bluuebunny/crossref_metadata_2025 huggingface dataset:
(A303) Aspects Actuels Du Triage, Pour Une Synthèse
Authors: Julien H.
Published: May 2011

Le triage des victimes en nombre s'impose aujourd'hui comme une nécessité opérationnelle. Les deux actions complémentaires qui le caractérisent: catégorisation des blessés et dispensation des soins d'urgence sont universellement admis. Il a plusieurs buts: repérer les blessés les plus graves pour leur donner les soins dans les meilleurs délais, les regrouper par niveaux de soins afin d'y consacrer les sauveteurs-soignants correspondants, mieux gérer les flux de blessés et dans le même temps administrer les premiers soins. Le triage de victimes de catastrophes civiles, a longtemps été considéré en France comme un acte médical, réalisé par les seuls médecins placés à l'entrée du Poste Médical Avancé, où sont dispensés les soins d'urgence et la mise en condition des victimes, nécessaires à leur évacuation vers les structures d'accueil et de soins. Aujourd'hui, notamment sous l'influence anglo-saxone un triage préalable est effectué par les sauveteurs sur le terrain, afin de catégoriser les victimes du ramassage avant leur transfert sur le PMA: ce pré-triage, premier triage, est connu sous le nom de « Simple Triage And Rapid Treatment ». Une synthèse est nécessaire afin notamment que dans des conditions d'intervention internationalisées, les personnels de sauvetage et de soins d'urgence disposent d'une méthode à application universelle. Cela est rendu possible en soulignant l'aspect dynamique du triage qui se réalise et se complète d'étape en étape: sur le terrain au moment du ramassage par les sauveteurs, médicalisés ou non, au niveau du PMA ou du module de chirurgie vitale où seront pratiquées « damage control », réanimation et mise en condition d'évacuation, à la structure d'accueil ou sera réalisé le triage de vérification. Les critères retenus pour le triage des enfants, des brûlés, des victimes irradiées ou contaminées chimiques, les blessés psychiques viennent compléter les critères fonctionnels et lésionnels classiquement retenus.
(A305) Un Outil Pour La Maîtrise De L'accident Collectif
Authors: Pitteloud J.
Published: May 2011

Le tableau croisé, un outil pour la maîtrise de l'accident collectif Dr J.-C. Pitteloud, Sion (Suisse) Lorsqu'on est confronté Á un accident Á plusieurs victimes, il est souvent difficile de garder en tête Á la fois les victimes et les moyens dont vous disposez. Le tableau croisé est un formulaire qui permet de diriger et de documenter efficacement une intervention sur un accident Á plusieurs victimes. Le principe du tableau croisé est que vous allez regrouper les informations sur les victimes, comme leur numéro et leur catégorie de triage sur les lignes horizontales de votre tableau (l'axe des X). Les information sur les vecteurs (heure d'appel, heure d'arrivée) seront notées sur les colonnes (l'axe des y). L'heure de prise en charge de chaque victime par une unité est notée Á l'intersection correspondante. L'heure d'Évacuation vers l'hôpital est notée au bout de chaque colonne et de chaque ligne. Ce formulaire permet de garder une vue d'ensemble des opérations de secours Á victime ainsi que de documenter l'action de chaque Équipe et le devenir de chaque patient. Il est utilisable dû l'arrivée de la première Équipe sur place, puisqu'il suffit d'un stylo et d'une feuille de papier pour le réaliser. Dans notre expérience, une feuille de format A4 européen permet de gérer une intervention pour une dizaine de victime, une feuille de format A5 jusqu'Á une trentaine.
(A307) Disaster Task Force's Management Support at Emergency Response Phase in the Merapi Eruption November 2010
Authors: Wartatmo H.
Published: May 2011

Background

Merapi, the most active volcano in the world, erupted on the 26th October 2010 at 17.02, and followed by several eruptions. The biggest eruption was on the 5th of November 2010. Damages were catastrophic: 386 people killed, and more than $400 million lost. A wide area of fertile lands and settlements were destroyed which resulted in more than 200.000 refugees. This disaster had impact to 2 provinces and 6 districts. At the emergency phase, a special task force was established by central government of Indonesia. This paper aims to evaluate the task force and the role of its management support during the acute phase in the disaster.

Method

an input and process evaluation of task force work was implemented.

Results

The input evaluation shows that the task force members for emergency response came from central, provincial, district government employees, universities and non government organisation members. The financial sources are from public and private funding. The activities process of task force in forms of health response command system, temporary information system, communication and telecommunication system, supporting the volunteer groups, managing the refugees camps, implementing surveillance system, and backed up the local district health officers. There were problems of programs coordination and channelling the budget from national treasury due to the multiple eruptions. Most of these problems were solved by a management support team for the task force.

Conclusion

The multiple strikes of Merapi eruption needs better human resources management and financial support. During Merapi eruption, it is proved that a management support for emergency response task force is important. This management support allowed better control and coordination of available resources.
(A310) Academic Training for Paramedics - A Unique University Based Model
Authors: Schwartz D. , Aronson L. , Adini B. , Nesher L.
Published: May 2011

Introduction

The paramedic profession is relatively new, dating to the 1970's. In Israel, it was introduced in 1980 and paralleled the introduction of advanced life support units (ALS) to Israel's national emergency medical services (EMS), Magen David Adom (MDA).The curriculum and assigned roles were adopted with minor changes from Anglo-American systems. Initially, paramedics were assigned alongside physicians, but in recent years a growing percentage of units operate without an on-board physician. Despite the increasing complexity of required tasks and the move toward paramedic-led crews, paramedic training has changed little. Most are trained through a non-academic, certificate granting tracts. In 1998, a fully academic bachelor's degree program was launched at the Ben-Gurion University (BGU).

Methods

The programs aims, curriculum, and experience are described, based on past and current curriculum and on interviews with past and current staff and students.

Results

The BGU program is a three year program that grants its graduates both a University BA and professional paramedic certification. The program is housed as a university department within the Faculty of Health Sciences. First year courses center on basic sciences. The second year centers on classroom and simulation-based learning of the clinical topics. The third is devoted mostly to clinical clerkships, in hospital wards in the first semester and on MDA ALS units in the second. To date, the program boasts more than 300 graduates, many attaining higher academic degrees in healthcare sciences and many who work in Israel's national EMS.

Discussion

The BGU academic paramedic training program is the only such program in Israel and one of a few worldwide. Questions regarding the increasing responsibility and task complexity require a move from certificate training to University degree granting learning and the possible contribution of such
(A315) Improvement of the Prehospital Healthcare System in Iran
Authors: Khankeh H.R. , Jallali A.R. , Masoomi G.R.
Published: May 2011

Background

The prehospital time delay in acute health problem still is a problem in most low- and middle-income countries, like Iran. It often is possible to minimize adverse consequences by promptly providing effective prehospital services

Aim

This study was designed to compare the response time interval occurring during the prehospital care process in Tehran during the last decade.

Methods

A retrospective, comparative study was designed, and the mean response time intervals in relation to prehospital care were identified from September 1999 until September 2000 were compared with data from September 2009 until September 2010. Data were collected from Tehran emergency medical services (EMS) center registries.

Results

The EMS center of Tehran dispatched 213 ambulances every day in 1999–2000 compared with 1,200 in 2009–2010. During the 2009–2010 period, the mean response time for city locations was 14.18(+ /−4) minutes, compared with 1999–2000 the mean response time for city location was 16(+ /− 8). The mean response time from the time period of 1999–2000 also was longer than for 2009–2010 (14.18 vs. 16.58 minutes).

Conclusions

Despite the prominent increase in the number of ambulance dispatching everyday, the mean response time in Tehran decreased during last decade. This improvement can be due to the improvement of the prehospital system in Tehran, including the number of: ambulances, trained staff, EMS stations, etc. However, it still is far from a national standard (eight minutes for city).
(A316) Pre-Hospital Emergency Care in Sudan - Current Practices in Disaster Management (DM)
Authors: Elbashir K. , Gore R. , Bloem C. , Roblin P. , Ostrovskiy G. , Abuaaraki T. , Yousif M. , Arquilla B.
Published: May 2011

Introduction

The problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.

Methods

The information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.

Results

There are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.

Conclusion

Emergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.
(A342) Distribution Network Design in Relief Chain Management: Learnings from the 2008 Kosi Floods, Bihar, India
Authors: Prakash A.
Published: May 2011

Logistics has always been an important factor in humanitarian aid operations, to the extent that logistics efforts account for 80% of disaster relief. They often have to be carried out in an environment with destabilized infrastructures ranging from a lack of electricity supplies to limited transport infrastructure. Furthermore, since most natural disasters are unpredictable, the demand for goods in these disasters is also unpredictable. Thus it is evident that humanitarian logistics is challenging as it has to be more flexible, and has to function under severe constraints. In India, humanitarian logistics remains a neglected field ins disaster management, the cost of which is paid by loss of human lives and property. In recent Kosi Flood the total population of 33,45,545 people living in 993 villages of 412 panchayats of 35 blocks of 5 districts were affected. A total of 3, 40,742 houses were damaged and 7, 12,140 animals were affected. A total of 239 humans and 1232 animal's lives were lost (Department of Planning and Development, Government of Bihar). The Paper analyses, Madhepura district government's mechanisms of managing logistics while responding to Kosi floods 2008. It evaluates the efficiency of these mechanisms with respect to its outreach to flood affected people. It review and analyses the strengths and weaknesses of the adopted distribution network design for relief management with reference to strategic locations of the relief camps, during the first month of the kosi floods in 2008. It suggests ways to improve disaster logistics at district level in Bihar. The study looks into the possibilities of adopting newer approaches in the field of logistics that could be implemented with greater efficiency under similar conditions. The logistics in the devastating floods at the district level in a developing country has key learning lessons for similar resource poor environments.
(A345) The Longitudinal Study of Survivors' Daily Lives and Health Conditions after Sichuan Earthquake in China — The Result of the 3rd Year Compared with the 1st Year and 2nd Year Study
Authors: Hu X.Y. , Cheng Y.J. , Chen Q. , Long N. , Li J.P. , Luo Y.L. , Yamamoto A.
Published: May 2011

Objective

To longitudinally investigates the Survivors' daily lives and healthy condition after Sichuan earthquake in China. This study identifies Survivors' daily lives and health conditions for 3-years.

Ethical Consideration

The study was conducted after obtaining approval in Ethical Review Board of Sichuan University.

Method

The study was conducted for the survivors who experienced the earthquake and aged 18 years and over, and joined the 1st year and 2nd year study. Questionnaire included the survivors' socio-demographics, impact of disaster and the health status after disaster. The date was analyzed using SPSS 13.0 software.

Results

Results showed the follow-up date which was results of 3-years. The changes of daily lives of survivors for 3-years were fluctuations. As their health conditions in the 3rd year, the following symptoms were decreased: locomotors system disease, respiratory disease, Autoimmunity and endocrine diseases, asthma and allergy, Gout, Irregular menstruation/dysmenorrheal, kidney disease and the others. In contrast, the following symptoms were increased: cardiac disease, weight gain/less, hypertension, diabetes, and liver disease. About their self-rated health, “Not healthy” at 3rd year was 26.4%. Compared with the 1st year and 2nd year results, it has taken a turn for the significantly better (1st year 49.9%; 2nd year 35.1%). With regard to the psychological condition, the Positive response of IES-R at 3rd year was 11.6%. Compared with the 1st year and 2nd year results, the Positive response of IES-R significantly decrease (1st year 49.8; 2nd year 31.8%. p < 0.001, by Pearson Chi-square).

Conclusion

After 3rd year of the Sichuan earthquake disaster, the survivors' physical and psychological conditions have improved compared to 1st year and 2nd year results. However most of the survivors still had some health problems in their health. Our local nursing authorities still need to go on their health promotion, which can further improve the survivors' health status.
(P1-3) Frequency of Cerebrovascular Diseases and Risk Factors in Emergency Department in Banja Luka
Authors: Banjac N. , Kezic S. , Maravic-oplakan G. , Vukadinovic S. , Janjic N. , Vulic V. , Kovacevic D.
Published: May 2011

Introduction

Cerebrovascular disease include all disorders in which a part of brain is transiently or persistently damaged by ischemia or bleeding and/or where one or more blood vessels of brain are primarily damaged by pathological processes. The research confirmed the influence of risk factors.

Objective

The primary objective was to measure frequency of patients with cerebrovascular diseases in the Emergency Service during the period from September 1, 2008 to March 1, 2009. The secondary objective was to prove co-morbidity between the risk factors and cerebrovascular diseases.

Method

Numerical indicators for patients with cerebrovascular diseases are extracted retrospectively by statistical work-up for the six-month period. The data indicating the risk factors predisposing cerebrovascular diseases are obtained through the (hetero)anamnesis.

Results

From the overall number of 24,600 patients, 127 patients had a diagnosis of cerebrovascular diseases. The frequency of cerebrovascular diseases is linearly increasing with age; after the age of 50, frequency is doubled. The frequency of cerebrovascular diseases is higher in women than in men, the role of heredity is significant, and risk factors influenced development of cerebrovascular diseases as follows: 50.40% of patients had hypertension, 16.54% diabetes mellitus, 48.82% smoking cigarettes, 40.94% obesity, 20.47% alcohol abuse, 11.02% migraine-like headaches, 30.71% cardiovascular diseases and 22.05% hyperlipidemias.

Conclusion

Cerebrovascular diseases are increasing in developing countries. The main reason is poor control of risk factors. In the majority of cases it is possible to produce decrease of frequency of cerebrovascular diseases by elimination and reduction of risk factors through the change of life style. Pre-hospital urgent concept of therapy and improving of organization of emergency service will contribute to decreasing mortality and morbidity of cerebrovascular diseases.
(P1-7) Disasters and Implications for Changes in Vulnerability: A Case Study of Vavaniya Village Affected by the 2001 Gujarat Earthquake
Authors: Saroha R.
Published: May 2011

Disasters tend to exacerbate and bring to surface the socio-economic, political, environmental vulnerabilities of the different sections of a community and thus, are seen as opportunities for reduction of vulnerability. In a post-disaster recovery program, organizations often come together in an effort to create safe conditions, reduce pressures and address root causes. These programs, at times, may further strengthen the existing vulnerabilities, thereby making some groups of the community better off than the others. Vulnerability is a dynamic process and no individual is completely vulnerable or resilient. Root causes, dynamic pressures and unsafe conditions also change with time and depends on the context of analysis. This study examines changes in vulnerability after intervention by organizations using a case study of one of the villages affected by the 2001 Gujarat Earthquake. The case study of the village gives an insight into the intra-societal vulnerabilities and how these vulnerabilities change with time. The study is qualitative in nature and has used purposive sampling technique to collect data. Data analysis was done using inductive coding methods. The study is of practical significance for the local authorities to understand peoples' perception of their vulnerabilities and ways to decrease them. It also adds to the body of knowledge by understanding vulnerability and resilience as social processes and offer lessons for future recovery processes.
(P1-9) Multinational Disaster Response Exercise: Critical Look and Lessons Learned
Authors: Norii T. , Terasaka Y. , Miura M. , Nishinaka T. , Lueken R. , Sasaki H. , Alseidi A.
Published: May 2011

Introduction

International collaboration for disaster response is an increasing phenomenon. Japan-United States joint field exercises have been conducted annually since 2004, triggered by an incident in which a US helicopter crashed into a university campus in Okinawa, Japan. The fifth Japan-US disaster field exercise was conducted testing the disaster response of the Okinawa government and US military.

Methods

The simulated exercise involved a US Navy aircraft that crashed into a city center in Okinawa, Japan. There were 16 simulated casualties that included US military members and Japanese citizens. The participants in this exercise were US military members, including the Disaster Assistance Response Team (DART) and local rescue and medical teams including the Okinawa Disaster Medical Assistance Team (DMAT). Data were gathered from the joint debriefing session held by both medical teams. Furthermore, interviews with team leaders from both nations were conducted and feedback obtained.

Results

Lack of communication and inaccurate communication remained the root of most problems encountered. There were several miscommunications at the scene due to the language barrier and ignorance of different medical teams' capability and method of practice. Due to the unclear signage of the initial triage zone, another triage zone was developed later by a second medical team. Confusion regarding gathering information and order of transport also was witnessed. The capabilities of team members were not well known between teams, resulting in inappropriate expectations and difficulty in effective cooperation.

Conclusions

Understanding the systems and backgrounds of each medical team is essential. Signs or symbols of key elements including triage areas should be clear, universal, and multilingual. Communication remains the Achilles' heel of multi-national disaster response activities.
(P1-10) Post-Deployment Survey of Korean Disaster Relief Team Medical Team Members after the Earthquake in Haiti
Authors: Kim H. , Ahn M.E. , Oh B.J. , Kim K.H. , Shin D.W. , Hong E.
Published: May 2011

Introduction

The Korean Disaster Relief Team (KDRT) medical team, mainly composed of graduates from first government certified international disaster support education course, deployed to Haiti after the earthquake in January 2010, and operated a medical relief mission. The present study was designed to evaluate the KDRT medical team mission in Haiti.

Methods

Data were collected via an anonymous questionnaire that was distributed one day after the completion of the mission in Haiti. Questionnaires were composed of four categories.

Results

The response rate for this survey was 72% (18/25). The KDRT members were relatively young, with 72% of personnel.
(P1-12) Had the Times Square Bomb Exploded: What about the Injured Children?
Authors: Conway E. , Flamm A. , Foltin G. , Cooper A. , Greenwald B.M. , Biagas K. , Sagy M. , Hojsak J. , Abularrage J. , Shah V. , Ushay M. , Uraneck K. , Gonzalez D. , Treiber M. , Goldfeder M. , Tunik M. , Frogel M.
Published: May 2011

Introduction

Children frequently are the victims of disasters due to natural hazards or terrorist attacks. However, there is a lack of specific pediatric emergency preparedness planning worldwide. To address these gaps, the federal grant-funded New York City Pediatric Disaster Coalition (PDC) established guidelines for creating Pediatric Critical care (PCC) surge plans and assisted hospitals in creating their plans. To date, five hospitals completed plans, thereby adding 92 beds to surge capacity. On 01 May 2010, 18:00h, there was an attempt to detonate a car bomb in Times Square, a large urban attraction in the heart of New York City. The perpetrator was later convicted of the attempted use of a weapon of mass destruction. Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.

Methods

The unit director or a senior attending of nine major hospitals in the NYC area (five in close proximity and four at secondary sites) were surveyed for the number of their vacant pediatric critical care beds at the time of the event before activation of surge plans.

Results

At the time the car bomb was discovered, the nine hospitals, which have a total of 141 PCC beds, had only 29 vacant approved pediatric critical care beds.

Conclusions

Had the event resulted in many pediatric casualties, the existing PCC vacant beds at these hospitals may not have satisfied the need. Activating surge plans at five of these hospitals would have added 92 to the 29 available PCC beds for a total of 121. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans.
(P1-24) Future Weapons of Mass Destruction: Preparing For Emerging Threats
Authors: Mcisaac J.
Published: May 2011

Introduction

Civilian Weapons of Mass Destruction (WMD) training involves preparing for threats well-known to the military since World War II. Present and future developments in Chemical-Biological (CB) research have resulted in new potential agents, modes of action, and methods of delivery. Chemical-Biological defense training should include these new agents and anticipate contact with previously unknown ones. The natural response to an unknown threat is fear and panic, out of proportion to the actual threat. Specific training in management of new pathogens and toxidromes should be incorporated into existing preparedness regimes. Leadership skills that address uncertainty and inspire constructive responses will increase resiliency.

Methods

Literature Review

Results

Recent and Future CB Agents: (1) 4th Generation AchE inhibitors: Novichoks, Substance 33, etc.; (2) Genetically enhanced bacteria and engineered chimeric diseases; (3) Modified viral diseases: Variola, Influenza, filoviruses, flaviviruses, arenaviruses; (4) Bacteriophage induced diseases; (5) Agents targeting specific racial or genetic groups; (6) Mid-spectrum agents; (6) Bioregulators: Substance P, vasopressin, enkephalin, etc.; (7) Novel toxins: tetrodotoxin, SEB, saxitoxin, etc.; (8) Hallucinogens and incapacitants (LSD, DMT, carfentanyl, cis-fluoro-ohmefentanyl); (9) Prions and infectious nucleic acids Delivery: (1) New delivery methods: micro- and nano-robots modeled on insects (MEMS systems), microencapsulation; (2) Directed Energy Weapons Mitigation: (1) Development of systems for identifying and dealing with unknown agents and symptoms; (2) Hazard Identification, Risk Estimation, Risk Reduction Strategies, Residual Risk Evaluation and Monitoring, Mitigation and Recovery Leadership skills needed during uncertainty: Sense making, Visioning, Relating, Inventing.

Conclusions

Preparing for events without training for new and novel CB agents leaves us unprepared. Incorporating modern science with leadership skills will lessen the impact of future CB release and improve organizational resiliency. The main mistake people make is that they fear current problems more than future ones. Carl von Clausewitz Chance favors the prepared mind. Louis Pasteur.
(P1-25) Risk Management in Emergency Situations: Does Germ Simulation Improve the Level of Care?
Authors: Lee B.D. , Lee B.
Published: May 2011

Simulation is a major part of the training process for emergency medical professionals. The scenery, sounds, smells, situations, etc. all have been replicated for the benefit of the student. These simulation factors prepare the student to react according to the trainings they received in a controlled environment, but what about germ simulation? The premise of this research is to determine if the outcome of treatment changes when germ simulation is added as a factor. The majority of emergency medical simulations do not factor germs into the situation, and potentially leave the emergency responders exposed, which causes liability, complications, side effects, etc. Generally, the current standards for care and certification include lessons on blood-borne pathogens, disease prevention, personal protective equipment, etc., but there still is a shortcoming between the classroom lessons and a real situation. This research helps answer the following questions: What is the simulation method that can best replicate a real situation? How much potential disease exposure can an emergency medical responder expect? Does the level of treatment increase with the introduction of a germ simulation? What behavior changes occur when germs become a main factor in a simulation? The goal of this research and presentation is to find out if the amount of risk can be reduced with more comprehensive simulations. Ultimately, researchers hope to diminish the risk of disease and illness spreading among responders and at the same time increase the level of care among disaster victims.
(P1-30) Natural Disasters Challenge for Emergency and Rescue Services - Lessons Learned
Authors: Gula P.W. , Szafran E.M.
Published: May 2011

Natural disasters challenge for Emergency and Rescue Services- lessons learned Przemyslaw Gula MD PhD, Edyta Szafran Institute for Emergency Medicine. Krakow, Poland.

In the period 2008–2010 Poland experienced series of natural disasters including 3 large scales flooding, 2 periods of extremely high snowfalls followed by low temperature periods and finally local flush flooding in different locations. The time of each disaster elapsed from several days up to 6 weeks. All of them had severe impact on local infrastructure by destroying road systems, communication as well as healthcare and fire brigade facilities. The rescue efforts required evacuation, Search and Rescue operations, providing medical care and shelter. The most problems occurred in following areas: - large scale evacuation - collapse of communication systems (including 112 dispatch) - inadequate number of specialized rescue equipment (helicopters, vehicles, boats, snowmobiles, etc.) - providing EMS in affected areas - necessity of evacuating hospitals. The lessons learned showed the need for following changes: - strong trans regional coordination in means of facilitation of utilizing civil protection and military recourses - unification of operative procedures for all actors of the response operation - improvement of communication systems and reducing their vulnerability on environmental factors - establishing regional crisis management and control centers, covering the emergency response activities in affected areas - need of large-scale use of HEMS as well as Police and military helicopters in natural disasters - need for better supply in specialized rescue equipment including recue motorboats, 4 wheels drive recue vehicles and ambulances, snowmobiles, quads in local response units. The main rule of commanding the entire operation is subsidiary. Local coordinating structures should be supported by regional and central governments by supplying necessary recourses. However the operational command should be unified and include all participating units and organizations.
(P1-33) Psychological Stress and Effect of War on Education and Educator
Authors: Reha A.
Published: May 2011

Background

A well sounded education in a peaceful environment is a stepping stone to a good future of a society. Therefore, we can say the foundation and potentiality of economic and socioeconomic of any country is well defined by this.

Discussion

Not everyone receives the reward of education that plays a vital part in their lives. The main reasons as to why this is the case, Is due to the environment the person/individual lives in. For example, when a child is living in conflict and poverty as a major crisis the need for education will be ignored. Children in war torn countries such as Afghanistan where children are constantly under physical and psychological stress due to their schools being destroyed by bombardment and also the killing of their educators. Furthermore, children in war torn countries have a high risk of concern for a pointless education as they don't get a chance to attend school regularly, but they will dapper with educational stress. In this situation all the educators and their students will be whirling in the storms and floods of psychological stress. Education is very emotional and traumatic as it is in Afghanistan, where they suffered through the unfair interference of outsiders in their home country as the Russian did by the name of democracy in 1979–1998. Unfortunately, following 09/11 a new time has set with a new kind of invasion which is going on. We now observe more tragic situation which again external powers are injecting their culture and foreign bodies in Afghanistan. It's obviously drying out the water of our culture.

Conclusions

Where the Culture itself is one of the most important and valuable aspect of life it is a tower of education. Without culture, education would never have been built and so never could be improved.
(P1-35) Adapting a Humanitarian Organization for Disaster Response, Operation Smile in Haiti, 2010
Authors: Zoraster R. , Beers M. , Crabtree T.
Published: May 2011

Background

Operation Smile International (OSI) is a Non-Government Organization (NGO) with experience providing surgical care throughout the world. OSI has vast logistical capacity, skilled and credential providers, and international relationships. Disaster response had been considered by OSI in the past, but never initiated. However, the magnitude of the Haiti disaster, coupled with request from Haitian OS Partners led to the initial disaster response of the OSI organization.

Discussion and Observations

This presentation will: (1) Describe the considerations and rationale that led OSI to this intervention. (2) Discuss the process of developing a disaster response within a relatively short period of time. (3) The response itself, and (4) Present how the lessons learned will be adapted to future OSI capacity and planning.
(P1-37) Over and Undertriage in Simulation Exercises
Authors: Styrwoldt E.
Published: May 2011

Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.

Material and Method

76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.

Results

Of the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.

Conclusions

Triage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.
(P1-38) Emergency Department Preparedness for Training Management Plan towards Mass Casualty Incidents
Authors: Chan W.L.
Published: May 2011

It is important to equip emergency department (ED) staff with skills to manage mass casualty incidents (MCI) as disasters strike without warning. Our hospital, Tan Tock Seng Hospital, has been the national screening centre for severe acute respiratory distress syndrome (SARS) and H1N1 outbreaks in 2003 and 2009. Furthermore, our ED has managed casualties from mass food poisoning in the community. We would like to share our experiences in training our staff for MCI. For the ED to operate smoothly in a MCI, comprehensive training of staff during “peace” time is essential. We have a selected team of doctors and nurses as the department disaster workgroup. This team, together with the hospital emergency planning department, prepare the disaster protocols using an “all hazard approach concept” and aim to minimise variations between different protocols (Conventional, Infectious disease, Hazmat, Radioactive MCI). These protocols are updated regularly, with new information disseminated to all staff. Next, all staff must be well-versed in the protocols. New staffs undergo orientation programmes to familiarize them with the work processes. Regular audits are conducted to ensure that the quality is well-maintained. Additionally, training also occurs at the inter-departmental and national levels. There are regular activation exercises to test inter-departmental response to MCI and collaborations with Ministry of Health to conduct disaster exercises e.g. the biennial Kingfisher Exercise in preparation for radiation-related MCI. Such exercises improve communication and working relationships within the ED and with other departments. The camaraderie developed can act as a pillar of support during stressful times of MCI. Lastly, the ED staffs attend local and international courses and conferences to update ourselves on the latest training and knowledge in the handling of MCI. This allows us to share our ideas and to learn from our local and international counterparts, and helps better prepare ourselves.
(P1-46) A Model of Mass Casualty Management Education: The Prehospital Mass Casualty Exercise and Trauma Management Course
Authors: Eryilmaz M. , Durusu M. , Tuncer S.K. , Bayir A. , Arziman I. , Eyi Y.E.
Published: May 2011

Introduction

In this article, we aimed to share “the prehospital mass casualty exercise and trauma management course” which is performed at the 10th European Congress of Trauma & Emergency Surgery as a model.

Methods and Materials

The preparation, format, participant properties and the discussion of the course were evaluated.

Results

The course performed in 4 parts. On the first part, a panel discussion including opening, targets of course and a conference was performed. On the second part, the prehospital mass casualty exercise was performed. On the third part, the participants discussed in different 4 workshops. On the last part, basic discussion results were declared. At the mass casualty exercise, the scenario was adapted from bus bombing which was in Diyarbakir on 03.01.2010, 6 deaths, 96 wounded. Field and injury simulations were performed. We trained 15 paramedic volunteers to act as wounded patients. Moulage and make-ups were made due to previously defined injuries as in Diyarbakir. The victims were placed in simulated maneuvers field. Participants were accepted in five each groups to the maneuvers field and they were requested to manage the scene, triage, first aid. After the exercise, 4 workshops themed as Scene Medical Management, Ground and Air Evacuations, Preparedness of the E D's and Preparedness of the OR's, and ICU's were performed. The results of the workshops were presented at the last part.

Discussion and Conclusion

The participants expressed that observing and experiencing the chaos circumstances during the maneuvers are the most important things in scene management and these must be considered in preparedness and planning phases.
(P1-47) Disaster Medicine and the Philosophy
Authors: Haraguchi Y.
Published: May 2011

There are many problems, to be solved in the actual fields of disaster medicine. That is the reason why we completed the disaster medicine compendium, 2005. As the next stage, we focused upon the significance of the philosophy from the viewpoint of the disaster medicine.

Results

In the disaster situation, leaders are obliged to determine the policies under the mental/ sophisticated consideration. Basically, the following famous phrase “the greatest good (happiness) for the greatest number of people” are accepted simply/childishly without profound thought. This phrase is presented by the popular concept of Utilitarianism beggined by Jeremy Bentham, followed by John Stuart Mill, etc. This concept strongly influenced in the field of disaster medicine, especially the decision making of triage. However, several argument or criticisms have been pointed out: i.e., definition of happiness, relief of the minority or so-called CWAP, etc. Other opinions are included, as follows: John Rawls: The Principle of Justice or Maximin Principle, Kan Naoto: Minimal unhappiness/misery in the society/people, etc.

Conclusions

I basically appreciate the concept utilitarianism. But, especially, if we consider the CWAP or people in the poor countries under the actual unfavorable condition, the latter concepts should also be included.
(P1-52) Educational Program of Disaster Preparedness in the Earthquake Prone Area, Mie, Japan
Authors: Takeda T.
Published: May 2011

Background

Major earthquakes with a magnitude of 7-8 are anticipated to occur in the next 30 years at a 60 percent chance on the southern coast of Mie, Japan. Since the most part of the Mie Prefecture, Japan, is likely to be damaged by tsunami and landslides, residents are expected to take self-reliant approach on the initial several days after the earthquake.

Aim

Developing disaster support system in including community based medical disaster preparedness in the region.

Methods

We have been providing knowledge and techniques to cope with the earthquake cooperated with experts of earthquake engineering. Basic and advanced life support educational programs for acute illness and trauma that may occur in earthquake and/or tsunami as well as during the evacuation and sheltering have been developed for public, local medical associations and the main hospital in the region. Moreover, we have started a new community continuous educational course to promote the public disaster preparedness. We teach introduction of emergency and disaster medicine to enhance knowledge of natural and social science on disaster preparedness.

Results

Local residents including public and medical personnel started to acquire a general idea of disaster and emergency medicine. The educational programs seemed to motivate local residents and healthcare professions.
(P1-75) Medical Measurement against Disaster — From the Viewpoint of “Disaster Medicine Compendium”
Authors: Haraguchi Y.
Published: May 2011

The world must be resilient against major disasters, whether they are caused by natural hazards or human-related mechanisms. Nowadays, outbreaks of emerging infectious diseases, such as new strains of influenza, are a world wide problem. Special consideration is necessary against chemical, biological, radiological, or nuclear (CBRN) hazards.

Results

The hardware/mechanical preparedness, measurements of the severe influence in mental/psychological aspects, official public system, incident command system, public education system, and the needs of vulnerable populations should be established prior to a disaster. It is also important to prepare the necessary medical resources. The technical skills needed for triage, emergency care, and appropriate transportation should be trained for.

Discussion and Conclusion

Measures should be prepared both from the macroscopic viewpoint as well as microscopic approach. A “Disaster Medicine Compendium” consisting of 20 volumes with more than 5,000 pages, was developed in 2005. Currently, a new version is being prepared.
(P1-78) Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital Pediatric Critical Care Surge Plans
Authors: Flamm A. , Foltin G. , Uraneck K. , Cooper A. , Greenwald B.M. , Conway E. , Biagas K. , Sagy M. , Frogel M.
Published: May 2011

Purpose

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.

Methods

Members of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.

Results

New York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.

Conclusions

Providing surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.
(P1-82) Implementation of an Active Vaccination Strategy Increased the Pandemic Influenza A (H1N1) 2009 Vaccine Coverage among Swedish Children
Authors: Omberg M.
Published: May 2011

Introduction

The European Center for Disease Control and Prevention (ECDC) identified young children as a group at higher risk of developing severe pandemic influenza A (H1N1) 2009 infection compared with the general population. Since children have high attack rates and seem essential in augmenting local outbreaks of influenza, vaccination of children was an important objective in the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign. Children < 13 years of age were recommended to take two doses of the pandemic vaccine (Pandemrix®).

Objective

The objective of this study was to compare the vaccination coverage among children 1–12 years of age in different councils in the County of Jämtland, Sweden that either implemented an active advocating or a passive vaccination strategy. The active strategy included direct information to parents promoting vaccination, individual appointments, collaboration between different care providers, and visits of vaccination teams to day care centers and schools, whereas no specific measures, except general information in press and media, were undertaken in councils using a passive approach.

Methods

All pandemic vaccinations in the County of Jämtland were registered in a Web-based registration software system. Vaccine coverage was determined by comparing the actual number of children residing in different councils with the number of vaccinated children.

Results

A total of 4,162 of 6,000 children (69.3%) residing in councils using an active vaccination strategy were vaccinated compared with 5,059 of 9,373 children (53.9%) living in councils using a passive vaccination strategy (p < 0.0001)

Conclusions

Implementation of an active advocating vaccination strategy during the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign resulted in a significantly higher vaccination coverage rate compared with a passive vaccination strategy.