bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of Psychiatric Morbidity among the Displaced and Non-Displaced Populations in the Andaman and Nicobar Islands following the Tsunami
Authors: Math Suresh Bada , John John P. , Girimaji Satish Chandra , Benegal Vivek , Sunny Biju , Krishnakanth K. , GS Uday Kumar , Hamza Ameer , Tandon Shweta , Jangam Kavitha , Meena K.S. , Chandramukhi Biju , Nagaraja D.
Published: August 2016

Objective:

The objective of this study was to compare the psychiatric morbidity between the displaced and non-displaced populations of the Andaman and Nicobar Islands during the first three months following the 2004 earthquake and tsunami.

Methods:

The study was conducted at the 74 relief camps in the Andaman and Nicobar Islands. Port Blair had 12 camps, which provided shelter to 4,684 displaced survivors. There were 62 camps on Car-Nicobar Island, which provided shelter to approximately 8,100 survivors who continued to stay in their habitat (non-displaced population). The study sample included all of the survivors who sought mental health assistance inside the camp. A psychiatrist diagnosed the patients using the ICD-10 criteria.

Results:

Psychiatric morbidity was 5.2% in the displaced population and 2.8% in the non-displaced population. The overall psychiatric morbidity was 3.7%. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population.The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder (PTSD) were distributed equally in both groups.

Conclusions:

Psychiatric morbidity was found to be highest in the displaced population. However, the incidence of depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally acceptable interventions improved the community participation. Cohesive community, family systems, social support, altruistic behavior of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster.
Drug Abuse-Related Emergency Calls: A Metropolis-Wide Study
Authors: Togia Athanasia , Sergentanis Theodoros N. , Sindos Michael , Ntourakis Dimitrios , Doumouchtsis Evangelos , Sergentanis Ioannis N. , Bachtis Constantinos , Pyrros Demetrios , Papaefstathiou Nikolaos
Published: August 2016

Introduction:

Drug abuse is an important sociomedical problem in large metropolitan areas. Drug addicts represent a group with particularities, since they hesitate to seek medical care and often refuse hospitalization. Therefore, there is a scarcity of data on drug abuse-related calls. The burden imposed by such calls on emergency health services has not been evaluated in detail.

Objectives:

The objectives of this study are to: (1) assess the profile of drug abuse-related calls in a large European metropolis, including the spatiotemporal distribution, as well as the frequency and variability of cancellations; and (2) evaluate the mobilization of emergency prehospital care services in response to the calls.

Methods:

In 2005, the Hellenic National Centre for Emergency Care received 5,836 emergency drug abuse-related calls pertaining to the metropolitan area of Athens, Greece. The analysis focused on: (1) spatiotemporal features of calls/cases; (2) step-by-step cancellation rates in the mobilization of ambulances or other means (mobile intensive care units, specially equipped motorcycles, and super-mini city cars); and (3) response time of the mobilized means. Pearson's chi-square, goodness-of-fit chi-square, and the Kruskal-Wallis tests were used as appropriate.

Results:

Drug abuse-related calls represented 2% of all emergency calls. Only one-third of these cases were transported to the Accident and Emergency Departments of area hospitals. A total of 9% of the calls were cancelled before transportation arrived; another 20% of victims could not be found when authorities arrived on-scene, and 36% of patients refused transport to the hospital. The cancellation rate is significantly higher in the evening and at night, as well as in summer and autumn. The major burden is imposed on the municipality of Athens (67% of all calls).

Conclusions:

Drug abuse-related calls represent a significant load for emergency medical services in metropolitan Athens. However, a relatively small percentage of the drug addicts finally are transported to the hospital. Appropriately equipped motorcycles seem to be an effective means for the prehospital management of drug-abuse cases.
Chief Complaints, Diagnoses, and Medications Prescribed Seven Weeks Post-Katrina in New Orleans
Authors: Howe Erica , Victor David , Price Eboni G.
Published: August 2016

Background:

In the aftermath of Hurricane Katrina, widespread flooding devastated the New Orleans healthcare system. Prior studies of post-hurri-cane healthcare do not consistently offer evidence-based recommendations for re-establishing patient care post-disaster. The primary objective of this study is to examine associations between patient characteristics, chief com-plaints, final diagnoses, and medications prescribed at a post-Katrina clinic to better inform strategic planning for post-disaster healthcare delivery (e.g., charitable donations of medications and medical supplies).

Methods:

This study is a retrospective chart review of 465 patient visits from 02 September 2005 to 22 October 2005 at a post-Katrina clinic in New Orleans, Louisiana that was open for seven weeks, providing urgent care services in the central business district. Using logistic regression, the relationships between patient characteristics (date of visit, gender, age, evacuation status), type of chief complaint, final diagnosis, and type of medication prescribed was examined.

Results:

Of 465 patients, 49.2% were middle-aged, 62.4% were men, 35% were relief workers, and 33.3% were evacuees; 35% of visits occurred in week five. Of 580 chief complaints, 71% were illnesses, 21% were medication refill requests, and 8.5% were injuries. Among 410 illness complaints, 25% were ears, nose, and throat (ENT)/dental, 17% were dermatologic, and 11% were cardiovascular. Most requested classes of medication refills for chronic medical conditions (n = 121) were cardiovascular (52%) and endocrine (24%).Most illness-related diagnoses (n = 400) were ENT/dental (18.2%), dermatologic (14.8%), cardiovascular (10.2%), and pul-monary (10.2%). Thirty-six percent of these diagnoses were infectious. Among 667 medications prescribed, 21% were cardiac agents, 13% pulmonary, 13% neurologic/musculoskeletal/pain, 11% antibiotics, 10% endocrine, and 9.3% anti-allergy. The likelihood of certain chief complaints, diagnoses, and medica-tions prescribed varied with patient characteristics.

Conclusions:

Donations of certain classes of medications were more useful than others. Prevalence of select co-morbidities, the nature of patient involve-ment in recovery activities in the disaster area, and post-disaster health haz-ards may explain variations in chief complaints, diagnoses, and medications prescribed by patient characteristics.
Faith-Based Organizations and Sustainable Sheltering Operations in Mississippi after Hurricane Katrina: Implications for Informal Network Utilization
Authors: Pant Anjali T. , Kirsch Thomas D. , Subbarao Italo R. , Hsieh Yu-Hsiang , Vu Alexander
Published: August 2016

Introduction:

In the aftermath of Hurricane Katrina, a significant number of faith-based organizations (FBOs) that were not a part of the formal National Response Plan (NRP) initiated and sustained sheltering operations.

Objective:

The objective of this study was to examine the sheltering opera-tions of FBOs, understand the decision-making process of FBO shelters, and identify the advantages and disadvantages of FBO shelters.

Methods:

Verbal interviews were conducted with FBO shelter leaders. Inclusion criteria were: (1) opening in response to the Katrina disaster; (2) oper-ating for more than three weeks; and (3) being a FBO. Enrolled shelters were examined using descriptive data methods.

Results:

The majority of shelters operating in Mississippi up to three weeks post-Katrina were FBO-managed. All of the operating FBO shelters in Mississippi that met the inclusion criteria were contacted with a response rate of 94%. Decisions were made by individuals or small groups in most shelters regarding opening, operating procedures, and closing. Most FBOs provided at least one enabling service to evacuees, and all utilized informal networks for sheltering operations. Only 25% of FBOs had disaster plans in place prior to Hurricane Katrina.

Conclusions:

Faith-based organization shelters played a significant role in the acute phase of the Katrina disaster. Formal disaster training should be ini-tiated for these organizations. Services provided by FBOs should be standard-ized. Informal networks should be incorporated into national disaster planning.
Differences in Sources of Information Used by the Population between the Affected Area and the General Population during the First Phase of a Bird Flu Outbreak
Authors: Peltz Rami , Galit Avisar-Shohat , Ventura-Gabay Miri , Bar-Dayan Yaron
Published: August 2016

Introduction:

In March 2006, a few cases of bird flu were discovered in approximately 10 rural settlements in Israel. As a result, approximately one million birds were destroyed within a three kilometer radius of the settle-ments. The Israeli population was instructed to take preventive measures against the spread of the infection.

Objectives:

The objective of this study was to compare the frequency of use of different sources of information by the population in the affected area with the general population during the first phase of a bird flu outbreak in Israel.

Methods:

A telephone survey among two randomly selected, representative samples of adults was conducted. One sample involved 500 adult Israeli resi-dents; the other sample involved 103 adult residents from the affected area during the first phase of the outbreak. The use of different sources of infor-mation by the population concerning the disease was assessed. The differences in these parameters between the affected area and the nationwide population were analyzed using a chi-square andt-test analysis. Ap-value of <0.05 was considered statistically significant.

Results:

Television was a significantly more common source of information in Israel as a whole (p<0.05), whereas friends (p<0.05) and local authorities (p<0.05) were significantly more common sources of information in the affected area.

Conclusions:

The frequency of use of the sources of information by the pop-ulation during the early phase of a bird flu outbreak is different in the affect-ed area compared with the general population in the same country. Authorities must pay attention to this phenomenon and use the correct sources of information in each area in order to achieve better exposure of the population to the recommended behaviors during an outbreak.
Defining the Problem, Main Objective, and Strategies of Medical Management in Mass-Casualty Incidents Caused by Terrorist Events
Authors: Ashkenazi Itamar , Kessel Boris , Olsha Oded , Khashan Tawfik , Oren Meir , Haspel Jacob , Alfici Ricardo
Published: August 2016

Based on the experience of managing >20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients opti-mal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treat-ment of seriously injured victims instead of more traditional management roles such as triage and incident manager.
Introduction of a Prehospital Critical Incident Monitoring System—Pilot Project Results
Authors: Stella Julian , Davis Anna , Jennings Paul , Bartley Bruce
Published: August 2016

Background:

Hospital medical incident monitoring improves preventable morbidity and mortality rates. Error management systems have been adopted widely in this setting. Data relating to incident monitoring in the prehospital setting is limited.

Problem:

Implementation of an incident monitoring process in a prehospital setting.

Methods:

This is a prospective, descriptive study of the pilot phase of the implementation of an incident monitoring process in a regional prehospital setting, with a focus on trauma care. Paramedics and emergency department staff submitted anonymous incident reports, and a chart review was performed on patients who met major trauma criteria. Selected trauma cases were analyzed by a structured interview/debriefing process to elucidate undocumented incidents.A project committee coded and logged all incidents and developed recommendations.

Results:

Of 4,429 ambulance responses, 41 cases were analyzed.Twenty-four (58.5%; 95% CI = 49.7–67.4%) were reported anonymously, and the rest were major trauma patients. A total of 77 incidents were identified (mean per case = 1.8; CI = 1.03–2.57). Anonymous cases revealed 26 incidents (mean = 1.1; CI = 0.98–1.22); eight trauma debriefings revealed 38 incidents (mean = 4.8; CI = 0.91–8.69) and nine trauma chart reviews revealed 13 incidents (mean = 1.6; CI = 1.04–2.16). A total of 56 of 77 (72.7%; CI = 65.5–80.0%) incidents related to system inadequacies, and 15 (57.7%; CI = 46.7–68.6%) anonymously reported incidents related to resource problems. A total of 35 of 77 (45.5%; CI = 40.4–50.5%) incidents had minimal or no impact on the patients' outcomes. Thirty-four of 77 (44.2%; CI = 39.3–49.1%) incidents were considered mitigated by circumstance. Incident monitoring led to generalized feedback in most cases (65 of 77; 84.4%; CI = 77.6–91.3%); in three cases (3.9%; CI = 3.7–4.1%), specific education occurred; two cases were reported to an external body (2.6%; CI = 2.5–2.7%); three cases resulted in remedial action (3.9%; CI = 3.7–4.1%); four for trend/further observation and analysis responses (5.2%; CI = 4.9–5.5%).

Conclusions:

The pilot project demonstrates successful implementation of an incident monitoring system within a regional, prehospital environment. The combination of incident detecting techniques has a high yield with potential to capture different error types.The large proportion of incidents in the “near miss” category allows analysis of incidents without patient harm. The majority of incidents were system related and many were mitigated by circumstance. The model used is appropriate for ongoing incident monitoring in this setting.
Why the Closest Ambulance Cannot be Dispatched in an Urban Emergency Medical Services System
Authors: Dean Stephen F.
Published: August 2016

Introduction:

Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety.

Problem:

The objective of this study was to identify opportunities for improving ambulance response-time performance in an urban EMS system using fixed deployment.

Methods:

This was a qualitative and quantitative case study which consisted of structured interviews with policy makers, managers, and workers in a fire department EMS division, as well as analysis of dispatch data and observation of dispatch operations.

Results:

The current computer-aided dispatch (CAD) system does not identify the closest ambulance to the emergency, and therefore, dispatchers must guess which unit is closer when units are not within their stations or “first due” areas. There is no means to track how often dispatchers guess correctly or how often the closest ambulance actually is dispatched to the emergency.

Temporal and geographic patterns were identified. Opportunities also were identified to improve response time performance through the use of dynamic deployment and peak-load staffing.

Conclusions:

The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixeddeployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.
Disaster Preparedness: Hospital Decontamination and the Pediatric Patient— Guidelines for Hospitals and Emergency Planners
Authors: Freyberg Christopher W. , Arquilla Bonnie , Fertel Baruch S. , Tunik Michael G. , Cooper Arthur , Heon Dennis , Kohlhoff Stephan A. , Uraneck Katherine I. , Foltin George L.
Published: August 2016

In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients.The panel was comprised of experts from a variety of medical and psychosocial areas.Using an iterative process, the panel created guidelines that were approved by the stakeholders and are presented in this paper.These guidelines must be utilized, studied, and modified to increase the likelihood that they will work during an emergency situation.
Disasters and Humanitarian Crises: A Joint Future for Responders?
Authors: Leaning Jennifer
Published: August 2016

In the last 35 years, the disaster and humanitarian communities have evolved rapidly in two parallel cohorts. The disaster enterprise in the US and Latin America grew up in the 1970s in response to a series of major earthquakes, hurricanes, and forest fires, culminating with the nuclear disaster at Three Mile Island and the formation of the Federal Emergency Management Agency (FEMA) in 1979/80. The Disaster Program at the Pan-American Health Organization also took form in the 1980s.

The humanitarian enterprise can be traced to the Biafran War of 1968/69, where a range of international, non-governmental organizations (NGOs) converged to respond to support a population that was fleeing a civil war and famine. In the years since, drawn to refugees and internally displaced persons in war circumstances as varied as Angola, Afghanistan, and Bosnia, the humanitarian community has expanded in numbers, reach, and budget.
Burn Survival in Mass-Casualty Situation Planning, Preparation, Response: What is the Key?
Authors: Wood Fiona
Published: August 2016

When facing a situation involving mass casualties, we must consider the choices we have as individuals and as communities. The range of opportunity and privilege across the world is vast. Set against the background of natural and manmade disasters, how do we provide the right care at the right time for those in need? How can we share our collaborative knowledge?.

The recognition of the dignity of those in need is the first step.

Relationship building in the time of non-disaster leads to mutual understanding, facilitating care. Medicine brings science and experience into the art of clinical problem-solving. Disaster situations require rapid solutions based on prior planning, communicated with the understanding that optimal outcomes depend upon relationships based on respect, sharing knowledge of the local environmental resources, coupled with clinical care.
Preparedness of Primary Healthcare Centers for Critical Emergency Situations in Southwest Turkey
Authors: Yorganci Mustafa , Yaman H.
Published: August 2016

Introduction:

Primary healthcare centers (PHCCs) frequently are contacted for emergency reasons and are expected to provide basic and advanced life support during emergency situations.

Objectives:

The aim of this study was to assess the availability of emergency equipment and the knowledge of the staff working in PHCCs.

Methods:

The survey was conducted in 21 PHCCs located in the rural city of Isparta, Turkey, in 2001. The availability of emergency equipment, emergency drugs, intravenous parenteral solutions, and diagnostic-therapeutic equipment was evaluated. Knowledge of basic life support of the staff (n = 195) was evaluated using a 10-item test.

Results:

Two (9.5%) PHCs had a complete emergency kit with an airways bag, mask, intravenous parenteral solutions, emergency drugs, and other diagnostic equipment. Emergency equipment was easily accessible in 19 PHCCs (90.5%), while in the remaining centers, the equipment and drugs were stored in locked cabinets.The staff that was evaluated consisted of 43 doctors (22%), 132 nurses and midwifes (67%), and 20 health officers (11%). Doctors scored the highest knowledge score (65.5%), followed by nurses and midwives (58.6% and 56.7%, respectively), and health officers (52.5%).

Conclusions:

Primary healthcare centers were not prepared to provide advanced life support. Knowledge scores were low and the staff was in need of basic life support training. Further arrangements must be stressed to make PHCC's “emergency-friendly centers” in Isparta, Turkey.
Cognitive-Behavioral Psychology: Implications for Disaster and Terrorism Response
Authors: Ruzek Josef I. , Walser Robyn D. , Naugle Amy E. , Litz Brett , Mennin Douglas S. , Polusny Melissa A. , Ronell Dianna M. , Ruggiero Kenneth J. , Yehuda Rachel , Scotti Joseph R.
Published: August 2016

Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The purpose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitivebehavioral perspectives and intervention methods can enhance the effectiveness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individuals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cognitive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral therapy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response.
Profile of Emergency Medical Dispatch Calls for Breathing Problems within the Medical Priority Dispatch System Protocol
Authors: Clawson Jeff , Olola Christopher , Heward Andy , Patterson Brett , Scott Greg
Published: August 2016

Introduction:

A common chief complaint to emergency dispatch communication centers worldwide is “breathing problems”. The chief complaint of breathing problems represents a wide spectrum of underlying diseases, patient conditions, and onset types. The current debate is on the potential ability of a dispatch protocol to safely and with high specificity, differentiate patients with minor or non-critical conditions from those conditions that pose risk to the patient and require advanced life support evaluation and care. This issue also has extended into the paramedic prehospital evaluation realm.

Objective:

The objective of this study was to describe the distribution of Medical Priority Dispatch System (MPDS) codes representing the spectrum of clinical descriptions within the breathing problems chief complaint and their associated outcomes, at the scene and during transport, as determined by [UK] paramedics.

Methods:

A retrospective, one-year study (September 2005 to August 2006) of a de-identified aggregate dataset from the London Ambulance Service (LAS) Trust was evaluated. A profile of the distribution of calls, incidents, patients, and outcomes (cardiac arrest [CA] and blue-in [BI] high acuity i.e., patients transported with lights and siren based on paramedic protocol) for the breathing problems chief complaint was evaluated.Odds ratios and 95% confidence intervals (CI) were used to quantify associations between the MPDS priority level's concurrent asthmatic conditions and outcomes. Two-sided Fisher's exact p-values were obtained to determine statistically significant associations, at a level of 0.05.

Results:

Sixteen percent (95,848/599,093) of all the patients were classified under the breathing problems chief complaint.Of these 95,848 patients,367 (0.38%) were CA outcomes, and 7.82% (n = 7,493) were BI outcomes.The Cardiac Arrest Quotient (i.e., the number of CA cases as a percentage of the number of patients) for the ECHO priority level was 46 times higher than was that of non-ECHO priority levels: DELTA and CHARLIE (17.05% vs. 0.37%). Asthmatics were associated with CA outcome (OR(95%CI): 0.60(0.47, 0.77), p <0.001), but not with BI outcome.

Conclusions:

The MPDS coding yielded a richer mix of severe outcomes in the higher priority levels. The Severe Respiratory Distress coding had the greatest number of patients and severe outcomes. Future studies that help refine the Severe Respiratory Distress code in the MPDS by more specific subgroups of patients would be beneficial.
Development of Prehospital, Population-Based Triage-Management Protocols for Pandemics
Authors: Bielajs Ingrid , Burkle Frederick M. , Archer Frank L. , Smith Erin
Published: August 2016

The lack of disease-specific triage-management protocols that address the unique aspects of a pandemic places emergency medical services, and specifically, emergency medical services practitioners, at great risk.Without adequate protocols, the emergency health system will risk needless exposure, loss of functional capacity, and inappropriately triaged patients.This paper reports on the development of population-based triage-management protocols at two patient points of contact. The primary objective of the triage-management protocols is to identify patients infected by or exposed to the biological agent, and consequently, appropriately triage patients so as to optimize the utilization of emergency medical services and surge capacity resources through disposition and care at hospital-and non-hospital-based care facilities. Protocols must include standardized “flu questions”and a Fear and Resiliency Checklist to ensure protection and separation of the susceptible population from those infected or exposed.
Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control
Authors: Brown David W. , Young Stacy L. , Engelgau Michael M. , Mensah George A.
Published: August 2016

Introduction:

Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death.

Problem:

A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications.

Methods:

Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented.

Results:

The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions.

Conclusions:

Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.
Model for Preparedness of a Public Institution for a Terrorist Attack
Authors: Lifshitz Izak , Adler Jakov , Katz Joseph
Published: August 2016

Public institutions such as governmental facilities, hospitals, universities, and amusement parks may be targeted by terrorists using weapons of mass destruction due to their potential to cause large numbers of casualties.

Consequentially, these institutions should be prepared to manage such an event by the development and implementation of specific preparedness guidelines for any conventional or unconventional terrorist attacks.

In order to test the preparedness of such an institution for a chemical event, a large-scale drill focusing on the first medical team to respond was conducted.

Some important lessons regarding the way the medical team operates and communicates were learned from this drill. Periodic drills should be performed in order to assess the practicality and applicability of these guidelines.
Earthquake Related Injuries: Assessment of 854 Victims of the 2003 Bam Disaster Transported to Tertiary Referral Hospitals
Authors: Mohebbi Hassan Ali , Mehrvarz Shaban , Saghafinia Masoud , Rezaei Yadollah , Kashani Seyed Mohsen Towliat , Naeeni Seyed Morteza Moussavi , Motamedi Mohammad Hosein Kalantar , Hoseini Seyed Hamed , Moharamzad Yashar
Published: August 2016

Background:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. Objective: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran.

Methods:

The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed.

Results:

There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value ±SD for ISS was 6.7 ±5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14).

Conclusions:

Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.
Critical Challenges Ahead in Bioterrorism Preparedness Training for Clinicians
Authors: Hartwig Kari A. , Burich David , Cannon Christopher , Massari Louis , Mueller Lloyd , Dembry Louise-Marie
Published: August 2016

Purpose:

A survey was distributed to determine physicians' confidence levels in recognizing potential Category-A bioterrorism disease threats (e.g., smallpox, anthrax), preferred means of obtaining continuing medical education (CME) credits, and their knowledge of the Connecticut Department of Public Health's (DPH) disease reporting requirements.

Methods:

Surveys were mailed to all physicians in the three-hospital Yale New Haven Health (YNHH) System (2,174) from January to March 2004; there were 820 respondents for a 37.7% response rate.

Results:

A total of 71% of physicians indicated that they were “not confident” that they could recognize five of the infectious agents named;they had higher confidence rates for smallpox (48.8%). Infectious diseases and emergency medicine physicians had the highest rates of confidence. Seventy-eight percent of physicians indicated conferences and lectures as their preferred CME learning modality. Nearly 72% of physicians reported a low familiarity with the DPH reporting requirements.

Discussion:

The results highlighted the breadth of perceived weaknesses among clinicians from disease recognition to reporting incidents, which signifies the need for greater training in these areas. As clinicians themselves emphasized their lack of skills and knowledge in this area, there should be a rapid development and dissemination of problem-based learning CME courses in bioterrorism preparedness.
Resilience and Challenges among Staff of Gulf Coast Nursing Homes Sheltering Frail Evacuees following Hurricane Katrina, 2005: Implications for Planning and Training
Authors: Laditka Sarah B. , Laditka James N. , Cornman Carol B. , Davis Courtney B. , Richter Jane V.E.
Published: August 2016

Purpose:

The purpose of this study was to: (1) explore experiences and responses of staff in caring for sheltered, frail, Hurricane Katrina evacuees; and (2) identify how planning and training can be enhanced for staff who may care for frail older populations during and after disasters.

Methods:

Individual, in-person, semi-structured interviews were conducted with 38 staff members in four nursing homes in Mississippi, sheltering 109 evacuees in November 2005, nine weeks after Hurricane Katrina.Twenty-four were direct care staff, including certified nursing assistants, licensed nurses, dietary aides, and social workers; 14 were support staff, including maintenance and business managers. The number interviewed in each nursing home averaged 9.5 (range 6–15). Using a discussion guide and focusing on their experiences caring for nursing home evacuees, staff were asked to describe: (1) experiences; (2) problems; (3) what helped; and (4) what was learned. Data were processed using grounded theory and thematic analysis. Responses of direct care staff differed in emphasis from those of support staff in several areas; responses from these groups were analyzed separately and together. Three of the researchers identified recurring themes; two organized themes conceptually.

Results:

Staff emphasized providing emotional reassurance to evacuees as well as physical care. Many described caring for evacuees as “a blessing,” saying the experience helped them bond with residents, evacuees, and other staff. However, caring for evacuees was difficult because staff members were extremely anxious and in poor physical condition after an arduous evacuation. Challenges included communicating with evacuees' families, preventing dehydration, lack of personal hygiene supplies, staff exhaustion, and emotional needs of residents, evacuees, and staff. Teamwork, community help, and having a well-organized disaster plan, extra supplies, and dependable staff helped personnel cope with the situation.

Conclusions:

Staff of nursing homes that sheltered Katrina evacuees demonstrated resilience in the disaster's aftermath. Many placed the well-being of residents as their first priority. Results underscore the importance of planning, teamwork, and adequate supplies and staffing. Training for long-term care staff should emphasize providing emotional support as well as physical care for residents and evacuees during and following disasters. Nurses, social workers, and other staff members responsible for promoting emotional well-being for nursing home residents should be prepared to respond to disasters.
Ethical Considerations of Research in Disaster-Stricken Populations
Authors: Jesus John E. , Michael Glen E.
Published: August 2016

Recently, emphasis has been placed on improving and expanding research in disaster response and the treatment of disaster-stricken populations. However, research in these settings presents unique ethical challenges with which the scientific and biomedical ethics communities continue to struggle. At the core of the controversy is the question of how best to balance the critical need for research with the equally important obligation to respect and protect the interests of research participants within the unique stress of a disaster. This concern stems from the potential of increased vulnerability of individuals stricken by disaster over and above their usual vulnerability to risk and exploitation as research subjects. Ethical principles that must be considered in these situations are the same as those that are important when conducting any human research: respect for persons, non-maleficence, beneficence, and justice. This paper explores the ethical challenges that accompany inadequate resources and personnel, the potential vulnerability of research participants, the dual role of physician-researcher, and the importance of the public's perception and trust are explored. It then proposes a number of potential avenues through which to conduct ethically justifiable research that could answer many of the pressing questions in disaster medicine and response.
The “RTR” Medical Response System for Nuclear and Radiological Mass-Casualty Incidents: A Functional TRiage-TReatment-TRansport Medical Response Model
Authors: Hrdina Chad M. , Coleman C. Norman , Bogucki Sandy , Bader Judith L. , Hayhurst Robert E. , Forsha Joseph D. , Marcozzi David , Yeskey Kevin , Knebel Ann R.
Published: August 2016

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The “RTR” system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur.
Rationing of Resources: Ethical Issues in Disasters and Epidemic Situations
Authors: Lin Janet Y. , Anderson-Shaw Lisa
Published: August 2016

In an epidemic situation or large-scale disaster, medical and human resources may be stretched to the point of exhaustion. Appropriate planning must incorporate plans of action that minimize public health morbidity and mortality while maximizing the appropriate use of medical and human healthcare resources. While the current novel H1N1 influenza has spread throughout the world, the severity of this strain of influenza appears to be relatively less virulent and lethal compared to the 1918 influenza pandemic.However, the presence of this new influenza strain has reignited interest in pandemic planning.

Amongst other necessary resources needed to combat pandemic influenza, a major medical resource concern is the limited number of mechanical ventilators that would be available to be used to treat ill patients. Recent reported cases of avian influenza suggest that mechanical ventilation will be required for the successful recovery of many individuals ill with this strain of virus. However, should the need for ventilators exceed the number of available machines, how will care providers make the difficult ethical decisions as to who should be placed or who should remain on these machines as more influenza patients arrive in need of care?

This paper presents a decision-making model for clinicians that is based upon the bioethical principles of beneficence and justice. The model begins with the basic assumptions of triage and progresses into a useful algorithm based upon utilitarian principles. The model is intended to be used as a guide for clinicians in making decisions about the allocation of scarce resources in a just manner and to serve as an impetus for institutions to create or adapt plans to address resource allocation issues should the need arise.
Air-Medical Transport Experience in Emergency Medicine Residencies: Then and Now
Authors: Tang Nelson , Fredericksen Kim , Sauer Lauren , Kozen Buddy , Liang Horace , Chanmugam Arjun S.
Published: August 2016

Objective:

The appropriate activation and effective utilization of air-medical transport (AMT) services is an important skill for emergency medicine physicians in the United States.Previous studies have demonstrated variability with regards to emergency medical services (EMS) experience during residency training. This study was designed to evaluate the nature and extent of AMT training of the emergency medicine residency programs in the United States.

Methods:

An identity-unlinked survey of the program directors of all Accreditation Committee for Graduate Medical Education (ACGME) approved emergency medicine residency programs was conducted.The survey focused on EMS and AMT resident training opportunities and was conducted in two phases (1999 and 2006) using near-identical methodologies.

Results:

Response rates of 82% and 84% were achieved in 1999 and 2006, respectively. Percentages of programs offering AMT experiences were similar between the two study phases (76% in 1999 and 65% in 2006). The roles of residents during AMT experiences ranged widely between observer-only, active team member, and medical director/team leader in both 1999 and 2006. Compared to those in 1999, programs in 2006 demonstrated a greater frequency of EMS rotations being provided earlier, by year of training during emergency medicine residency. Residencies located in non-metropolitan centers only were slightly more likely to offer AMT training than were those in metropolitan locations.

Conclusions:

A majority of emergency medicine residency programs offer AMT experience that includes both scene responses and inter-facility transports. The role of residents during AMT training varies widely, as does the timing of their experiences during residency. The geographical locations of programs do not appear to impact the availability of AMT training.