bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Evidence to Encourage Inclusive School Development: Possibilities and Challenges
Authors: Ainscow Mel , Kaplan Ian
Published: May 2019

Recent research suggests that inquiry‐based approaches can be powerful in stimulating the development of inclusive practices. However, the implementation of such approaches can be difficult, particularly in contexts where there is a strong emphasis on improving standards, as measured by test and examination scores. This article describes and reflects on the authors’ experiences in working with staff in an English secondary school. It illustrates how the use of evidence, particularly the views of students themselves, can be a powerful lever for change. The paper argues that the successful use of such approaches will depend on forms of leadership that foster a willingness to address the challenges that emerge as a result of listening to the voices of different people.
Sustaining an Inclusive Approach to Schooling in a Middle School Location
Authors: Forlin Chris , Bamford Garry
Published: May 2019

In Western Australia (WA), similar to practices elsewhere, there has been a strong focus on the need for schools to reconsider their practices to increase opportunities for more equitable and inclusive access for all children. Subsequent to a major review of service provision for students with disabilities in WA (Department of Education and Training, 2004), a Building Inclusive Schools initiative is being implemented in all Government schools (Department of Education and Training, 2003). This paper explores how, following a trial inclusive program, one middle school is utilizing this initiative to further its own inclusive practices. To support this review a collaborative partnership has been established between the school and a university to provide an avenue for deliberate reflection on the processes employed to develop the school’s vision of Education For All by Incorporating Diversity. A model on sustaining education for all is identified and the impact of government directives is investigated. Consideration is given to the likely impact on the school of systemic procedures being developed to support the progress of the Building Inclusive Schools initiative.
Recommendations for the use of palivizumab as prophylaxis against respiratory syncytial virus in infants with congenital cardiac disease
Authors: Tulloh Robert , Marsh Michael , Blackburn Michael , Casey Frank , Lenney Warren , Weller Peter , Keeton Barry R.
Published: May 2019

New data are emerging on the use of palivizumab as prophylaxis against infection with the respiratory syncytial virus in infants with congenital cardiac disease. Following a 4-year multicentre randomised trial, it was shown that prophylactic injections with palivizumab were effective and safe for such children. Prophylaxis consists of 5, monthly, intramuscular injections of palivizumab, at a dose of 15 mg/kg, given during the season for infection with the respiratory syncytial virus. Timing is at the discretion of the physician, depending on the onset of the season locally. It is suggested that, in the United Kingdom, this should be commenced in mid-September. To help clinicians to identify appropriate candidates for palivizumab, a working group of the British Paediatric Cardiac Association has developed recommendations.

Infants, namely those under 1 year old, with congenital cardiac disease likely to benefit from prophylaxis include those with haemodynamically significant lesions, particularly increased pulmonary blood flow with or without cyanosis; pulmonary venous congestion, pulmonary hypertension or long-term pulmonary complications, residual haemodynamic abnormalities following medical or surgical intervention (patients who have undergone cardiopulmonary bypass should receive an injection as soon as they are medically stable), cardiomyopathy requiring treatment, and congenital cardiac disease likely to need hospital admission for medical or surgical intervention during the season of infection with the virus. Prophylaxis with palivizumab may also be indicated, at the discretion of the physician, in some children with complex cardiac disease over the age of 1 year. Children less likely to benefit from prophylaxis are those with haemodynamically insignificant disease, or those with lesions adequately corrected by medical or surgical intervention.
Complex congenital cardiac disease in a patient with partial trisomy for the long arms of chromosomes 11 and 22
Authors: Chetcuti-Ganado Claudia , Grech Victor
Published: May 2019

Abnormalities of chromosomes 11 and 22 are associated with congenital cardiac disease and/or various syndromes. We present a patient with partial trisomy for the long arms of chromosomes 11 and 22, the result of a maternal balanced reciprocal translocation between these two chromosomes. Our patient was dysmorphic and had coarctation of the aorta, an atrioventricular septal defect with common atrioventricular junction and exclusively atrial shunting, patency of the arterial duct, supracardiac totally anomalous pulmonary venous connection, a single kidney, and tracheobronchomalacia. This patient is unusual in having extensive left-sided cardiac involvement, a feature not usually found in this condition.
Advanced atrioventricular conduction block in acute rheumatic fever
Authors: Zalzstein Eli , Maor Rachel , Zucker Nili , Katz Amos
Published: May 2019

We carried out a retrospective case control analysis to evaluate the outcome, and the need for treatment, of problems with atrioventricular conduction occurring during an acute attack of rheumatic fever, assessing the occurrence of second and third atrioventricular block versus first degree block.

We reviewed and analysed the clinical, electrocardiographic and echocardiographic records of all children diagnosed in a single institute as having acute rheumatic fever during a period of seven consecutive years.

During the period from October, 1994, through October, 2001, 65 children meeting the modified Jones criterions for acute rheumatic fever were hospitalized in the Soroka University Medical Center, Israel. First-degree atrioventricular block was identified in 72.3% of the children, and resolved with no specific treatment other than non-steroidal anti-inflammatory medications. Second-degree atrioventricular block of Mobitz type I, was observed in one child (1.5%), which progressed from first-degree block, and subsequently resolved. Complete atrioventricuar block was found in 3 children (4.6%), one progressing from Mobitz type I second-degree block, and two being seen as the first presentation. Of the three children with complete atrioventricular block, one patient was not treated, the second was treated with aspirin, and the final one with combined aspirin and steroids. The disturbances of conduction resolved in all three.

We conclude that advanced atrioventricular block is rare during acute rheumatic fever. If occurring, block appears to be temporary, and resolves with conventional anti-inflammatory treatment. Specific treatment, such as insertion of a temporary pacemaker, should be considered only when syncope or clinical symptoms persist.
The implications of common brachiocephalic trunk on associated congenital cardiovascular defects and their management
Authors: Moskowitz William B. , Topaz On
Published: May 2019

A common brachiocephalic trunk is an anatomic variant in which both common carotid arteries and the right subclavian artery arise from the aortic arch via a single trunk. The impact of this condition on associated congenital cardiac malformations is presently unknown. Out of a total of 1480 cardiac catheterizations performed in children over a period of 10 years, we discovered 48 patients (3.2%) to have a common brachiocephalic trunk, of whom 98% had associated congenital cardiac malformations. A spectrum of associated lesions was identified, including left-to-right shunts in 19 patients, right-sided anomalies in 18 patients, left-sided obstructive lesions in 12 patients, and coronary arterial abnormalities in 10 patients, eight of whom had other cardiac defects. Genetic syndromes were present in one-fifth of the cases. When found with left-sided malformations, the common trunk was associated with persistent hypoplasia of the aortic arch, likely related to diminished flow through the arch during development. In each of four patients in whom the brachiocephalic trunk had been used during construction of a palliative shunt, we observed inadequate growth and deformation of the pulmonary arteries. Thus, angiographic identification of a common brachiocephalic trunk may be a marker for the presence of accompanying congenital cardiac defects and coronary arterial abnormalities. Understanding the pathophysiologic effects of the common trunk is important when planning the palliative or corrective procedures, and when assessing the potential benefit of the surgical repair over the long term.
Midaxillary lateral thoracotomy for closure of atrial septal defects in pre-pubescent female children: reappraisal of an “old technique”
Authors: Schreiber Christian , Bleiziffer Sabine , Lange Rüdiger
Published: May 2019

Our long-term follow-up has revealed that symmetrical development of the breasts is significantly impaired in pre-pubescent female patients subsequent to an anterolateral thoracotomy. Although standard posterolateral and anterolateral right-sided thoracotomies are used for correction of “simple” cardiac lesions such as patency of the arterial duct, coarctation of the aorta, or atrial septal defect, the required partial transection of large muscle groups, and injury to the developing tissues of the breast, may contribute to an unfavourable cosmetic outcome. Over the years, many surgeons, mostly specialising in thoracic procedures, have advocated mini- or axillary thoracotomies. In an attempt to improve surgical and cosmetic outcome, we have now adopted such a muscle-sparing approach, using a small horizontal midaxillary incision. We have now successfully employed the technique to close atrial septal defects in the oval fossa in 17 pre-pubescent females.
Haemoptysis in a patient with tetralogy of Fallot: a combined surgical and interventional approach
Authors: Budts W. , Moons P. , Gewillig M.
Published: May 2019

Haemoptysis may occur in patients with tetralogy of Fallot and major aorto-pulmonary collateral arteries. We describe such a patient in whom bleeding from a major aorto-pulmonary collateral artery produced severe pulmonary haemorrhage. Interventional closure of the artery could not be performed because it perfused the native pulmonary arteries. Instead, we inserted a conduit between the right ventricle and the native pulmonary arteries, followed by percutaneous closure of the collateral artery. Our patient demonstrates the increasing necessity for combined surgical and interventional procedures.
Resurgence of Vector-Borne and Vaccine-Preventable Diseases in Venezuela in Times of a Complex Humanitarian Health Crisis: A Regional Menace
Authors: Tami Adriana , Grillet Maria Eugenia , Paniz-Mondolfi Alberto , Oletta José , Llewellyn Martin S , Hernández-Villena Juan V , Márquez Marilianna ,   on behalf of the working group on emerging and re-emerging diseases in Venezuela
Published: May 2019

Introduction:

Venezuela has plunged into a humanitarian, economic, and health crisis of extraordinary proportions. This complex situation is derived from dismantling of structures at the institutional, legal, political, social, and economic level affecting the life and wellbeing of the entire population.

Aim:

This study aims to assess the impact of Venezuela’s healthcare crisis on vector-borne and vaccine-preventable diseases and the spillover to neighboring countries.

Methods:

Since October 2014, there is a paucity of official epidemiological information in Venezuela. An active search of published and unpublished data was performed. Venezuela and Latin America data were sourced from PAHO Malaria Surveillance and from Observatorio Venezolano de la Salud. Brazil and Colombian data were accessed via their respective Ministries of Health.

Results:

Economic and political mismanagement have precipitated a general collapse of Venezuela’s health system with hyperinflation rates above 45,000%, people impoverishment, and long-term shortages of essential medicines and medical supplies. In this context, the rapid resurgence of previously well-controlled diseases, such as vaccine-preventable (measles, diphtheria) and arthropod-borne (malaria, dengue) diseases has turned them into epidemics of unprecedented magnitudes. Between 2000-2015 Venezuela witnessed a 365% increase in malaria cases followed by a 68% increase (319,765 cases) in late 2017. The latest figures have surpassed 600,000 malaria cases with a prediction to reach 1 million by the end of 2018. Measles and diphtheria have recently re-emerged after a progressive interruption of the national immunization program, with vulnerable indigenous population being particularly affected. In response to Venezuela’s rapidly decaying situation, a massive population exodus is ongoing towards neighboring countries causing a spillover of diseases.

Discussion:

Action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. Global and hemispheric health authorities should urge the Venezuelan government to allow establishing a humanitarian channel to bring relief.
Training Emergency Department Charge Nurses Through Tabletop Exercises
Authors: Weeks Beth
Published: May 2019

Introduction:

In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.

Aim:

To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.

Methods:

A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.

Results:

ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.

Discussion:

Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.
Use of Moulage in Multi-Disciplinary Mass Casualty Incident (MCI) Training: Cost-Effective Tool or an Expectation?
Authors: Rihter Sasha , Coppersmith Veronica
Published: May 2019

Introduction:

A 2018 poll by the American College of Emergency Physicians shows 93% of surveyed doctors believe their emergency department is not fully prepared for patient surge capacity in the event of a natural or man-made disaster. While an emergency disaster plan is activated during any incident where resources are overwhelmed, many US emergency physicians today think of a mass casualty incident (MCI) as the inciting event. To better prepare our communities, an MCI simulation took place in Chicago 2018 with participation from local and federal representatives. Included were Chicago fire, police, and emergency medical services agencies, emergency medicine physicians, resident participants, and medical student volunteer victims.

Aim:

The study’s aim was to determine whether resource intensive moulage was an expected component or a beneficial adjunct, if moulage-based training would improve physician preparedness, and if such a training would increase the likelihood of future involvement in local disaster preparations. Analysis was performed on pre- and post-training surveys completed by participants. By reviewing the benefits versus cost, future MCI simulation planners can efficiently use their funds to achieve training goals.

Methods:

Thirty-two emergency medicine physicians were surveyed before and after a five-hour training session on October 20, 2018, which included 89 moulage victims. Twenty-four after-event surveys were completed. All completed surveys were utilized in data analysis.

Results:

Of polled participants, a 68% improvement in general preparedness was achieved. While only 19% of participants cited current involvement in their facility’s disaster planning in pre-event survey, the likelihood of involvement after training was 8.2/10. Overall, the importance of moulage an essential component to such trainings remained constant.

Discussion:

Moulage is an expected and crucial element to MCI training and should be incorporated as extensively as resources allow. MCI trainings improve physician preparedness and potentially increase physician involvement in disaster planning at home institutions.
Reviewing Disasters: Hospital Evacuations in the United States from 2000 to 2017
Authors: Sharma Aishwarya , Mace Sharon
Published: May 2019

Introduction:

Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.

Aim:

The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.

Methods:

Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.

Results:

There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.

Discussion:

Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.
Beyond EMT 2 Minimum Standards
Authors: Stephens Dianne , Thomas Jane
Published: May 2019

Introduction:

The World Health Organization’s (WHO) minimum standards are used to verify Emergency Medical Teams (EMTs) internationally. The National Critical Care and Trauma Response Center (NCCTRC) was one of the first few EMT 2 verified teams globally.

Aim:

The NCCTRC aims to innovate and provide leadership in the provision of best practice clinical care in the EMT 2 setting in disaster-affected countries.

Methods:

The NCCTRC developed a clinical governance framework and committee with a view of improving practice in the deployed environment. A gap analysis against the Australian National Standards was done and a decision was made to proceed with accreditation against the ACHS EQUIP 6 framework.

Results:

The process of accreditation required a self-assessment that identified gaps in our guidelines and care processes thereby leading to innovative projects to meet the criterion in a sustainable way for the deployed field hospital environment. The NCCTRC has developed adapted clinical tools to manage pressure injury, falls risk, handover, hand hygiene, audits, and consumer feedback.

Discussion:

The deployed field hospital environment can meet national accreditation standards for clinical care. The WHO minimum standards were introduced in 2013 and serve as a marker of the minimum requirements in the field. The challenge is to do better than the minimum. This study demonstrated that it is possible to adapt hospital accreditation standards to the field environment and provide a higher, safer quality of care to affected populations. EMT teams should maintain their clinical care standards from their home environment wherever possible in the field hospital environment. Striving to provide the best and safest care is the duty of care for vulnerable populations.
Development of a Mobile Laboratory for Sudden Onset Disasters
Authors: Marr Ian , Stephens Dianne , Baird Rob , Francis Josh , Read David , Coatsworth Nicholas
Published: May 2019

Introduction:

Clinical diagnostics in sudden-onset disasters (SOD) has historically been limited. With poor supply routes, lack of a cold chain, and challenging environmental conditions, many diagnostic platforms are unsuitable.

Aim:

We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type II emergency medical team (EMT) field hospital.

Methods:

Available diagnostic platforms were reviewed and selected against infield need. Platforms included HemoCue301/WBC DIFF, i-STAT, BioFire multiplex RT-PCR, Olympus BX53 microscopy, ABO/Rh Grouping, and specific rapid diagnostic tests (RDT). This equipment was trialed in Katherine, Australia and Dili, Timor-Leste.

Results:

During the initial deployment, validation of FilmArray rt-PCR multiplex tests was successful on blood culture, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) haemoglobin values were compared on Sysmex XN 550 (r = 0.94). Analysis of HemoCue WBC DIFF samples had some variation when compared to Sysmex XN 550, (neutrophils r = 0.88, lymphocytes r = 0.49, monocytes r = 0.16, eosinophils r = 0.70, basophils r = 0.16). i-STAT showed non-significant differences for CHEM4 (n=10), CG8 (n = 10), and TnI (n = 5) against Vitros 250. A further trial of BioFire rt-PCR testing in Dili, Timor-Leste diagnosed 117 causative pathogens on 168 FilmArray test cartridges.

Discussion:

This mobile laboratory represents a major advance in SOD. Setup of the service was quick (<24hr) and transport to site rapidly. Training was simple and performance consistent. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostics.
The Evaluation of the World Health Organization’s Minimum Dataset in Disaster Health Management in the Association of Southeast Asian Nations
Authors: Limpaporn Sansana , Silapunt Phumin , Wuthisuthimethawee Prasit
Published: May 2019

Introduction:

The Minimum Data Set (MDS) developed by the World Health Organization (WHO) has been widely used among medical practitioners in International Emergency Medical Team (I-EMT) as tools to collect health information and statistics in disaster health management. The I-EMT submits MDS to the Emergency Medical Team Coordination Cell (EMTCC) for the planning of responses. The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the ASEAN’s project that has applied MDS to its activities with the main purpose of strengthening informational management during a disaster.

Aim:

The study aims to evaluate the performance of MDS after being utilized in the Regional Collaboration Drill (RCD) organized by the ARCH Project in July 2017.

Methods:

The performance of MDS has been evaluated by ten International Emergency Medical Team (I-EMT) of ASEAN Member States who participated in the RCD.

Results:

The assessment forms were returned by ten I-EMTs, and all respondents addressed several points for the revision of MDS (10/10), including the format and the content of the MDS. Concerning the format, respondents stated that the fonts are too small (3/10), and spaces for recording additional information are needed (3/10). On the other hand, the majority of respondents suggested that some of the contents within the MDS are still unclear or some terminologies are needed to be further clarified (6/10), especially with the referral form (5/10).

Discussion:

The current version of the MDS utilized for the EMT coordination should be edited and revised for its optimal usage. Applying MDS to disaster simulation is an efficient approach to test its application.
International Humanitarian Law and Review of Recurrent Violations Including Chemical Weapons Use
Authors: Atti Sukhshant , Arquilla Bonnie
Published: May 2019

Introduction:

The basis of International Humanitarian Law (IHL) is the Theory of Natural Law, which states that the laws of morality and the ability to use reason in the determination of inalienable human rights, are innate to humans, and cannot be taken away by any states or laws. IHL is an agreement among nation-states that applies to situations of conflict to protect civilians and guides conduct in time of war. IHL extends protection to civilian medical personnel. The recent escalation in chemical weapons use by states has violated IHL and the 1997 Chemical Weapons Convention (CWC) treaty, with little repercussion from the international community.

Aim:

We review the increase in chemical weapons use, international chemical weapon treaty violations, and violations of IHL against medical personnel.

Methods:

A review was conducted of existing medical and grey literature for sources discussing chemical agents, their history, and violations of laws prohibiting their production, stockpiling, or use. The following publications were reviewed: PubMed, EBSCHost, and Google Scholar.

Results:

The use of sarin, chlorine, and mustard gas against civilians has been confirmed multiple times in Syria by the United Nations since 2011. Physicians for Human Rights mapped 537 attacks, both violent and chemical, against 348 different medical facilities in Syria from March 2011 to July 2018. Since March 2011, at least 847 civilian medical personnel have reportedly been killed. Many were killed by government forces as part of a war strategy creating further incapacitation. Most recently, Medecins Sans Frontiers concluded its Yemen mission due to repeated attacks, including two in one week in October 2018.

Discussion:

There must be recognition and emphasis on the health severity of such attacks and the violations of IHL and the CWC. Physicians must use their unique positions for advocacy and call for action in upholding international treaties.
“What Do You Know About Zika?”: Investigating Women at a Primary Healthcare Facility in a Small Municipality in Brazil
Authors: Miranda Elaine , Santos-Pinto Claudia , Antunes-de-Lima Clarice , Osorio-de-Castro Claudia
Published: May 2019

Introduction:

In Brazil, poverty-stricken population groups were the most affected by Zika virus (ZIKV). Women and children are fragile links that need focused attention, especially in relation to health care.

Aim:

To investigate vulnerable, at-risk women in relation to their awareness of the ZIKV infection knowledge about the disease.

Methods:

With evidence-based risk communication literature and consequences of ZIKV infection, a data collection instrument with open-ended questions was developed. Women from a small municipality in west-central Brazil, most from a rural setting, were interviewed at primary health care centers in April 2018. Interviews were recorded and transcribed. A preliminary analysis ensued.

Results:

Forty women were interviewed. The average age was 42.3 (21-74 yrs) and 39 women had at least one child. The average number of people living in the same home was 3.8 (1-18) and 24 homes (60%) had one to four children. Fourteen women (54%) were beneficiaries of income supplementation programs. Two interviewees mentioned they had never heard of Zika and eight (20%) had no actual knowledge to convey. Other groups had some knowledge about ZIKV. Fifteen (37.5%) associated ZIKV with mosquito bites and another 15 with pregnancy or birth defects. Ten women (25%) mentioned dengue or chikungunya, but only 7 (17.5%) were aware of symptoms. Only eleven women (27.5%) declared public health workers as information sources.

Discussion:

Positive aspects of awareness and knowledge were the tentative relationship some women made between pregnancy risk and exposure to mosquitoes, and with dengue or chikungunya. However, given ample media coverage and the severity of the epidemic, it is noteworthy to point out that all aspects were mentioned by fewer than half of the women. Health workers were not represented as relevant sources of information. Future in-depth content analysis of interviews may reveal important issues for risk communication strategies for this population.
Axis Dimensional Analysis of Religious Mass Gathering Human Stampede Reports
Authors: Alhadhira Abdullah A , Molloy Michael S , Hart Alexander , Issa Fadi , Alossaimi Bader , Fletcher James , Voskanyan Amalia , Sarin Ritu , Ciottone Gregory R
Published: May 2019

Introduction:

Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.

Aim:

To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.

Methods:

Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.

Results:

34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.

Discussion:

HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.
They have Arrived! How Dallas, Texas Provided Shelter-Based Onsite Medical Care to Evacuees from Hurricane Harvey
Authors: Flax Lindsay A. , Liu E. Liang , Klein Kelly R. , Fowler Raymond L. , Swienton Raymond E.
Published: May 2019

Introduction:

After Hurricane Harvey and the flooding that ensued, 3,829 displaced persons were transported from their homes and sheltered in the Dallas Convention Center. This large general population sheltering operation was medically supported by the onsite Mega-Shelter Medical Clinic (MMC). In an altered standard of care environment, a number of multi-disciplinary medical services were provided including emergent management, acute pediatric and adult care, psychiatric/behavioral services, onsite pharmaceutical, and durable medical equipment distribution, epidemiologic surveillance, and select laboratory services.

Aim:

To describe how onsite medical care in the adapted environment of a large population shelter can provide comparable services and limit the direct impact on the local medical community.

Methods:

A retrospective chart review of medical records was generated for all clinical encounters at the MMC. Data were sorted by daily census, disease surveillance, medical decision making, treatment, and transport destinations.

Results:

40.7% of registered evacuees utilized the MMC accounting for a total of 2,654 clinic visits by 1,560 unique patients representing all age groups. During the sustained MMC operations, 8% of patients required emergency transport and 500 additional patient transports were arranged for clinic appointments. No deaths occurred and no iatrogenic morbidity was reported.

Discussion:

Medical care was provided for a large number of evacuees which mitigated the potential impact on the local medical infrastructure. The provision of medical services in a large population shelter may necessitate adaptation to the standard of care. However, despite the nontraditional clinical setting, care delivery was not compromised.
Disaster Nursing: Trends in the Professional Literature
Authors: Cohen Odeya , Stewart David , Kanbara Sakiko , Catton Howard , Shamian Judith
Published: May 2019

Introduction:

Nurses’ broad knowledge and treatment skills are instrumental to disaster management. Roles, responsibilities, and practice take on additional dimensions to their regular roles during these times. Despite this crucial position, the literature indicates a gap between their actual work in emergencies and the investment in training and establishing response plans.

Aim:

To explore trends in disaster nursing reflected in professional literature, link these trends to current disaster nursing competencies and standards, and reflect based on the literature how nursing can better contribute to disaster management.

Methods:

A systematic literature review, conducted using six electronic databases, and examination of peer-reviewed English journal articles. Selected publications were examined to explore the domains of disaster nursing: policy, education, practice, research. Additional considerations were the scope of the paper: local, national, regional, or international. The International Nursing Councils’ (ICN) Disaster-Nursing competencies are examined in this context.

Results:

The search yielded 171 articles that met the inclusion criteria. Articles were published between 2001 and 2018, showing an annual increase. Of the articles, 48% (n = 82) were research studies and 12% (n = 20) were defined as dealing with management issues. Classified by domain, 48% (n = 82) dealt with practical implications of disaster nursing and 35% (n = 60) discussed educational issues. Only 11% of the papers reviewed policy matters, and of these, two included research. Classified by scope, about 11% (n =18) had an international perspective.

Discussion:

Current standards attribute a greater role to disaster-nursing in leadership in disaster preparedness, particularly from a policy perspective. However, this study indicates that only about 11% of publications reviewed policy issues and management matters. A high percentage of educational publications discuss the importance of including disaster nursing issues in the curricula. In order to advance this area, there is a need to conduct dedicated studies.
The Forgotten Patients in Cyclones: The Continuation of Opioid Replacement Therapy Program
Authors: O’Dwyer Niamh , Cliffe Harrison , Watson Kaitlyn E. , McCourt Elizabeth , Singleton Judith A.
Published: May 2019

Introduction:

Cyclones are expected to increase in frequency and intensity, significantly impacting communities and healthcare services. During these times, those with chronic diseases such as opioid dependence are at an increased risk of disease exacerbation due to treatment regimen interruptions. Disruptions to the continuity of the opioid replacement therapy (ORT) service can be detrimental to both clients and the community which can potentially lead to relapse, withdrawal, and risky behaviors.

Aim:

To explore the impacts of cyclones on opioid treatment programs within community and hospital pharmacies in Queensland.

Methods:

Qualitative research methods were used in this study with two methods of data analysis employed: the text analytics software, Leximancer®, and manual coding. Interviews were conducted with five hospital and five community pharmacists and four Queensland opioid treatment program (QOTP) employees. Participants worked in Mackay, Rockhampton, Townsville, and Yeppoon in a community impacted by a cyclone and involved with ORT supply.

Results:

The themes developed in the manual coding were “impact on essential services,” “human experience,” “healthcare infrastructure,” “preparedness,” and “interprofessional networks.” These themes were aligned with those identified in the Leximancer® analysis. The community pharmacists focused on client stability, whereas, the hospital pharmacists and QOTP employees focused on the need for disaster plans to be implemented.

Discussion:

The greatest concern for participants was maintaining the stability of their clients. Communication amongst the dosing sites and ORT stakeholders was most concerning. This led to a lack of dosing information in a timely manner with pharmacists being hesitant to provide doses and takeaways due to legislative restrictions. A review of coordinated efforts and the legislative constraints is recommended to ensure continuity of ORT supply during cyclones.
Unsuccessful, Unwanted, and Unwarranted Resuscitation: Exploring Ambulance Personnel Preparation and Support for Death in the Field
Authors: Anderson Natalie , Slark Julia , Gott Merryn
Published: May 2019

Introduction:

In many countries, ambulance personnel are authorized to start or stop resuscitation efforts in accordance with clinical guidelines. Research shows that decisions to withhold or terminate resuscitation and manage patient death scenes can be particularly challenging.

Aim:

To identify preparation and support mechanisms for ambulance personnel who are authorized to withhold or terminate resuscitation efforts, and manage patient death in the field.

Methods: A scoping review provided an overview of international research in this area. A qualitative exploratory study was then undertaken. Focus groups were held with senior ambulance personnel currently working in clinical education, managerial, or pastoral support roles across New Zealand.

Results:

Well-supported clinical experiential learning and resolved personal experiences with grief and death were considered most useful to increase self-efficacy and coping with patient death. Participants felt some of the personal and interpersonal skills needed to manage death in the field were difficult to teach. Relatively little time is spent preparing ambulance personnel for the non-technical skills associated with resuscitation decision-making, particularly communicating with family and bystanders. Ambulance personnel responses and support-needs during or after the event are idiosyncratic. Ambulance personnel appear to primarily rely on colleagues and managers checking in and offering informal debriefing.

Discussion:

Results from this study identify opportunities for improvement in the preparation and support of ambulance personnel faced with managing patient death in the field. Clinical experience with supportive mentoring may provide the best opportunities for learning, but novices may not get exposure to patient death in this context. Ambulance personnel may benefit from training, which includes opportunities to role-play death notification and communication with family and bystanders at the scene of a patient death. Ambulance employers should allow downtime to facilitate personalized peer and managerial support where needed.
The Illinois EMSC Pediatric Preparedness Checklist Does Impact Pediatric Disaster Planning and Preparedness in Chicago: A Comparison of 2012 and 2016 EMSC Facility Recognition Surveys
Authors: Severin Paul , Lyons Evelyn , Weber Elisabeth
Published: May 2019

Introduction:

The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.

Aim:

The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.

Methods:

Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.

Results:

Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.

Discussion:

Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.
Getting There: Evidence-Based Decision-Making in Road Trauma Prehospital Transport and Care in Queensland
Authors: Andrews Robert , Wynn Moe , ter Hofstede Arthur , Vallmuur Kirsten , Bosley Emma , Elcock Mark , Rashford Stephen
Published: May 2019

Introduction:

Process mining, a branch of data science, aims at deriving an understanding of process behaviors from data collected during executions of the process. In this study, we apply process mining techniques to examine retrieval and transport of road trauma patients in Queensland. Specifically, we use multiple datasets collected from ground and air ambulance, emergency department, and hospital admissions to investigate the various patient pathways and transport modalities from accident to definitive care.

Aim:

The project aims to answer the question, “Are we providing the right level of care to patients?” We focus on (i) automatically discovering, from historical records, the different care and transport processes, and (ii) identifying and quantifying factors influencing deviance from standard processes, e.g. mechanisms of injury and geospatial (crash and trauma facility) considerations.

Methods:

We adapted the Cross-Industry Standard Process for Data Mining methodology to Queensland Ambulance Service, Retrieval Services Queensland (aero-medical), and Queensland Health (emergency department and hospital admissions) data. Data linkage and “case” definition emerged as particular challenges. We developed detailed data models, conduct a data quality assessment, and preliminary process mining analyses.

Results:

Preliminary results only with full results are presented at the conference. A collection of process models, which revealed multiple transport pathways, were automatically discovered from pilot data. Conformance checking showed some variations from expected processing. Systematic analysis of data quality allowed us to distinguish between systemic and occasional quality issues, and anticipate and explain certain observable features in process mining analyses. Results will be validated with domain experts to ensure insights are accurate and actionable.

Discussion:

Preliminary analysis unearthed challenging data quality issues that impact the use of historical retrieval data for secondary analysis. The automatically discovered process models will facilitate comparison of actual behavior with existing guidelines.
The Future of Disaster Medicine is Based on Primary Care Involvement
Authors: Burns Penelope , Douglas Kirsty , Hu Wendy , Aitken Peter
Published: May 2019

Introduction:

When disasters happen, people experience broad environmental, physical, and psychosocial effects that can last for years. Researchers continue to focus on the acute physical injuries and aspects of patient care without considering the person as a whole. People who experience disasters also experience acute injury, exacerbations of chronic disease, mental and physical health effects, effects on social determinants of health, disruption to usual preventative care, and local community ripple effects. Researchers tend to look at these aspects of care separately, yet an individual can experience them all at once. The focus needs to change to address all the healthcare needs of an individual, rather than the likely needs of groups. Mental and physical care should not be separated, nor the determinants of health. The person, not the population, should be at the center of care. Primary care, poorly integrated into disaster management, can provide that focus with a "business as usual" mindset. This requires comprehensive, holistic coordination of care for people and families in the context of their local community.

Aim:

To examine how Family Doctors (FDs) actually contribute to disaster response.

Methods:

Thirty-seven disaster-experienced FDs were interviewed about how they contributed to response and recovery when disasters struck their communities.

Results:

FDs reported being guided by the usual evidence-based care characteristics of primary practice. The majority provided holistic comprehensive medical care and did not feel they needed many extra clinical training or skills. However, they did wish to understand the systems of disaster management, where they fit in, and their link to the broader disaster response.

Discussion:

The contribution of FDs to healthcare systems brings strengths of preventative care, early intervention, and ongoing local surveillance by a central, coordinating, and trusted health professional. There is no reason to not include disaster management in primary care.