bluuebunny/crossref_metadata_2025 huggingface dataset:
Disaster Healthcare System Management and Crisis Intervention Leadership in Thailand–Lessons Learned from the 2004 Tsunami Disaster
Authors: Peltz Rami , Ashkenazi Issac , Schwartz Dagan , Shushan Ofer , Nakash Guy , Leiba Adi , Levi Yeheskel , Goldberg Avishay , Bar-Dayan Yaron
Published: August 2016

Introduction:

Quarantelli established criteria for evaluating the effectiveness of disaster management.

Objectives:

The objectives of this study were to analyze the response of the healthcare system to the Tsunami disaster according to the Quarantelli principles, and to validate these principles in a scenario of a disaster due to natural hazards.

Methods:

The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research team to study the response of the Thai medical system to the disaster. The analysis of the disaster management was based on Quarantelli's 10 criteria for evaluating the management of community disasters. Data were collected through personal and group interviews.

Results:

The three most important elements for effective disaster management were: (1) the flow of information; (2) overall coordination; and (3) leadership. Although pre-event preparedness was for different and smaller scenarios, medical teams repeatedly reported a better performance in hospitals that recently conducted drills.

Conclusions:

In order to increase effectiveness, disaster management response should focus on: (1) the flow of information; (2) overall coordination; and (3) leadership.
The Volendam Fire: Lessons Learned from Disaster Research
Authors: Harten Sabine M.van , Bierens Joost J.L.M. , Welling Lieke , Patka Peter , Kreis Robert W. , Boers Maarten
Published: August 2016

Introduction:

After the Volendam fire, a multidisciplinary, integral evaluation, called the Medical Evaluation of the Disaster in Volendam (MERV), was established. This article is a discussion of disaster research methodology. It describes the organizational framework of this project and the methodological problems.

Methods:

A scientific steering group consisting of members from three hospitals prepared and guided the project. A research team wrote the final study protocol and performed the study. The project was funded by the Ministry of Health. The study protocol had a modular design in which each of the modules focused on one specific area or location. The main questions for each location were: (1) which treatment protocols were used; (2)what was the condition of the patient; and (3) was medical care provided according to existing protocols. After the fire, 241 victims were treated in hospitals; they all were included in the study. Most of the victims had burn injuries, and approximately one-third suffered from inhalation injury. All hospitals and ambulance services involved were visited in order to collect data, and interviewers obtained additional information. The government helped obtain permission for data-collection in three of the hospitals. Over 1,200 items of information about each patient and >200,000 total items were collected. During data processing, the data were re-organized, categorized, and presented in a uniform and consistent style. A cross-sectional site analysis and a longitudinal patient analysis were conducted. This was facilitated by the use of several sub-data-bases. The modular approach made it possible to obtain a complete overview of the medical care provided. The project team was guided by a multidisciplinary steering group and the research was performed by a research team. This enabled the research team to focus on the scientific aspects.

Conclusion:

The evaluation of the Volendam fire indicates that a project approach with a modular design is effective for the analysis of complex incidents. The use of several sub-databases makes it easy to combine findings and conduct cross-sectional and longitudinal analyses. The government played an important role in the funding and support of the project. To limit and structure data collection and analysis, a pilot study based on several predefined main questions should be conducted. The questions then can be specified further based on the availability of data.
Reactions to Cold Exposure Emphasize the Need for Weather Protection in Prehospital Care: An Experimental Study
Authors: Lintu Niina S. , Health M. , Mattila Matti A.K. , Holopainen Jaana A. , Koivunen Mari , Hänninen Osmo O.P.
Published: August 2016

Introduction:

Exposure to cold temperature is a serious but often neglected problem in prehospital care. It not only is an uncomfortable, subjective experience, but it also can cause severe disturbances in vital functions, gradually leading to hypothermia.

Objective:

The aim of this study was to examine healthy subjects'physiological and subjective reactions to cold exposure (30 minutes at -5°C in the a climatic chamber) while they were lying in a protective covering.

Methods:

Healthy volunteers (n = 20) participated in the experiment, which consisted of a 10-minute stabilization period of vital functions at room temperature (23°C), 30 minutes of cold exposure (-5°C), and a 30-minute recovery period at room temperature. Subjects lay supinely in protective covering during the entire experiment. Skin temperatures, oxygen saturation, pulse rates, pulse wave amplitude in the middle finger, and surface electromyography (EMG) activity of the major pectoral muscle were recorded continuously during the test. Before and immediately after the cold exposure, tympanic membrane temperatures were measured. In addition, subjects were asked to estimate cold using a standard scale.

Results:

During the cold exposure, the decrease in tympanic membrane temperature was not significant.The pulse wave amplitude in the finger decreased sharply upon entering the cold chamber. Skin temperatures, especially of the fingers and toes, decreased during the cold exposure.There were no clear signs of shivering in electromyographic recordings. Subjective cold feelings followed decreasing skin temperatures. Skin temperatures did not return quickly. Even 30 minutes after the exposure, all the skin temperatures still had not returnedto normal levels.However, subjective cold feeling was relieved immediately.

Conclusions:

Cold exposure provoked immediate protective vasoconstriction in the peripheral compartment, which caused linear decreases of local skin temperatures. This probably was triggered from the unprotected face and upper respiratory areas.
Express Railway Disaster in Amagasaki: A Review of Urban Disaster Response Capacity in Japan
Authors: Nagata Takashi , Rosborough Stephanie N. , VanRooyen Michael J. , Kozawa Shuichi , Ukai Takashi , Nakayama Shinichi
Published: August 2016

Introduction:

On the morning of 25 April 2005, a Japan Railway express train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst rail disaster in 40 years.This study chroniclesthe rescue efforts and highlights the capacity of Japan's urban disaster response.

Methods:

Public reports were gathered from the media, Internet, government, fire department, and railway company. Four key informants, who were close to the disaster response, were interviewed to corroborate publicdata and highlight challenges facing the response.

Results:

The crash left 107 passengers dead and 549 injured. First responders, most of whom were volunteers, were helpful in the rescue effort, and no lives were lost due to transport delays or faulty triage. Responders criticized an early decision to withdraw rescue efforts, a delay in heliport set-up, the inefficiency of the information and instruction center, and emphasized the need for training in confined space medicine. Communication and chain-of-command problems created confusion at the scene.

Conclusions:

The urban disaster response to the train crash in Amagasaki was rapid and effective.The KobeEarthquake and other incidents sparked changes that improved disaster preparedness in Amagasaki. However, communication and cooperation among responders were hampered, as in previous disasters, by the lack of a structured command system. Application of an incident command system may improve disaster coordination in Japan.
A Pilot Assessment of Hospital Preparedness for Bioterrorism Events
Authors: Thorne Craig D. , Levitin Howard , Oliver Marc , Losch-Skidmore Sue , Neiley Beth A. , Socher Myra M. , Gucer Patricia W.
Published: August 2016

Objective:

Lessons on question content and refinement of a 2003 Agency for Healthcare Research and Quality-Health Resources Services Administration (Agency for Healthcare Research and Quality-Health Resources Services) pilot hospital preparedness assessment tool designed to capture activities in more detail than previous studies are reported in this study.

Methods:

Responses from fixed-choice questions, including organizational and geographical differences, were analyzed using the chi-square test. Openended questions were evaluated qualitatively.

Results:

Of the respondents, 91% had developed plans and 97% designated a bio-event coordinator, but only 47% had allocated funds. Urban hospitals were more likely to participate in regional infectious disease monitoring. Hospitals that participated in a network were more likely to fund preparedness, share bio-event coordinators and medical directors, and provide advanced training.

Conclusions:

Several issues deserve further study: (1) hospital networks may provide the structure to promote preparedness; (2) specific procedures (e.g., expanding outpatient treatment capacity) have not been tested; and (3) special attention should be directed towards integrating non-urban hospitals into regional surveillance systems to ensure early identification of infectious disease outbreaks.
Treatment Management in Disaster: A Review of the Bam Earthquake Experience
Authors: Saghafinia Masoud , Araghizade Hassan , Nafissi Nahid , Asadollahi Reza
Published: August 2016

In the early morning of 26 December 2003, Bam, an old city in southeastern Iran, was devastated by an earthquake measuring 6.6 on the Richter scale. Managing such situations always brings about many problems. In the case of the Bam Earthquake, two of the most serious problems were rescue operations and provision of appropriate treatment within a short period of time.

By conducting an opinion survey, this study aims to assess different aspects of treatment management, including personnel, the transfer of the injured, equipment, facilities, and treatment planning. Questionnaires containing open questions regarding the management of treatment at five levels were prepared.Those engaged in treatment at different levels, including physicians, treatment workers, military personnel, and executives, were questioned. Several problems were revealed concerning the composition of the treatment forces dispatched, into the region, distribution of the tasks among treatment workers, and the transferring of equipment, and facilities. The most significant problem was a lack of coordination among the organizations responsible for the management of the disaster.

A comprehensive disaster plan is required if prompt handling of masscasualty incidents and coordinating the management of such large-scale disasters are to be ensured.
Standards in Collaborative International Disaster Drills: A Case Study of Two International Search and Rescue Drills
Authors: Rokach Ariel , Pinkert Moshe , Nemet Dani , Goldberg Avishay , Bar-Dayan Yaron
Published: August 2016

Introduction:

During the last few decades, various global disasters have ren-dered nations helpless (such as Thailand's tsunami and earthquakes in Turkey, Pakistan, Iran, and India). A lack of knowledge and resources make it difficult to address such disasters. Preparedness for a national disaster is expensive, and in most cases, unachievable even for modern countries. International collabo-ration might be useful for coping with large-scale disasters. Preparedness for international collaboration includes drills. Two such drills held by the Israeli Home Front Command and other military and civilian bodies with the nations of Greece and Turkey are described in this article.

Methods:

The data were gathered from formal debriefings of the Israeli teams collaborating in two separate drills with Greek and Turkish teams.

Results:

Preparations began four months before the drills were conducted and included three meetings between Israeli and foreign officials. The Israeli and foreign officials agreed upon the drill layout, logistics, communications, resi-dence, real-time medicine, hardware, and equipment. The drills took place in Greece and Turkey and lasted four days. The first day included meetings between the teams and logistics preparations. The second and third days were devoted to exercises. The drills included evacuating casualties from a demoli-tion zone and treating typical injuries such as crush syndrome. Every day ended with a formal debriefing by the teams' commanders. The fourth day included a ceremony and transportation back home. Members in both teams felt the drills improved their skills and had an important impact on creating common language that would enhance cooperation during a real disaster.

Conclusions:

A key factor in the management of large-scale disasters is coor-dination between countries. International drills are important to create com-mon language within similar regulations.
Practical Solutions for Injury Surveillance at Mass Gatherings
Authors: Zeitz Kathryn , Zeitz Chris , Arbon Paul , Cheney Fiona , Johnston Renee , Hennekam James
Published: August 2016

Introduction:

Public safety at mass gatherings is the responsibility of multi-ple agencies. Injury surveillance and inter-agency communication are pivotal to ensure continued public safety.

Objectives:

The principal objective of this pilot study was to improve the identification of trends and patterns of injury presentations at mass gather-ings. This was achieved through an electronic process for data gathering to support timely reporting of injury data. In addition, what evolved was the devel-opment of an inter-agency communication model to support information transfer.

Methods:

An Electronic Injury Surveillance System was created and piloted at two mass gatherings in South Australia. Live, real-time data were collect-ed via customized software supported by electronic report generation.

Results:

The Injury Surveillance System captured data on 181 injured patients and assisted in the identification of trends and patterns of presenta-tions. The relevant injuries and patterns of injuries were reported to the appropriate organizations based on pre-defined communication models.

Conclusions:

The pilot study demonstrated that it was possible to perform “live”, portable injury surveillance during patient presentations at two mass gatherings. The Injury Surveillance System ensured immediate data capture. Well-defined communication systems established for this pilot also enabled early action to rectify hazards. Further development of electronic injury sur-veillance should be considered as an essential tool for managing public safety at mass gatherings.
Polonium-210 Poisoning in London: Hypochondriasis and Public Health
Authors: Morgan Oliver W. , Page Lisa , Forrester Sarah , Maguire Helen
Published: August 2016

Introduction:

In November 2006, a Russian dissident died from radioactive Polonium-210 (210Po) poisoning in London. Providing reassuring messages during a public health incident may be ineffective for individuals with high health anxiety (hypochondriasis).

Methods:

Members of the public who called a 24-hour telephone helpline were offered a follow-up call by a health protection specialist for reassurance. A psychiatrist attempted to contact those callers who were unable to be reas-sured by the health protection specialist.

Results:

Of 872 individuals contacted for reassurance, seven (0.6%) could not be reassured. The psychiatrist contacted four of these individuals. Three had a history of health-related anxiety and two attributed somatic symptoms to 210 Po exposure.

Conclusions:

For individuals with hypochondriasis, reassurance during major public health incidents may be ineffective. Having a psychiatrist available was helpful in managing individuals with excessive health anxiety.
Use of “Shuttered” Hospitals to Expand Surge Capacity
Authors: Zane Richard D. , Biddinger Paul , Ide Lyndsley , Phillips Sally , Hurd Donna , Buatti Louisa , Eustace Hilary , Amsden Matthew , Carr Darcy , Hassol Andrea
Published: August 2016

Introduction:

With limited available hospital beds in most urban areas, there are very few options when trying to relocate patients already within the hospital to make room for incoming patients from a mass-casualty incident (MCI) or epidemic (a patient surge). This study investigates the possibility and process for utilizing shuttered (closed or former) hospitals to accept medically stable, ambulatory patients transferred from a tertiary medical facility.

Methods:

Two recently closed, acute care hospitals were evaluated critically to determine if they could be made ready to accept inpatients within 3–7 days of a MCI. This surge facility ideally would be able to support 200–300 patients/beds. Two generic scenarios were used for planning: (1) a patient surge (including one caused by conventional war or terrorism, weapons of mass destruction, or a disaster caused by natural hazards) requiring transfer of ambulatory, medically-stable inpatients to another facility in an effort to increase capacity at existing hospitals; and (2) a bio-event or epidemic where a shuttered hospital could be used as an isolation facility.

Results:

Both recently closed hospitals had significant, but different challenges to reopening, although with careful planning and resource allocation it would be possible to reopen them within 3–7 days. Planning was the most conclusive recommendation. It does not appear possible to reopen shuttered hospitals with major structural deterioration or a complete lack of current mission (i.e., no current utilities). Staffing would represent the most challenging issue as a surge facility would represent an incremental additional need for existing and scarce human resources.

Conclusions:

With careful planning, a shuttered hospital could be reopened and ready to accept patients within 3–7 days of a MCI or epidemic.
Twenty-Five Years of Violence: The Epidemiology of Terrorism in South America
Authors: Báez Amado Alejandro , Sztajnkrycer Matthew D. , Zane Richard , Giráldez Ediza
Published: August 2016

Introduction:

Terrorism is a global public health burden. South Americans have been victims of terrorism for many decades.While the causes vary, the results are the same: death, disability, and suffering.The objective of this study was to perform a comprehensive, epidemiological, descriptive study of terrorist incidents in South America.

Methods:

This is a cross-sectional, descriptive study. Data from January 1971 to July 2006 was selected using the RAND Terrorism Chronology 1968–1997 and RAND®-Memorial Institute for Prevention of Terrorism (MIPT) Terrorism Incident database (1998–Present). Statistical significance was set at 0.05.

Results:

The database reported a total of 2,997 incidents in South American countries that resulted in 3,435 victims with injuries (1.15 per incident) and 1,973 fatalities (0.66 per incident). The overall case fatality ratio (CFR) was 35.8%. Colombia had the majority of incidents with 57.9% (1,734 of 2,997), followed by Peru with 363 (12.1%), and Argentina with 267 (8.9%). The highest individual CFR occurred in Paraguay (83.3%), and the lowest in Chile with 4.8%. Of the total injuries and deaths, Colombia had 66.1% (2,269 of 2,997) of all injuries and 75.2% (1,443 out of 1,920) of all deaths. Living in the country of Colombia was associated with a 16 times greater likelihood of becoming a victim of terrorist violence [odds ratio (OR) 16.15; 95% CI 13.45 to 19.40; p <0.0001].The predominant method of choice for terrorist incidents was the use of conventional explosives with 2,543 of 2,883 incidents (88.2%).

Conclusions:

Terrorist incidents in South America have accounted for nearly 2,000 deaths, with conventional explosive devices as the predominant method of choice. Understanding the nature of terrorist attacks and the medical consequences assist emergency preparedness and disaster management officials in allocating resources and preparing for potential future events.
Decontamination of Multiple Casualties Who Are Chemically Contaminated: A Challenge for Acute Hospitals
Authors: Clarke Simon F.J. , Chilcott Rob P. , Wilson James C. , Kamanyire Robie , Baker David J. , Hallett Anthony
Published: August 2016

Patients who have been contaminated by chemical compounds present a number of difficulties to emergency departments, in particular, the risk of secondary contamination of healthcare staff and facilities. The Department of Health in the United Kingdom has provided equipment to decontaminate chemically contaminated casualties who present at emergency departments. The capacity of this equipment is limited, and although both the ambulance and fire services have equipment to cope with mass casualties at the scene of a chemical incident, there is still the possibility that acute hospitals will be overwhelmed by large numbers of self-presenting patients. The risks and potential consequences of this gap in resilience are discussed and a number of possible practical solutions are proposed.
Simulation of a Hospital Disaster Plan: A Virtual, Live Exercise
Authors: Franc-Law Jeffrey M. , Bullard Michael , Corte F. Della
Published: August 2016

Introduction:

Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient data- base and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan.

Purpose:

A virtual, live exercise was designed with the primary objective of evaluating a hospital's emergency department disaster plan. Education and training of participants was a secondary goal.

Methods:

A database (disastermed.ca) of histories, physical examination findings, and laboratory results for 136 simulated patients was created using information derived from actual patient encounters.The patient database was used to perform a virtual, live exercise using a training version of the emergency department's information system software.

Results:

Several solutions to increase patient flow were demonstrated during the exercise. Conducting the exercise helped identify several faults in the hospital disaster plan, including outlining the important rate-limiting step. In addition, a significant degree of under-triage was demonstrated. Estimates of multiple markers of patient flow were identified and compared to Canadian guidelines. Most participants reported that the exercise was a valuable learning experience.

Conclusions:

A virtual, live exercise using the disastermed.ca patient database was an inexpensive method to evaluate the emergency department disaster plan. This included discovery of new approaches to managing patients, delineating the rate-limiting steps, and evaluating triage accuracy. Use of the patient timestamps has potential as a standardized international benchmark of hospital disaster plan efficacy. Participant satisfaction was high.
Media Coverage of Violent Deaths in Iraq: An Opportunistic Capture-Recapture Assessment
Authors: Siegler Anne , Roberts Leslie , Balch Erin , Bargues Emmanuel , Bhalla Asheesh , Bills Corey , Dzeng Elizabeth , Epelboym Yan , Foster Tory , Fulton Latressa , Gallagher Meghan , Gastolomendo Juan David , Giorgi Genessa , Habtehans Semhar , Kim Jennifer , McGee Blake , McMahan Andrew , Riese Sara , Santamaria-Schwartz Rachel , Walsh Fiona , Wahlstrom Jessica , Wedeles John
Published: August 2016

Introduction:

Western media coverage of the violence associated with the 2003 US-led invasion of Iraq has contrasted in magnitude and nature with population-based survey reports.

Objectives:

The purpose of this study was to evaluate the extent to which first-hand reports of violent deaths were captured in the English language media by conducting in-depth interviews with Iraqi citizens.

Methods:

The England-based Iraq Body Count (IBC) has methodically monitored media reports and recorded each violent death in Iraq that could be confirmed by two English language media sources. Using the capturerecapture method, 25 Masters' Degree students were assigned to interview residents in Iraq and asked them to describe 10 violent deaths that occurred closest to their home since the 2003 invasion. Students then matched these reports with those documented in IBC. These reports were matched both individually and crosschecked in groups to obtain a percentage of those deaths captured in the English language media.

Results:

Eighteen out of 25 students successfully interviewed someone in Iraq. Six contacted individuals by telephone, while the others conducted interviews via e-mail. One out of seven (14%) phone contacts refused to participate. Seventeen out of 18 primary interviewees resided in Baghdad, however, some interviewees reported deaths of neighbors that occurred while the neighbors were elsewhere. The Baghdad residents reported 161 deaths in total, 39 of which (24%) were believed to be reported in the press as summarized by IBC. An additional 13 deaths (8%) might have been in the database, and 61 (38%) were absolutely not in the database.

Conclusions:

The vast majority of violent deaths (estimated from the results of this study as being between 68–76%) are not reported by the press. Efforts to monitor events by press coverage or reports of tallies similar to those reported in the press, should be evaluated with the suspicion applied to any passive surveillance network: that it may be incomplete. Even in the most heavily reported conflicts, the media may miss the majority of violent events.
Using Baseline Data to Address the Lack of Hospital Beds during Mass-Casualty Incidents
Authors: Hadef Hysham , Bartier Jean-Claude , Delplancq Herve , Dupeyron Jean-Pierre
Published: August 2016

The management of victims during mass-casualty incidents (MCIs) is improving. In many countries, physicians and paramedics are well-trained to manage these incidents. A problem that has been encountered during MCIs is the lack of adequate numbers of hospital beds to accommodate the injured. In Europe, hospitals are crowded. One solution for the lack of beds is the creation of baseline data systems that could be consulted by medical personnel in all European countries. A MCI never has occurred in northeastern Europe, but such an event remains a possibility. This paper describes how the use of SAGEC 67, a free-access, information database concerning the availability of beds should help the participating countries, initially France, Germany, and Switzerland, respond to a MCI by dispatching each patient to an appropriate hospital and informing their families and physicians using their own language.

Baseline data for more than 20 countries, and for hospitals, especially those in Germany, Switzerland, and France, were collected. Information about the number of beds and their availability hour-by-hour was included. In the case of MCIs, the baseline data program is opened and automatically connects to all of the countries. In case of a necessary hospital evacuation, the required beds immediately are occupied in one of these three countries.Questions and conversations among medical staff or family members can be accomplished between hospitals through computer, secured-line chatting that automatically translates into appropriate language.

During the patient evacuation phase of a MCI, respondents acknowledged that a combination of local, state, and private resources and international cooperation eventually would be needed to meet the demand. Patient evacuation is optimized through the use of SAGEC 67, a free baseline database.
Revisiting Blood Transfusion Preparedness: Experience from the Bam Earthquake Response
Authors: Abolghasemi Hassan , Radfar Mohammad H. , Tabatabaee Morteza , Hosseini-Divkolayee Nasim S. , Burkle Frederick M.
Published: August 2016

Blood transfusion plays a critical role in the provision of medical care for disasters due to man-made and natural hazards. Although the short-term increase in blood donations following national disasters is well-documented, some aspects of blood transfusion during disasters remain under study. The 2003 earthquake in Bam, Iran resulted in the death of >29,000 people and injured 23,000. In total, 108,985 blood units were donated, but only 21,347 units (23%) actually were distributed to hospitals around the country. Kerman Province, the site of the disaster, received 1,231 (1.3%) of the donated units in the first four days after the disaster.The Bam experience revealed crucial missteps in the development of a post-event strategy for blood product management, and led to the development of a detailed disaster preparedness and response plan that addresses issues of donation, distribution, communication, transportation, and coordination. The current plan requires the Iranian Blood Transfusion Organization to convene a disaster task force immediately as the main coordinator of all disaster preparedness and response activities.
KAMEDO Report No. 91 2004 Tsunami Disaster in Asia—Home Transport and Emergency Care in Sweden
Authors: Brokopp Tom , Brändström Helge , Edsander-Nord Åsa , Hedelin Annika , Johansen Lars , Lundin Tom , Nyström Robert , Riddez Louis , Örtenwall Per
Published: August 2016

This is a descriptive report of the Swedish authorities' responses to the tsunami that affected Southeast Asia in December 2004. The main focus is the care of survivors and the injured during their transportation from Thailand and their return to Sweden. The psychological and physical after-effects also are presented based on a poll conducted one year after the tsunami.
KAMEDO Report No. 92 Evacuation of Swedes from Lebanon—Observational Studies in Connection with the War in Lebanon in Summer 2006
Authors: Kulling Per , Sigurdsson Susannah , Hamberger Bertil
Published: August 2016

A large-scale armed conflict between Hezbollah and Israel in July 2006 caused the evacuation of a large number of Swedish residents from Lebanon. This report describes the evacuation throughout its various stages. Swedish authorities were prepared for an event of this type from the experience of the 2004 Asian tsunami disaster. Lessons learned from the management and medical care during the evacuations are presented in this report.
Non-Doctors as Trauma Surgeons? A Controlled Study of Trauma Training for Non-Graduate Surgeons in Rural Cambodia
Authors: Van Heng Yang , Davoung Chan , Husum Hans
Published: August 2016

Introduction:

Due to the accelerating global epidemic of trauma, efficient and sustainable models of trauma care that fit low-resource settings must be developed. In most low-income countries, the burden of surgical trauma is managed by non-doctors at local district hospitals.

Objective:

This study examined whether it is possible to establish primary trauma surgical services of acceptable quality at rural district hospitals by systematically training local, non-graduate, care providers.

Methods:

Seven district hospitals in the most landmine-infested provinces of Northwestern Cambodia were selected for the study. The hospitals were referral points in an established prehospital trauma system. During a four-year training period, 21 surgical care providers underwent five courses (150 hours total) focusing on surgical skills training. In-hospital trauma deaths and postoperative infections were used as quality-of care indicators. Outcome indicators during the training period were compared against pre-intervention data.

Results:

Both the control and treatment populations had long prehospital transport times (three hours) and were severely injured (median Injury Severity Scale Score = 9). The in-hospital trauma fatality rate was low in both populations and not significantly affected by the intervention. The level of post-operative infections was reduced from 22% to 10.3% during the intervention (95% confidence interval for difference 2.8–20.2%). The trainees' selfrating of skills (Visual Analogue Scale) before and after the training indicated a significantly better coping capacity.

Conclusions:

Where the rural hospital is an integral part of a prehospital trauma system, systematic training of non-doctors improves the quality of trauma surgery. Initial efforts to improve trauma management in low-income countries should focus on the district hospital.
Non-Doctors as Trauma Surgeons?
Authors: Sundnes Knut Ole
Published: August 2016

Some papers send more than just one message. And sometimes, the number of messages is unintentional or at least not explicitly debated in the article. Such papers have been produced before, but perhaps we should elaborate on these imbedded signals.

The primary messages brought forward by this paper include:

1. Non-doctors, if properly trained, but lacking pathophysiological insight, can provide acceptable surgical care and raise the standard of health care;

2. Training in science can be and should be dovetailed into capacity building as an integral part of quality control;

3. Scientific work can be performed outside the laboratory and the established, high-tech hospitals. Science/evidence can be produced where everyday activities occur; and

4. Large Level-1 Trauma Centers probably are cost-ineffective in most low-resource regions as they consume too many resources and most people do not have access to them.
Injury Perceptions of Bombing Survivors—Interviews from the Oklahoma City Bombing
Authors: Glenshaw Mary T. , Vernick Jon S. , Frattaroli Shannon , Brown Sheryll , Mallonee Sue
Published: August 2016

Introduction:

Bombings, including the 1995 Oklahoma City bombing, remain an important public health threat. However, there has been little investigation into the impressions of injury risk or protective factors of bombing survivors.

Objective:

This study analyzes Oklahoma City bombing survivors' impressions of factors that influenced their risk of injury, and validates a hazard timeline outlining phases of injury risk in a building bombing.

Methods:

In-depth, semi-structured interviews were conducted within a sample of Oklahoma City bombing survivors. Participants included 15 injured and uninjured survivors, who were located in three buildings surrounding the detonation site during the attack.

Results:

Risk factor themes included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as risk and protective factors. The hazard timeline was a useful tool, but should be modified to include a lay rescue phase. The combination of a narrative approach and direct questioning is an effective method of gathering the perceptions of survivors.

Conclusions:

Investigating survivors' impressions of building bombing hazards is critical to capture injury exposures, behavior patterns, and decision-making processes during actual events, and to identify interventions that will be supported by survivors.
Risk and Protective Factors that Impact Survival in Emergencies—The Time Has Come for an Upgrade in Preventive Emergency Population Behavior
Authors: Adini Bruria , Cohen Robert , Bar-Dayan Yaron
Published: August 2016

Mapping risk and protective factors that may result in increased chances of survival or a decrease in injuries and fatalities in mass-casualty incidents (MCIs) is an important component in the process of emergency preparedness. While expert risk analyses are based on calculations of probability and damage, public estimates of risks more often are based on qualitative factors. It is important to understand how the public, and not just professional experts, perceive and react to the threat of MCIs whether they stem from natural causes or terrorism. Glenshaw et al provide valuable insight into the impressions and responses of a sample of individuals, both injured and uninjured who were involved in the Oklahoma City bombing. Their analysis helps us better understand what factors influenced the risk of injury to the individuals involved in the event. The main risk factor themes that emerged from the analysis included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as both risk and protective factors.
Seatbelt Use in Qatar in Association with Severe Injuries and Death in the Prehospital Setting
Authors: Munk Marc-David , Carboneau Dora M. , Hardan Muhammed , Ali Faleh Mohamed
Published: August 2016

Introduction:

Road traffic crashes (RTCs) are common in Qatar, and are now considered the third leading cause of mortality. In this study, the safety devices used by the Qatari public at the time of RTCs were assessed and the association between seatbelt use by vehicle occupants involved in RTCs and severe injury/death in the prehospital setting was determined.

Methods:

This study was a retrospective case-control investigation. A Hamad Medical Corporation Emergency Medical Services (EMS) database of RTCs occurring from January 2006 to April 2007 was utilized for this study, providing a total of 5,267 patient records (83.5 % male, 16.5% female, median age = 28 years). Patient demographics, crash characteristics, prehospital assessments, and interventions were identified, and use of safety devices was determined. Univariate analysis including chi-square, Student's t-test, and analysis of variance (ANOVA) was performed as appropriate. “Case” patients are defined as those who had specific, critical prehospital assessments, or who received advanced cardio-respiratory life support measures in the field. Logistic regression modeling was used to predict the probability of a case being unbelted, controlling for confounders.

Results:

Seatbelt use in Qatar was low: 33.9% of males and 32.6% of females wore seatbelts at the time of the RTC. Victims involved in a vehicle rollover crash were less likely to be belted than were those involved in a non-rollover incident (26.2% belted vs. 37.8%; OR = 0.59; 95%CI = 0.50–0.68). Case patients—those with defined critical assessment findings or resuscitation in the field—and control patients were similar in age (30 years vs. 28 years median). Case patients were disproportionately male (89.1% vs. 83.2%; OR = 1.65; 95%CI = 1.01–2.83) and were more likely to be victims of a vehicle rollover crash (44.7% vs. 23.8%; OR = 2.57; 95%CI = 1.84–3.59). Seatbelt use was significantly lower among cases than controls: 19.7% of cases were reported to have worn seatbelts compared to 34.2% of controls (OR = 0.47; 95%CI = 0.31–0.69). This relationship also persisted (OR = 0.51; 95%CI = 0.33–0.76) after controlling for confounders.

Conclusions:

Seatbelt use in Qatar is low. Seatbelts are protective: in the pre-hospital setting unbelted vehicle occupants involved in RTCs were nearly twice as likely to suffer severe injury or death compared to belted patients. Prehospital morbidity and mortality appears to be reduced significantly by the consistent use of seatbelts by the motoring population in Qatar.
Needle Thoracostomy by Non-Medical Law Enforcement Personnel: Preliminary Data on Knowledge Retention
Authors: Sztajnkrycer Matthew D.
Published: August 2016

Introduction:

Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.

Methods:

After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.

Results:

Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.

Conclusions:

Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration for at least six months.
Mississippi's Infectious Disease Hotline: A Surveillance and Education Model for Future Disasters
Authors: Cavey Andrew M. J. , Spector Jonathan M. , Ehrhardt Derek , Kittle Theresa , McNeill Mills , Greenough P. Gregg , Kirsch Thomas D.
Published: August 2016

Introduction:

The potential for outbreaks of epidemic disease among displaced residents was a significant public health concern in the aftermath of Hurricane Katrina. In response, the Mississippi Department of Health (MDH) and the American Red Cross (ARC) implemented a novel infectious disease surveillance system, in the form of a telephone “hotline”, to detect and rapidly respond to health threats in shelters.

Methods:

All ARC-managed shelters in Mississippi were included in the surveillance system. A symptom-based, case reporting method was developed and distributed to shelter staff, who were linked with MDH and ARC professionals by a toll-free telephone service. Hotline staff investigated potential infectious disease outbreaks, provided assistance to shelter staff regarding optimal patient care, and helped facilitate the evaluation of ill evacuees by local medical personnel.

Results:

Forty-three shelters sheltering 3,520 evacuees participated in the program. Seventeen shelters made 29 calls notifying the hotline of the following cases: (1) fever (6 cases); (2) respiratory infections (37 cases); (3) bloody diarrhea (2 cases); (4) watery diarrhea (15 cases); and (5) other, including rashes (33 cases). Thirty-four of these patients were referred to a local physician or hospital for further diagnosis and disease management. Three cases of chickenpox were identified. No significant infectious disease outbreaks occurred and no deaths were reported.

Conclusions:

The surveillance system used direct verbal communication between shelter staff and hotline managers to enable more rapid reporting, mapping, investigation, and intervention, far beyond the capabilities of a more passive or paper-based system. It also allowed for immediate feedback and education for staff unfamiliar with the diseases and reporting process. Replication of this program should be considered during future disasters when health surveillance of a large, disseminated shelter population is necessary.
Poison Control Centers' Role in Glow Product-Related Outbreak Detection: Implications for Comprehensive Surveillance System
Authors: Chu Alvin F. , Marcus Steven M. , Ruck Bruce
Published: August 2016

Introduction:

The development of syndromic surveillance systems to detect bioterrorist attacks and emerging infectious diseases has become an important and challenging goal to many governmental agencies and healthcare authorities. This study utilized the sharp increase of glow product-related calls to demonstrate the utility of poison ontrol data for early detection of potential outbreaks during the week of Halloween in 2007.

Methods:

A review was conducted of the electronic records of exposures reported to the New Jersey Poison Information and Education System NJPIES) Poison Control Hotline from 2002 through 2007 with generic code number 0201027 (glow products) set by the American Association of Poison Control Centers (AAPCC). Key information such as age, gender, time of the call, exposure reason, clinical effects, and medical outcomes along with telephone number, zip code, and county location were used in the analyses to determine the extent of the outbreak.

Results:

Analyses included a total of 139 glow product-related calls during the week of Halloween in 2007 with a single-day high of 59 calls on Halloween Day. More than 90% of the glow product exposures were in children 1–10 years of age. The glow product-related calls on Halloween Day increased from 14 calls in 2002 to 59 calls in 2007, a 321% increase during a six-year period.

Conclusions:

Poison control centers in the United States are equipped with a unique and uniform input data collection system—the National Poison Data System—that provides an important data source in the development of a comprehensive surveillance system for early outbreak detection.
Experience of Health-Related Problems during House Parties in the Netherlands: Nine Years of Experience and Three Million Visitors
Authors: Krul Jan , Girbes Armand R. J.
Published: August 2016

Objective:

The objective of this study was to report on a nine years of experience of providing medical support during house parties (raves) in the Netherlands, where they can be organized legally.

Design:

This was a prospective, observational study of self-referred patients from 1997 to 2005. During raves, first aid stations are staffed with specifically trained medical and paramedical personnel. Self-referred patients were diagnosed, treated, and recorded using standardized methods.

Results:

During a nine-year period with 219 raves occurred, involving approximately three million participants, 23,581 patients visited the first aid stations. The medical usage rate (MUR) varied from 59–170 patients per 10,000 rave participants. The mean age increased from 1997 to 2005 from 18.7 ±2.7 to 23.3 ±5.7 years. The mean stay at the first aid station was 18 ±46 minutes. Most health problems were mild. Fifteen cases of severe incidents were observed with one death.

Conclusions:

Unique data from the Netherlands demonstrate a low number of serious, health-related, short-term problems during raves.
Transport and Use of Point-of-Care Ultrasound by a Disaster Medical Assistance Team
Authors: Mazur Stefan M. , Rippey James
Published: August 2016

The role of ultrasound in disaster medicine has not been not well established. This report describes the transport and use of point-of-care ultrasound by Disaster Medical Assistance Team (DMAT) responding to a mass-casualty incident due to a cyclone. Ultrasound-competent physicians on the team were able to use portable ultrasound on cyclone casualties to exclude intra-abdominal hemorrhage, peri cardial fluid, pneumothoraces, and hemothoraces Information obtained using ultrasound made initial patient management, and subsequent decisions regarding triage for transport safer and based on more detailed clinical information.