bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Measurement Against the Mega-Disaster: The Necessity of Systematization of the Disaster Medicine or the Disaster Medicine Compendium
Authors: Haraguchi Yoshikura , Tomoyasu Yozo , Tsubata Tohru , Ishihara Tetsu , Sakai Motohiro , Nagata Iyasu
Published: May 2019

Introduction:

The large number of casualties during major or mega-disasters are a global problem.

Aim:

The role of medicine against mega-disasters is analyzed from a worldwide perspective.

Methods:

Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.

Results:

These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).

Discussion:

Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.
Mental Health Impacts on People Living in Subdivided Flats in Hong Kong
Authors: Ng Angel W L
Published: May 2019

Introduction:

Housing has always been a source of stress for people in Hong Kong (HK), especially to those living in sub-optimal settings. About 210,000 people are forced to live in subdivided flats in HK. Most of these flats cannot meet health standards set by the UN even for prisoners, in terms of the floor space, climatic conditions, lighting, air quality, and ventilation. Fire and public safety equipment are lacking. Most believed that the substandard environment has a negative impact on one’s mental health.

Aim:

To investigate how the living condition in a subdivided flat affects a person’s mental health.

Methods:

104 households living in the subdivided flats in Kwai Tsing, one of the 18 Districts of HK, were surveyed by HKJCDPRI’s Collaborating Partner, HKSKH Lady MacLehose Centre in February 2017; while a follow-up study with purposive sampling was conducted in October 2017 to interview 10 households on their mental health status. A mixed Methods was used combining the quantitative Results of the WHO Quality of Life-BREF scale and Depression Anxiety Stress Scale 21, and qualitative Results of face-to-face interviews.

Results:

80% of 104 households surveyed suffered from mental distress. The follow-up study revealed that seven of them displayed signs of depression and/or anxiety, while two were diagnosed with a mental disorder. Distress is proven to associate with the environmental and health risks, including fire and disease outbreak, as well as chronic issues resulting from poor indoor air quality and extreme weather.

Discussion:

Low level of perception and preparedness among HK people is making these public health risks more apparent. The already desperate housing and land policy don’t seem to offer any help in the near future. Public educations efforts need tremendous enhancement, to engage, mobilize and empower individuals and communities, to actively plan and prepare for future shocks.
Neuropsychiatric Manifestations of Wildfire Exposure
Authors: Mohammad Sohail
Published: May 2019

Introduction:

Wildfires are life threatening incessant fires in thickly vegetated areas that spread extremely rapidly to human habitat and are difficult to control by human force. The impact of wildfires is enormous on population health and causes tremendous financial burden to individuals and communities.

Aim:

The aim is to understand the potential disease burden secondary to wildfires both at an individual and population level and reflect upon the immediate and delayed neuropsychiatric manifestations of smoke exposure.

Methods:

Data on wildfires associated direct and indirect costs on individual health and health care delivery appears to be scant. The effort of this presentation is to present the federal data from 2012 to 2016 on nationwide wildfires, estimated acreage consumed in wildfires, the population exposed, and deaths. Information was extracted from the National Interagency Fire Center, the United States Fire Administration, and the Federal Emergency Management Agency. Through literature review on neuropsychological sequelae of wildfires smoke inhalation and associated trauma, the goal is to reflect upon potential healthcare burden secondary to neuropsychiatric manifestations.

Results:

Per National Center for Health Statistics, the national fire death rates from 2012 to 2016 ranged 10 to 11 per million population each year, and the property loss both residential and non-residential was estimated at 9 to 10 billion dollars each year. We know healthcare cost is expensive in the United States, and with the stated estimates, one can only envision the health care and public health system burden.

Discussion:

The characteristic neuropathology of carbon monoxide toxicity is bilateral Globus pallidus necrosis and the common neuropsychological symptoms include fatigue, affective conditions, emotional distress, memory deficits, sleep disturbance, vertigo, dementia, and psychosis. The health effects and associated disability demand policymakers to allocate resources for wildfire prevention/ containment and primary health care providers education, research, and building effective healthcare delivery systems.
Next Level Triage: Applications of Point-of-Care Ultrasound in Disaster Response and Recovery
Authors: Stannard Tyler , Liu E. Liang , Flax Lindsay A. , Swienton Raymond E. , Klein Kelly R. , Jones Jodi D. , Pascual Mandy M.
Published: May 2019

Introduction:

Ultrasound applications are widespread, and their utility in resource-limited environments are numerous. In disasters, the use of ultrasound can help reallocate resources by guiding decisions on management and transportation priorities. These interventions can occur on-scene, at triage collection points, during transport, and at the receiving medical facility. Literature related to this specific topic is limited. However, literature regarding prehospital use of ultrasound, ultrasound in combat situations, and some articles specific to disaster medicine allude to the potential growth of ultrasound utilization in disaster response.

Aim:

To evaluate the utility of point-of-care ultrasound in a disaster response based on studies involving ultrasonography in resource-limited environments.

Methods:

A narrative review of MEDLINE, MEDLINE InProcess, EPub, and Embase found 20 articles for inclusion.

Results:

Experiences from past disasters, prehospital care, and combat experiences have demonstrated the value of ultrasound both as a diagnostic and interventional modality.

Discussion:

Current literature supports the use of ultrasound in disaster response as a real-time, portable, safe, reliable, repeatable, easy-to-use, and accurate tool. While both false positives and false negatives were reported in prehospital studies, these values correlate to accepted false positive and negative rates of standard in-hospital point-of-care ultrasound exams. Studies involving austere environments demonstrate the ability to apply ultrasound in extreme conditions and to obtain high-quality images with only modest training and real-time remote guidance. The potential for point-of-care ultrasound in triage and management of mass casualty incidents is there. However, as these studies are heterogeneous and observational in nature, further research is needed as to how to integrate ultrasound into the response and recovery phases.
Nursing Can Improve Shelter Environment: Cluster Approach and the Sphere Standard Based Community Shelter Drill
Authors: Harada Nahoko , Tanoue Hiroki , Aiboshi Yuma
Published: May 2019

Introduction:

As Florence Nightingale stated, nursing plays a critical role in environmental management for people in sick, injured, and even good conditions. In current practice, affected people are forced to reside in the evacuation shelters for a prolonged period in Japan. Unfavorable living conditions lead to adverse physical and psychological outcomes including cardiovascular events, depression, and more. However, environment management cannot be achieved without involving the community.

Aim:

To initiate community into shelter environment management a multi-cluster drill was coordinated by the Department of Psychiatric and Mental Health Nursing, University of Miyazaki, which appointed a director of Shelter Management for the annual nation-wide disaster drill hosted by the Cabinet Office of Japan.

Methods:

With the Department of Health and Pharmaceuticals, Miyazaki Prefecture, the director invited local communities and held an exhibition type disaster drill on August 4, 2018.

Results:

36 organizations, including prefectural and municipal crisis management departments, health care organizations, a social welfare council, Red Cross, a telecommunication company, WASH cluster organizations, and the Japan Ground Self-Defense Force participated. The director requested to develop a plan filled with tactics and techniques protecting the health of people living in the shelter. Through meetings, the organizations recognized similarities and differences in roles, responsibilities, and capacities leading to an organized inter-cluster network. Participants created and prosecuted the plan independently and the director only orchestrated and negotiated with other supporting entities. The organizations exhibited and demonstrated how residents can protect their own physical and psychological health by setting up a proper shelter environment. Direct feedback from residents to organizations resulted in an expanded local network and the organizations improving their capacities.

Discussion:

Shelter environment cannot be managed by nursing solely but coordination by nurses may consolidate multi-cluster aid organizations so that shelter environment management would be done by residents and local organizations.
One Hospital’s Timeline for In-Hospital Vertical Evacuation during a Flood Disaster
Authors: Iwasaki Megumi , Shoko Tomohisa , Akahoshi Koki , Adachi Tomohiro , Yoshikawa Kazuhide
Published: May 2019

Introduction:

Recently, the risk of flood disasters due to concentrated heavy rains has been increasing in Japan. While some cases of hospital evacuation have been reported, standards for hospital evacuation have not been established and regional administrative evacuation plans do not include medical facilities.

Aim:

To clarify the timeline for in-hospital vertical evacuation during a flood disaster.

Methods:

A timeline was set for vertical evacuation as criteria of the hospital’s emergency response based on the Arakawa River Downstream Timeline, which is an estimate of the time until river flooding based on the water level of the Arakawa River located near the facility. The timeline was calculated backward from 0 hours to when the river floods. A drill was held for verification.

Results:

The timeline was based on the water level of the Arakawa River and objective evidence of risky transfer of critical patients; therefore, the decision to evacuate was made when the water level reached a dangerous level (-3 hours). However, this did not provide enough time to evacuate patients in all hospital departments simultaneously, resulting in a shortage of human resources. There was a planned shutdown of the electronic clinical record system at 0 hours to avoid water damage and evacuation of its server, but three hours were not enough to prepare patient clinical summaries.

Discussion:

There is a need for greater and earlier preparation for evacuation to reduce or discharge patients who can leave the hospital when a flood disaster is predicted. Only in-hospital vertical evacuation was considered because it is very risky to transfer critical patients without an evacuation order from government or municipal officials. In fact, over 10,000 patients would need to be evacuated in the region if the Arakawa River floods. Therefore, a regional plan is indispensable for such large scale and simultaneous hospital evacuations.
Perspective of an Academic Consortium for Preparedness of Emergency/Disaster Medical Response during 2020 Tokyo Olympic/Paralympic Games
Authors: Morimura Naoto
Published: May 2019

Introduction:

A large number of visitors to Tokyo during the Tokyo Olympic and Paralympic Games in 2020 resulted in an increase of injury/illness and burden to the routine emergency medical services system. Furthermore, extremely hot and humid weather, terrorism, and outbreaks of infectious diseases are marked risks.

Aim:

We introduce the present status of an academic consortium (AC2020) to fulfill our mission as academic organizations. The Japanese Association for Acute Medicine (JAAM) and six academic associations have initially established the AC2020 since 2016, which consists of the 23 associations at this time. The role of the AC2020 is to provide knowledgeable evidence, intelligence, and support for constructing response plans for medical problems via the website (http://2020ac.com/).

Methods:

The joint committee of the AC2020 (JC-AC2020) has been launched to accomplish consortium activities; make statements and recommendations, compile manuals, conduct seminars, and coordinate the training program of on-site medical teams. The JC-AC2020 organizes nine working groups of heat stroke, lightning strike, nursing, athletes, first responders, foreigners, pre and in-hospital response of MCI, and data collection for audit.

Results:

As of December in 2018, AC2020 has released 30 documents and 10 event-news on the website including seven statements, two recommendations of a prerequisite of the on-site medical team, and two manuals concerning the treatment of gunshot and explosive injuries. Based on some of these statements, the Tokyo government has already enhanced the previous plan.

Discussion:

The AC2020 will propose the web site as a portal site and platform, disseminate the activities widely to society, and ask for the cooperation of other related organizations and academic societies. The AC2020 will aim to provide the landmark project of mass-gathering medical care in Japan as well as the transition to the Olympic Games in Paris in 2024.
Pharmaceutical Relief Activities at Western Japan Torrential Rain Disaster
Authors: Egawa Takashi , Watanabe Akihiro , Nakano Takafumi , Kubo Tatsuhikiko , Nawata Rie , Hayashida Yuki , Raisen Natsuki , Kataoka Yasufumi , Kondo Hisayoshi , Koido Yuichi
Published: May 2019

Introduction:

The torrential rain triggering massive flooding and hundreds of landslides was the worst weather disaster in Western Japan. A temporary pharmacy was established in the Kurashiki health center, which provided medicine to victims.

Aim:

To evaluate the supply status of prescription under the health insurance system during a disaster.

Methods:

When the enormous disaster occurred, victims get a prescription in the hospital or community pharmacy under the Disaster Relief Act or Health Insurance Act. Under the Disaster Relief Act, prescriptions that are given at a first aid station are able to be filled at the mobile pharmacies at no cost to the patient from the local government. Prescriptions that are issued by a medical institution, and are in accordance with the Health Insurance Act or National Health Insurance Act, can be dispensed at hospitals or community pharmacies. Patients may be exempt from the co-payment by being covered by their health insurance. Here, we investigated the supply status of prescription to affected people.

Results:

The good points of the supply status were as following: 1) dispensing out of disaster area was a good system to relieve a pharmacist2. ) J-SPEED was also a good reporting system to provide appropriative medicine inventory management, and 3) sending prescription using a mobile phone was very useful for pharmaceutical activities. On the other hand, the points for improvement were as following: 1) more time to learn the medical insurance system during the disaster was needed, and 2) the mobile pharmacy is better to make the rounds of shelters including health care consultation.

Discussion:

In case of a disaster, two different medicine supply systems cause confusion to medical relief teams. It is considered that collaboration relief activities with relief teams that included a pharmacist was very important.
Pharmaceutical Services Preparedness of Military Units in an Institution of Brazilian Armed Forces
Authors: de Souza Tatiana Holanda Pereira , Miranda Elaine Silva
Published: May 2019

Introduction:

Military participation in humanitarian operations, both in cases of armed conflict and in response to natural disasters, is a common phenomenon in several countries. In Brazil, the Armed Forces have a history in providing humanitarian assistance to victims of emergencies through their field hospitals, such as medical and dental care, laboratory and imaging diagnosis, and pharmaceutical services.

Aim:

To verify pharmaceutical services preparedness of military units in an institution of Brazilian Armed Forces to disaster response and humanitarian aid.

Methods:

A transversal study was carried out. The methodological approach was based on a logical model and indicators related to the preparedness of pharmaceutical services. Field research was carried out and good storage practices were investigated in loco. Key stakeholders were interviewed based on an open-ended questionnaire on the preparedness of pharmaceutical services. Interviews were transcribed and analyzed for overall content, according to analytical categories stemming from the literature and indicators prior defined.

Results:

Key stakeholders of three military units were interviewed, and official documents and guidelines were also analyzed. Some pronounced shortcomings were identified, such as the lack of a specific budget for medicines management, no surplus of health supplies, lack of appropriate transports, and need of capacity building of health professionals and support team. The existence of a disaster plan, selection of essential medicines for primary reaction, forecasting of medicines, field hospitals as mobile and adaptable health structures, and a system for military mobilization are some of the strengths identified. Two military units are better structured in the management of pharmaceutical service. The third unit still needs to mature its processes to fit the health purposes of its mission.

Discussion:

These findings can subsidize the improvement of pharmaceutical services’ efficiency and quality in means of providing better response in emergency situations supported by the Brazilian Armed Forces.
Putting the Theoretical to Practical Use
Authors: Jaffe Eli
Published: May 2019

Introduction:

Managing an MCI (Mass Casualty Incident) can be a daunting task for emergency responders. Effective management can be a matter of life and death but can be directly impacted by the feelings of the incident commander.

Aim:

Students were trained to be incident commanders, then following the course were given a survey. In the days following the training, an MCI occurred involving a train full of passengers. The students were then given another survey to assess their readiness following the practical use of their studies.

Methods:

Students were given a survey to determine their mean level of confidence in managing MCIs prior to training, and following the training. Following the training, there was an increase in confidence. After the training, there was an MCI in which their theoretical knowledge was put to the test.

Results:

The pre-training self-efficacy mean scores of younger students (M=3.5, SD+0.23) increased after the training (M=3.8, SD+0.28) and rose even more following the presentation of the Turin train accident (M=4, SD+0.26). While a similar increase in self-efficacy was found among the more mature students post-training compared to the level prior to the training (M=3.7, SD+0.44 versus M=3.4, SD+0.56), the mean self-efficacy score of the mature students decreased following the presentation of the Turin train accident to the pre-training level (M=3.4, SD+0.51).

Discussion:

Mean scores of self-efficacy and confidence in managing MCIs were found to be higher among medical students that were previously trained in coping with MCIs compared to medical students who participated in such a training program for the first time.
A Qualitative Study of Household Emergency Preparedness of the Elderly and the Medically Frail Living in Coastal Urban Environments
Authors: Heagele Tara
Published: May 2019

Introduction:

As more chronically ill people are living in the community and disasters are occurring frequently, the elderly and the medically frail vulnerable populations are experiencing significantly more disaster-related morbidity and mortality than the rest of the population. A failure to adequately address these vulnerabilities has been shown to have negative effects on the response to the disaster and the community as a whole.

Aim:

The purpose of this research was to understand how older and/or medically frail adults have experienced disaster and how this experience impacts what they do now to prepare for disaster. A second purpose was the generation of theory regarding the process through which community members prepare for disasters.

Methods:

This study employed a qualitative descriptive methodology, Situational Analysis, to explore the social processes of disaster preparedness in older and/or medically frail adults.

Results:

The core category was “Experience is the Best Teacher.” Based on the findings, it was theorized that these community members are generally considered unprepared for disaster. Their lack of preparedness is due in large part to a lack of education on how best to prepare. Once educated, motivation for self-responsibility of household emergency preparedness can be expected. Community interventions like distributing disaster supply kits and offering evacuation assistance help overcome their situational impediments to preparedness and provide the best chance for these community members to survive disasters without becoming ill or injured or experiencing a decline in their baseline functional status. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience.

Discussion:

The results from this study could inform emergency plans and policy efforts to better meet the needs of elderly and medically frail community members during disaster.
Regional Engagement Program: Supporting Local Leadership and Building Local Skills and Knowledge in Order to Develop a Systematic Approach to Disaster Medical Management
Authors: Vermeulen Lisa , Stephens Dianne
Published: May 2019

Introduction:

One of the key components in any effective disaster response is the capacity of local communities to respond in a timely and efficient manner. Over the last 3 years, the National Critical Care and Trauma Response Centre in Darwin has been involved in building regional capacity across the Asia-Pacific, supporting local leadership and building local skills and knowledge in order to develop a systematic approach to disaster medical management.

Aim:

This presentation is to describe the Regional Engagement Program, its strengths, weaknesses, and outcomes.

Methods:

We will describe the background to the program, the process for regional engagement and the Results of our evaluation. The program used the Major Incident Medical Management Systems (MIMMS) approach which was delivered in-country and included identifying and using local personnel to deliver the program. The program was conducted across the region in Myanmar, Fiji, Tonga, Vanuatu, Samoa, Timor, and Indonesia. Initially the courses were run by personnel from Australia but through engagement with local Ministries of Health and collaboration with identified key stakeholders, we have been able to build local faculty to ensure sustainability and local ownership.

Results:

Thirty-six personnel have been trained across four countries. Thirty-six candidates are now instructors, with a further 36 identified for future development as instructors. The evaluation illustrates the long-term partnerships that have been developed and the ongoing capacity development of key regional partners.

Discussion:

The Regional Engagement program demonstrates that prolonged engagement with key regional stakeholders and adequate and sustained mentoring will successfully build local capacity to the level needed to mount a successful response to a disaster. Personnel trained through this program helped guide the response to the Lombok earthquake and in Fiji, a MIMMS Team Member training program was conducted with minimal external support.
A Registry Software for Road Traffic Injury Patients at Apex Trauma Centre in India: An Innovation
Authors: Kaushik Gaurav , Gupta Amit , Kumar Subodh , Soni Kapil Dev , Sharma Ankita
Published: May 2019

Introduction:

A trauma registry is a disease-specific data collection composed of a file of uniform data elements that describe the injury even, demographics, prehospital information, diagnosis, care, outcomes, and costs of treatment for injured patients.

Aim:

To establish a trauma registry system on an electronic platform enabling data capturing through Android phones.

Methods:

A software has been developed for the registry data collection for road traffic injury patients arriving at JPNATC, AIIMS, New Delhi. The software has been designed to use in the Emergency Department on Android phones/laptops with internet access.

Result:

A detailed registry data set has been prepared to enter prehospital, in-hospital, and post-discharge details of all the admitted patients. This includes demographic data, prehospital data, injury event data, vital signs within 24-hrs of arrival, ED disposition (date and time), operative procedures within 48 hours of arrival, chest x-ray (date and time), CT (date and time), ventilation days, ICU-stay days, hospital disposition (date and time), injury coding data (region, severity level, ISS, AIS, ICD-10) and Others, e.g., first neurosurgical consultation (date and time) and first blood transfusion (date and time). There are two panels for this software; one for user panel and another for the administrative panel. User panel is being used for data collection by the trained data collectors 24/7 at the emergency department on a rotation basis. The administrative panel is accessible to only the investigator or other authorized persons. The administrative panel and user panels are password protected. The entered data is being saved in a spreadsheet in the backend and can be used for periodic data quality check and data analysis.

Discussion:

There is no trauma registry in India so far for the road traffic injury patients. Present innovation would lay the foundation of national Trauma Registry in India.
Rescue Operations in Underground Mines: Caring for Patients in a Challenging Environment
Authors: Karlsson Sofia , Saveman Britt-Inger , Gyllencreutz Lina
Published: May 2019

Introduction:

Major injury incidents in underground metalliferous and mineral mines are rare, but if, e.g., a major fire would occur, it is the emergency medical service (EMS) together with the mining company and rescue service who perform the rescue operation. Therefore it is important to develop safe and efficient rescue operation procedures for all the organizations involved, especially the EMS personnel.

Aim:

To examine EMS personnel’s perceptions and experiences regarding underground mining incidents.

Method:

Individual interviews were performed with 13 Swedish EMS personnel. The interviews were transcribed verbatim and analyzed with qualitative content analysis.

Results:

The theme “providing the same care in a difficult environment” emerged. Depending on the type of incident, the EMS personnel considered if the injured mining workers could be cared for either outside or in the mine in order to access and care for the injured mining workers as quickly as possible. The EMS personnel mentioned that it was difficult to make the decision if they should enter the mine or not due to the uncertainty of their safety. They also considered that it could be harder to accomplish the same level of care as in other incidents due to the difficult environment. In some instances, they cannot drive their ambulance vehicles into the mine, so they have to prioritize which equipment to bring as well as consider how to transport the patients.

Discussion:

The results identify some of the difficulties the EMS find challenging. Therefore the results could be used in finding solutions and making the EMS prepared for an effective and timely response for injured in underground mines.
Research on Design of a Disaster Medicine Course for Clinical Medical Student
Authors: Wan Zhi , Hu Hai
Published: May 2019

Introduction:

Currently, there is no uniform and standard disaster medicine course for students in medical school.

Aim:

To design a disaster medicine course model based on knowledge structure, teaching and evaluation methods according to experts’ advice and interest of undergraduates majoring in clinical medicine.

Methods:

The first and second level catalog defined as chapters and sections for the disaster medicine curriculum were drafted based on literature and summary of fragmentary experience. The teaching syllabus with methods of teaching and evaluation was initially outlined. The expert consultation form and student questionnaire were designed and validated. Experts in disaster medicine in China were consulted and students in our medical school were investigated. Delphi Methods was used and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts and students.

Results:

A total of 31 experts were consulted. 320 students were inquired. By two rounds of consultation with Kendall coordination coefficient W value 0.207, chi-square value 128.781(p=0.01), consensus about the knowledge structure for the curriculum were achieved, which consisted of 6 chapters (as Introduction to disaster medicine, incident command, medical knowledge and skills in disaster, public health, ethics in disaster, information management, with the weights of 0.1486, 0.1999, 0.4209, 0.0785, 0.0748, 0.0774 respectively)and 25 sections. Teaching methods for different knowledge module were determined, which included lecture, demonstration, case discussion, drill and sand table simulation. And the evaluation methods were affirmed as a quiz, written examination, skill test and teamwork test assessed by intra-group and inter-group evaluation.

Discussion:

Through scientific investigation of experts in disaster rescue and undergraduates majoring in clinical medicine, a disaster medicine course model for clinical medical students was established.
Resilience Training of Regional Medical Command and Control
Authors: Pettersson RN Jenny , Jonson Carl-Oscar , Berggren Peter , Woltjer Rogier , Hermelin Jonas , Prytz Erik
Published: May 2019

Introduction:

Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.

Aim:

To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.

Methods:

A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).

Results:

A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”

Discussion:

Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.
Sleep in Emergency Services Workers: What Do We Know and Why Does It Matter?
Authors: Ferguson Sally , Aisbett Brad , Wolkow Alexander , Jay Sarah , Ridgers Nicola , Vincent Grace
Published: May 2019

Introduction:

Emergency service workers perform physical work while being subjected to multiple stressors and adverse, volatile working environments for extended periods. Recent research has highlighted sleep as a significant and potentially modifiable factor impacting operational performance.

Aim:

This presentation would (a) examine the existing literature on emergency service workers’ sleep quantity and quality during operations, (b) synthesize the operational and environmental factors that impact sleep (e.g., shift start times, shift length, sleeping location, smoke, noise, heat), and (c) assess how sleep impacts aspects of emergency service workers’ health and safety, including mental and physical health and performance.

Methods:

This presentation would be based on a narrative review conducted by the authors which used a systematic search strategy of health-related databases. Articles that were not relevant, duplicate or from non-peer-reviewed sources were excluded.

Results:

Sleep is restricted during emergency service deployments, particularly when shifts have early start times, are long duration, and/or when sleeping in temporary accommodation (e.g., tents, vehicles). Shortened sleep impairs cognitive but not physical performance under simulated emergency services conditions.

Discussion:

Depending on the organization and jurisdiction, these findings warrant re-evaluation of existing policies, formalization of beneficial but currently ad-hoc practice, or provide support for current procedures. Work shifts should be structured, wherever possible, to provide regular and sufficient recovery opportunities (rest during and sleep between shifts), especially in dangerous working environments where fatigue-related errors have more severe consequences. For agencies to continue to defend local communities against natural hazards, strategies should be implemented to improve and manage emergency service workers sleep and reduce any adverse impacts on work.
Strategies to Decrease Nurses’ Stress in a Federal Medical Station (FMS) Medical Needs Shelter in the U.S. after a Hurricane Disaster
Authors: Smith Montray , Hines-Martin Vicki
Published: May 2019

Introduction:

National Disaster Medical System (NDMS) Disaster Medical Assistance Teams (DMATs) are used to provide medical care when local and state resources are overwhelmed in response to natural and human-made disasters. The stress these professionals experience during these events requires intentional and therapeutic interventions to support emotional and mental resilience. Evidence-based interventions will be presented.

Aim:

DMATs were deployed after Hurricane Maria to work in a Federal Medical Station (FMS), at the Coliseum Bencito, Manati, Puerto Rico. The FMS was operated through a collaboration of federal agencies and non-government agencies. Community infrastructure was impacted, including two damaged area hospitals, overwhelming available resources with increased patient care demands. The facility provided acute care and short-term services around the clock for a 10-day period, serving several hundred clients, in and around the municipality of Manati.

Methods:

Several strategies were utilized to decrease stress levels while nurses worked at the FMS included having a safe and secure environment, sharing stories with peers, taking scheduled breaks, utilizing physical activities (Zumba), and having designated sleeping areas. Additional strategies used for clients were relief supply choices, allowing one person to stay with special needs client, and bereaved care.

Results:

Nurses were able to decrease stress levels to themselves and clients while working with community partners providing acute and chronic health care needs at the area where health care services were impacted. Verbal and written feedback was provided during formal and informal meetings as well as receiving client comments on the services given at the facility.

Discussion:

Contribution to practice-heightened emotional responses in a disaster setting are expected and should be a focus of intervention even with health care providers. Nurses were able to employ disaster nursing knowledge, including mental health strategies in this setting and be able to better address the needs of others.
Study on the Effectiveness Evaluation of Personal Protective Equipment for Health Care Staff Trained with Graphical Interpretation and Operation
Authors: Sha Yang , Jian-Ping You , Hui-Lan Zhang , Hong-Xia Luo
Published: May 2019

Introduction:

Proper use of personal protective equipment (PPE) is essential when facing emerging infectious diseases. Proper training methods can promote the use of the PPE correctly.

Aim:

To explore the effect of the training method of sequential operation training on medical staff to master PPE penetration and removal skills, and to study the memory attenuation after training.

Methods:

Fifteen medical staff with no experience of PPE operation in a hospital were trained to wear PPE in accordance with WHO standards by illustration and sequential operation method. The training included 30 minutes of theoretical teaching and 60 minutes of practical exercises. At the end of the training and 1 week after the training, the training objects were evaluated for PPE operation. A 2.5 x 2.5 cm fluorescent agent was applied on 6 parts, such as hands, chest, abdomen, and knees, to simulate contamination. After taking the PPE off, the parts of the whole body and the inner layer of clothing that were fluorescently contaminated were recorded. The whole operation process was recorded by video to evaluate whether the operation was correct. The error rates of two operations and the contamination position and frequency were compared.

Results:

The error rate of the operating PPE after training was 18.6%, rising to 31.9% after 1 week (Z=16.0, P<0.05). After the training, the average number of contaminated PPE removal was 1.96±1.56, which rose to 2.96±2.03 one month later. The difference was statistically significant (Z=8.92, P<0.05). The main vulnerable sites are the wrist, chest, abdomen, and left calf.

Discussion:

Illustrative sequential operation training is an important means to improve the way for medical staff to wear PPE, but it must be completed more than once to ensure that medical staff can firmly master the skills of wearing and removing PPE.
A Study on the Process of Donning and Doffing Personal Protective Equipment of Health Care Workers (HCWs) in China
Authors: Hong-Xia Luo , Hui-lan Zhang , Jian-Ping You , Sha Yang
Published: May 2019

Introduction:

Personal protective equipment (PPE) is a necessary item in the period of unknown and high risk emerging infectious disease. It is not only the necessary requirement of strict isolation but also the last line of defense to protect medical staff.

Aim:

To determine the frequency and sites of contamination of personnel during the process of using Chinese PPE.

Methods:

Recruit 56 health care workers (HCWs) who worked in front-line clinical to test PPE issued by the Chinese Center for Disease Control for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion. Then the frequency and sites of contamination of personnel were recorded after removal of contaminated PPE. The method of visual observation was used to determine contamination.

Results:

The frequency of easily contaminated parts included: left hand and wrist (7 times), left calf (7 times), front chest center, left and right chest (6 times each), and left abdomen (5 times). Mistakes in the process of wearing PPE included: clothing touching the ground (20.00%), N95 air mask tightness not checked (13.33%), glove air-tightness not checked (4.44%), protective clothing zipper not checked (4.44%). Mistakes in doffing PPE included: clothes touching the ground or the inner surface is polluted (20.00%), the wrong method of removing N95 mask (14.44%), touching the pollution goggles mirror with hands (12.22%), incomplete washing steps, insufficient time and frequency of hand hygiene (11.11%).

Discussion:

It is necessary to carry out training on PPE donning and doffing for Chinese medical workers.
To Sedate or Not to Sedate? Lessons Learned from a Novel Pediatric Simulation-Based Training Curriculum for Procedural Sedation Privileges in Acute Care Pediatricians
Authors: Severin Paul , Robin Beverley
Published: May 2019

Aim:

To develop a simulation-based pediatric procedural sedation curriculum for acute care attending physicians to achieve and maintain privileges in this important skill.

Methods:

Neonatal and pediatric intensive care physicians participated in simulation-based sedation training to achieve and maintain sedation privileges. Participants were required to review pediatric sedation materials prior to participation. Demographic data were collected prior to the simulations, and all participants completed a pre-test to assess their baseline knowledge. Sessions were held in the simulation center or neonatal intensive care unit (depending on group), and the attending physicians, in pairs, participated in two high-fidelity mannequin scenarios (sedation for a painful procedure; hypoxia during sedation). Simulations were followed by a facilitated debriefing session while utilizing a standard performance checklist. All participants completed a program evaluation at the conclusion of their training.

Results:

Neonatal (n=11) and pediatric (n=9) intensive care attending physicians participated in the sedation simulation training. The program was well received and 100% rated it as “excellent” or “very good”. All participants strongly agreed the instructors allotted time for questions/answers, 100% strongly agreed the debriefing/feedback was effective, 95% strongly agreed instructors had a thorough knowledge and understanding of the program, were supportive, and facilitated learning, and 95% strongly agreed the equipment and physical environment were conducive to learning. Participants reported that simulation-based training and the use of a standardized checklist during facilitated debriefing were very helpful and effective for sedation training. Additionally, many participants indicated the desire for more simulation-based training.

Discussion:

Simulation-based sedation training is a feasible, easy to implement, and viable learning technique for acute care physicians.
Using Security Guards and Civil Volunteers as First Responders in Medical Emergency Response - Tasks, Needs, and Challenges
Authors: Pilemalm Sofie
Published: May 2019

Introduction:

Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.

Aim:

To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.

Methods:

A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.

Results:

The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.

Discussion:

Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.