:Navajeevan”: Novel PPP Model Flood Relief Camp
Authors: Haris Sonia , Anaswara Naveen , Poovathumparambil Venugopal
Published: May 2019

Introduction:

In August 2018, Kerala, India witnessed its worst flood in over a century. With the support of the national health mission, Operation Navajeevan, a public-private partnership between the district health administration and local hospitals was established in Kozhikode to provide medical aid to flood victims. This study identifies prerequisites, describes challenges, and depicts the epidemiology of patients seen in these camps.

Aim:

1.

Identify prerequisites and medical needs/challenges faced by medical relief camps in a flood-affected region

2.

Formulate protocols to avoid duplication of services

3.

Prepare an ideal PPP emergency medical camp model

Methods:

A control center with drugs and a logistics unit was set up at the district administration to monitor and supervise various camps. A mobile medical documentation format was created to record the details of each camp. Cases of patients seen at these camps were compiled and later analyzed. The medical officer sent reports from each camp to the control center each day to specify the daily difficulties faced by each camp. Mobile ICUs were kept on standby to respond in the event of emergent circumstances or surge demands. Transfer protocol and treatment guidelines were formulated and standardized.

Results:

Over two weeks, approximately 40,000 patients were seen in 280 medical camps. Major medical issues included exacerbation of chronic illnesses due to loss of medications (18,490), acute respiratory infections (7,451), psychiatric illnesses (5,327), trauma (3,736), skin infection (792), tropical fever (498), acute gastroenteritis (394), and ACS (17). Of the cases of fever, 137 people had leptospirosis. Major challenges included a lack of training in disaster management and failure of documentation systems.

Discussion:

A well-organized control center, improved training in disaster medicine, and reliable documentation systems are crucial for coordinating medical camps in disaster areas. Public-private partnerships offer a model for providing medical relief in disaster settings.
Study of Medical Supply and Demand Balance for the Nankai Trough Earthquake
Authors: Takada Yosuke , Otomo Yasuhiro
Published: May 2019

Introduction:

The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.

Aim:

To clarify the gap between medical supplies and demand.

Methods:

Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.

Results:

The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.

Discussion:

Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”
Advancing Performance Measurement for Public Health Emergency Preparedness: An Integrated Knowledge Translation Approach
Authors: Khan Yasmin , O’Sullivan Tracey , Brown Adalsteinn , Gibson Jennifer , Henry Bonnie , Généreux Mélissa , Schwartz Brian
Published: May 2019

Introduction:

Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.

Aim:

To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.

Methods:

The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.

Results:

iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.

Discussion:

The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.
Palliative Care Training for Work in an Austere Environment After a Natural Disaster
Authors: Goodman Annekathryn , Black Lynn
Published: May 2019

Introduction:

Healthcare professionals working in a disaster face destroyed physical infrastructures, scarce supplies, and a limited-in-training peer group. During a mass casualty event, disaster victims are triaged to the “expectant” category of care because either their injuries are not survivable or the resources needed to care for them are not available.

Aim:

To examine the challenges that disaster responders face in caring for dying patients in the field, and advocate for basic palliative care training prior to deploying to a disaster.

Methods:

The world’s literature was reviewed to identify challenges for disaster teams in providing compassionate end-of-life care and to find training exercises for pre-deployment competency building.

Results:

Training Topics in Palliative Care Prior to Disaster Deployment include the following:

1.

Symptom Management Protocols:

Pain

Anxiety

Respiratory distress

Delirium

Nausea and Vomiting

2.

Spiritual Management

Grief

Identify meaning

3.

Cultural Training specific to the location of the disaster

The meaning of death in the culture

Who are the decision makers in the family

4.

Training for difficult conversations

Delivering Bad News

Managing a grieving family

5.

Self-Care Training

Develop a system for debriefing

Develop a buddy system

Self-care exercises: deep breathing, prayer, meditation, yoga

Discussion:

Challenges to the care of the dying during a disaster include a loss of medical infrastructure and scarce medical or physical resources. Palliative care training for non-palliative care specialists can be instructive for the development of palliative care training for medical care responders after disasters. Applying standards, identifying goals of care for the expectant patient, communication to the patient and family members, if available, can help reduce suffering of this group of devastatingly vulnerable patients. In addition, peer support, on-site discussions and debriefing, and problem-solving when resources are limited will help alleviate moral distress among the providers.
The Development of a Community-wide Primary Health Comprehensive Planning and Response Coordination Group to Plan for and Manage Seasonal Influenza and Possible Pandemic Response
Authors: Schroeder Philip , Robertson Kelly , Callahan Deborah , Frew Gareth , McColl Graeme
Published: May 2019

Introduction:

The Canterbury Primary Response Group (CPRG) was formed following the threats of severe acute respiratory syndrome (SARS) and avian influenza worldwide. The possible impact of these viruses alerted health care professionals that a community-wide approach was needed to manage and coordinate a response to any outbreak or potential outbreak. In Canterbury, New Zealand, the CPRG group took the responsibility to coordinate and manage the regional, out of hospital, planning and response coordination to annual influenza threats and the possible escalation to pandemic outbreaks.

Aim:

To outline the formation of a primary health and community-wide planning group, bringing together not only a wide range of health providers, but also key community agencies to plan strategies and responses to seasonal influenza and possible pandemic outbreaks.

Methods:

CPRG has developed a Pandemic Plan that focuses on the processes, structures, and roles to support and coordinate general practice, community pharmacies, community nursing, and other primary health care providers in the reduction of, readiness for, response to, and recovery from an influenza pandemic. The plan could reasonably apply to other respiratory-type pandemics such as SARS.

Results:

A comprehensive group of health professionals and supporting agencies meet monthly (more often if required) under the chair of CPRG to share information of the influenza-like illness (ILI) situation, virus types, and spread, as well as support strategies and response activities. Regular communication information updates are produced and circulated amongst members and primary health providers in the region.

Discussion:

Given that most ILI health consultations and treatments are self or primary health administered and take place outside of hospital services, it is essential for providers to be informed and consistent with their responses and knowledge of the extent and symptoms of ILI and any likelihood of a pandemic.
Using the MCRISP Network to Study Acute Gastroenteritis and Influenza-Like Illness Outbreaks in Child Care Centers Compared to Statewide Epidemics
Authors: Hashikawa Andrew , DeJonge Student Peter , Bradin Stuart , Martin Emily
Published: May 2019

Introduction:

Biosurveillance is critical for early detection of disease outbreaks and resource mobilization. Child care center (CCC) attendance has long been recognized as a significant independent predictor for respiratory and gastrointestinal diseases, but CCC surveillance is currently not part of the statewide disease surveillance system. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is an independent, online reporting network with >30 local CCCs that was created to fill this surveillance gap.

Aim:

To describe the capability of a novel CCC biosurveillance system (MCRISP) to report pediatric Influenza-Like Illness (ILI) and Acute Gastroenteritis (AGE) illness over three years to (i) assess both the timing and magnitude of epidemics in CCCs and (ii) compare CCC outbreak patterns with those of the state database.

Methods:

MCRISP collates real-time syndromic reports of illness from local county CCCs. The statewide Michigan Disease Surveillance System (MDSS) collects reports of diagnosed illness from designated laboratories, clinics, and hospitals statewide. We assessed epidemic curves based on MCRISP incidence rates and MDSS case counts for ILI and AGE over three seasons (2014-7).

Results:

A total of 4,627 MCRISP cases (2,425 ILI and 2,202 AGE reports) were reported during the three years of study surveillance. Epidemic patterns (seasonal peaks, troughs, and breadth) for both ILI and AGE in CCCs mirrored those reported at county and state levels, respectively. Two distinguishing features of CCC ILI outbreaks were noted in all three seasons: MCRISP ILI rates remained elevated after MDSS influenza counts abated, and MCRISP rates consistently peaked prior to MDSS influenza peaks. Neither of these phenomena were observed in comparing AGE outbreaks between surveillance systems.

Discussion:

ILI and AGE incidence rates from the MCRISP network appeared to broadly mirror epidemics from the established state surveillance system. MCRISP may act as a sentinel system for larger community outbreaks of respiratory disease.
Primary Care Pharmacist Interventions in Risk Reduction for the Zika Virus Epidemic: A Study in Campa Grande, Mato Grosso do Sul, Brazil
Authors: Miranda Elaine , Santos-Pinto Claudia , Antunes Clarice , Ferreira Larissa , Osorio-de-Castro Claudia
Published: May 2019

Introduction:

Pharmaceutical services for public health emergencies, such as the Zika virus (ZIKV) epidemic, are relevant for service effectiveness in the Brazilian health system. Pharmacists can act strategically in risk reduction. However, official guidelines do not consider pharmaceutical services when approaching health emergencies.

Aim:

To identify and understand primary healthcare pharmacist interventions in risk reduction for the recent ZIKV epidemic in Brazil.

Methods:

The study took place in Campo Grande, Mato Grosso do Sul, in November 2017. A semi-structured questionnaire was developed, including general issues related to knowledge of Zika, risk communication, and the pharmacist's role in patient care for ZIKV disease. The instrument was pre-tested. Primary healthcare center (PHC) pharmacists were subsequently interviewed. Aspects related to knowledge, risk reduction measures, and role were categorized and analyzed. The project received approval from the Institutional Review Board (IRB) at the Sergio Arouca National School of Public Health.

Results:

Forty-two of the 48 PHC pharmacists in Campo Grande were interviewed. Risk reduction measures were cited by most interviewees. Among these strategies, 92% were collective measures, such as making information available for the population (30%) and for the health workers (8%), and vector control strategies (43%). Use of mosquito nets was the most cited individual risk-reduction strategy. Only one pharmacist cited risk for pregnant women and suggested birth control as a strategy. Another pharmacist pointed to ZIKV “treatment.” No interviewee mentioned measures related to preparedness of pharmaceutical services.

Discussion:

PHC pharmacists do not place themselves at the frontline of risk reduction for the ZIKV epidemic. In the face of potential hazards and consequences of this disease, action by pharmacists is deemed critical. This study highlights pharmacist's misconceptions and lack of focused knowledge, pointing to the need for training and capacity-building in order to increase quality of care and positive management of future epidemics.
A New Strategy for Swiftwater Rescue from Roadways during Urban and Small Stream Flash Flooding
Authors: Jaslow David , Zecher Derek , Synnestvedt Ryan , Melly Kevan , Overberger Ryan
Published: May 2019

Introduction:

The swiftwater rescue (SWR) concept of operations (CONOPS) is to access as many victims as quickly as possible using strategies and tactics that maximize safety and minimize risk to all involved. “Reach, throw, row, go” has defined the primary water rescue strategy for 50+ years. However, this paradigm, originally designed for rescue from swimming pools, ponds and lakes, slow-moving rivers, and the ocean, is not conducive to SWR incidents involving submerged vehicles, which is the most common scenario during urban and small stream flash flooding.

Aim:

To present a new SWR strategy for urban and small stream flood response.

Methods:

Water rescue strategies and tactics were mapped against the SWR CONOPS to determine which ones are most likely to be successful in the rescue of victims trapped in submerged vehicles.

Results:

Rescue should be attempted via high water vehicles (HWVs) whenever possible, followed by watercraft and “go rescues” using advanced line systems techniques and/or tethered rescuers, dependent on incident characteristics. Positioning HWVs at the incident site permits rescuers to access victims quickly from the rear or sides of the vehicle, thereby reducing rescuer time in floodwaters. Multiple sequential rescues can be made since victims are held and medically monitored in the cargo area rather than transporting them to shore individually.

Discussion:

SWR from submerged vehicles is unique among emergency incidents because neither shelter-in-place nor self-evacuation are tenable options until the water recedes. "Reach" and "throw" rescue attempts are only possible if the victim is close to shore. Watercraft operations, whether motorized or manually pulled, can be technically complex, require numerous rescuers, and typically take 30-60 minutes per vehicle. Use of HWVs meets the CONOPS for SWR on flooded roadways since this strategy facilitates the rescue of multiple victims quickly while reducing the time rescuers spend in the water.
The Role of Primary Health Networks and General Practitioners in Disasters: Nepean Blue Mountains Primary Health Network’s Preparedness Guide
Authors: Reay Lizz , Burns Penny
Published: May 2019

Introduction:

Disasters are part of the Australian landscape. Bushfires, floods, cyclones, and drought reoccurring consistently across the continent. Primary Health Networks (PHNs) and general practitioners (GPs) are scattered across Australia and are inevitably involved when disasters strike their local communities. Limited guidance exists to guide their systematic involvement within the broader disaster response system. In October 2013, large bushfires swept through the NSW Blue Mountains. The response was unusual in its inclusion of NSW general practice networks within the response system, most crucially the local (now) Nepean Blue Mountains Primary Health Network (NBMPHN).

Methods:

The lessons learned by GPs and NBMPHN during the fires highlighted the need for GP preparedness to improve recovery outcomes. This led to the development of a living discussion document “Emergency management: the role of the GP,” created with input from the various GP groups. More recently, a PHN emergency preparedness guide aimed at strengthening communication and formalizing the role of the PHNs and GPs before, during, and after a natural disaster.

Results:

Clarity and implementation of a process for disaster preparedness have enabled a more proactive and coordinated approach to local emergency management with a distinct role for both the PHN and local GPs when responding to a natural disaster.

Discussion:

This presentation discusses lessons learned and the preparedness strategy now in place in the Nepean Blue Mountains PHN region, and launches the emergency preparedness guide that can be used and adapted by GPs and other PHNs across Australia.
Averting ‘Albo-Geddon’: Challenges to Metro South Health Emergency Response to Invasive Mosquito Detections in a Complex Stakeholder Environment
Authors: Jarvinen Kari , Montgomery Brian , Shillig Greg , McCall Bradley
Published: May 2019

Introduction:

Invasive mosquito species present significant organizational and health risks of covert disease outbreaks (dengue, Zika, or chikungunya) following an incursion into novel geographies. In Australia, detections at international First Points of Entry will trigger a multi-agency response to prevent escape into nearby urban environments that are largely unmonitored. Brisbane’s mosquito surveillance and response systems were challenged in 2017-2018 by the unprecedented frequency of detections in imported oversized tires that stretched the biosecurity response with escape opportunities.

Aim:

Describe the unique challenges to Metro South Public Health Unit within a complex stakeholder environment represented by federal, state, and municipal agencies.

Methods:

We present as a case study of an invasive mosquito detection that escalated to a public health incident of statewide significance through an incident management team structure. We focus on describing the significant governance and logistic challenges to the emergency mobilization of Metro South Health staff.

Results:

Since mid-December 2017 biosecurity have reported 12 detections of invasive mosquito species (Aedes aegypti, Ae. albopictus, Ae. japonicus) in infested tires arriving in Brisbane. Each emergency response was successful due to amendments to operational protocols and policy review. The legacy is a permanent enhancement of local mosquito monitoring, improved response systems, and greater operational preparedness.

Discussion:

The organizational impact of invasive mosquitoes is likely to be underestimated and under-resourced in jurisdictions beyond their expected distributions. Our experiences demonstrate the value of a clear and shared understanding of interagency emergency frameworks to effectively integrate each response. Resolution of uncertainties around organizational roles and responsibilities, and interpretations of guidelines, implementation strategies for mosquito surveillance, and control in novel contexts will require organizational agility and robust partnerships. Strategic re-focus is recommended to embed robust preventative measures and review of policy to mitigate the risk and impact of emergency responses to future invasive mosquito detections.
Pseudo Epidemic of Diarrhea Incidence: A Month Post Tsunami in Central Sulawesi, Indonesia
Authors: Tias Endarti Ajeng , Radjak Abdul , Handito Agus , Adisty Marlina , Ronoatmodjo Sudarto
Published: May 2019

Introduction:

On Friday, September 28, 2018, the 7.4 Richter Scale earthquake hit Central Sulawesi and was followed by a tsunami. Within a month after the unpredictable earthquake and tsunami, a 773 aftershock earthquake was noted. These events took a major toll on the population in the affected areas. 2,086 people died and more than four thousand people were injured. 1.373 people went missing and 206.494 were evacuated. Surveillance data from November 4, 2018, to October 24, 2018, showed that an increased number of illnesses such as diarrhea was the second leading reported cases. Data showed that the number of diarrhea cases was 3.350 with two peaks of epidemic curves on October 10 and 22, 2018.

Aim:

To verify the diarrhea outbreak after the tsunami in Palu, Donggala, and Sigi District.

Methods:

Verification of medical records at six selected primary healthcare institutions with the highest number of cases of diarrhea.

Results:

A pseudo-epidemic of diarrhea occurred. A high number of diarrhea cases occurred due to double reporting and misdiagnosed cases. Investigation reports showed that liquid defecation was considered diarrhea even though it occurred less than three times a day. The follow-up activity was contacting data entry managers to revise data, disseminate findings during the daily meeting of the health-related officers, and broadcasting findings through a WhatsApp group of provincial and district surveillance officers. Post-investigation, the number of diarrhea incidences was lower and the peak was not shown on the epidemic curve. It can be interpreted that a diarrhea outbreak did not occur in the tsunami-affected area in the Palu, Donggala, and Sigi districts.

Discussion:

During a time of disaster, a chaotic situation led to improper data collection. Data verification should be conducted to assure the validity of reported data.
Relating the All Hazard Approach of Hospitals to that of Public Authorities
Authors: van der Torn Pieter , Geene Roel , den Hartog Dennis
Published: May 2019

Introduction:

Hospitals and the healthcare sector suffer from chronic work overload and personnel shortages in many nations. This poses strong incentives to rationalize all activities not directly related to care, such as the preparations for disasters and other hazards. One such rationalization is to turn from a rule-based to a risk-based approach. However, the risk landscape of hospitals and the relationship to the risk landscape of public authorities are ill-defined. Health Care Coalitions (HCCs) are in a good position to fill this gap and serve as an intermediary. We developed a scheme for defining the risk landscape of HCCs and its members and performed a prioritization process.

Aim:

Objectives were to develop a knowledge platform of hospitals on risk assessment, promote integrated risk management by the HCC and its members, and determine the limiting (response) state for all relevant hazards.

Methods:

We put maximum effort in limiting the time consumption for hospitals and align with the regular practices in hospitals for business continuity management. Strong points included the cooperation with the public authorities for safety and for health, a stepwise development of risk awareness and stepwise guidance for the assessment by hospitals, and formalization of the scenario-selection and choice of priorities by the HCC board.

Results:

A gross list of (>230) safety hazards was produced along with a netlist of (>80) hazards relevant to health care. In addition, an impact-scale for the continuity of care serving as a measurement stick for all health care sectors was developed. Risk diagrams were developed to present the results in a simple and clear format.

Discussion:

The HCC risk landscape served its purpose in improving the mutual understanding with the public authorities. The formal assessment provides a solid basis for operational planning, education, training, and future investments.
Safer Hospitals in North Queensland - Assessment of Resilience
Authors: Luke Jenny , Franklin Richard , Aitkin Peter , Dyson Joanne
Published: May 2019

Introduction:

Hospitals are fundamental infrastructure, and when well-designed can provide a trusted place of refuge and a central point for health and wellbeing services in the aftermath of disasters. The ability of hospitals to continue functioning is dependent on location, the resilience of buildings, critical systems, equipment, supplies, and resources as well as people. Working towards ensuring that the local hospital is resilient is essential in any disaster management system and the level of hospital resilience can be used as an indicator in measuring community resilience. The most popular measure of hospital resilience is the World Health Organisation’s Hospital Safety Index (HSI) used in over 100 countries to assess and guide improvements to achieve structurally and functionally disaster resilient hospitals. Its purpose is to promote safe hospitals where services “remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.” It identifies likely high impact hazards, vulnerabilities, and mitigation/improvement actions.

Aim:

The HSI can be a valuable tool as part of the 2015-2030 Sendai Framework for Disaster Risk Reduction. However, to date, it has been used infrequently in developed countries. This project pilots the application of the HSI across seven facilities in a North Queensland health service (an area prone to cyclones and flooding), centered on a tertiary referral center, each providing 24-hour emergency health services.

Results:

Key indicators of resilience and the result of the audit will be discussed within geographical and cultural contexts, including the benefits of the HSI in augmenting existing hospital assessment and accreditation processes to identify vulnerabilities and mitigation strategies.

Discussion:

The research outcomes are to be used by the health service to improve infrastructure and provide anticipated community benefits, especially through the continuation of health services post disasters.
DisasterSISM: A Multi-Level Blended Learning Program in Disaster Medicine for Medical Students
Authors: Ragazzoni Luca , Conti Andrea , Caviglia Marta , Maccapani Fabio , Corte Francesco Della
Published: May 2019

Introduction:

Disaster medicine has been identified as a fundamental discipline for health professionals. In Italy, the role of physicians during disaster response is officially recognized by the Italian Code of Medical Ethics and by the Ministry of Education. Nevertheless, few Italian medical schools include this discipline in their curricula.

Aim:

With the aim of teaching basic knowledge of disaster medicine to Italian medical students, Research Center in Emergency and Disaster Medicine (CRIMEDIM) and Italian Medical Students’ Association (SISM) developed DisasterSISM, a nationwide training project in disaster medicine.

Methods:

DisasterSISM consists of three courses: Basic, Advanced, and Train-of-Trainers (ToT). The Basic courses are managed by medical students who are trained during the one-week intense ToT. All courses are delivered using innovative training methodologies, such as e-learning, peer education, table-top exercises, and virtual reality simulations.

Results:

From 2012 to 2018, a total of 122 courses (111 Basic, 5 Advanced, and 6 ToT) have been delivered. DisasterSISM reached 37 out of 45 Italian medical schools, training more than 2,500 students. A survey conducted after the end of each course showed that participants considered the knowledge in Disaster Medicine essential for their future profession, regardless of the specialty chosen. Students also expressed their appreciation about the blended-learning approach, with a predilection for virtual reality simulations. The comparison between the entrance and the final exam scores showed a significant increase in knowledge.

Discussion:

In six years, DisasterSISM reached the majority of Italian medical schools, providing disaster medicine knowledge to hundreds of undergraduates. Considering the fast growth and diffusion of the project, the significant increase of knowledge, and the positive feedback received from participants, we suggest that the DisasterSISM model be implemented in other countries to widely disseminate information about prevention and disaster preparedness among medical students and health professionals.
Red Cross and Red Crescent Health Information System (RCHIS): Functional Design and Usability Testing Protocol
Authors: Moore Roxanne , Archer Laura
Published: May 2019

Introduction:

The Red Cross and Red Crescent Health Information System (RCHIS) combines the functionality of an Electronic Medical Record (EMR), Health Information System (HIS), as well as Human Resource and stock management system. Its purpose is to facilitate patient quality of care, early warning for outbreak detection, accountability/reporting, and resource management. Short-term, emergency medical teams and support staff responding to acute clinical needs in a humanitarian context are the intended end users.

Aim:

To explain the functional design principles and usability testing protocol implemented in initial RCHIS design and development phases to ensure technological fit within the humanitarian medical context.

Methods:

RCHIS development followed the patient-user journey, with each patient/staff interaction encapsulated by a microservice. The integration of multiple microservices enabled RCHIS to mimic various patient journeys. The functional scope of each microservice was designed by medical end-users and was further used for access management. The value and variable design, including validation rules, were led by health informaticians and existing medical standards. Intuitiveness and ease of use guided User Interface design, with targeted medical end-user feedback collected on a twice-monthly basis in addition to early design workshops, field immersion, and post-development pilot testing.

Results:

Support and implementation of RCHIS were not inherently guaranteed. As such, the process of co-designing with end users had the primary benefit of ensuring effective scope and technological fit given the humanitarian context, but also the secondary benefit of improving internal acceptability and advocacy.

Discussion:

The added value of digital health records as a quality assurance mechanism is well documented. However, the increased workload and reduced employment satisfaction affiliated with the rise of EMRs illustrated a need to re-evaluate current design and use within clinical settings. The design and development approach taken for RCHIS is one attempt to improve human-computer interaction in the clinical setting.