bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Major and Minor Events that Occurred in Italy during the Last Century Using a Disaster Severity Scale Score
Authors: Ferro Giorgia
Published: August 2016

Introduction:

Epidemiological research about disasters is difficult to perform. Most often, it must be completed retrospectively, since data collection may not be feasible or possible during the disaster.Now, there is a recognized need for a standard method to assess the severity of a disaster.

Objectives:

The aim of this paper is to assess the severity of the disasters that occurred in Italy during the 20th century, using a Disaster Severity Scale (DSS). Another goal is to find a standard method for the classification of previous disasters, test the feasibility and reliability of the use of the Disaster Severity Scale, and improvedisaster management and planning.

Methods:

Data were obtained from formal reports of the Civil Defence Unit (Italy) and were used to calculate the Disaster Severity Scale score. Disasters were classified into major and minor disasters, according tothe numbers of deaths and severity of the damage. The number of deaths was compared with the obtained Disaster Severity Scale score. A seasonal trend for different types of events was obtained to assess if there is a relationship between the type of event and the time of the year in which it occurred, as related to the weather conditions existing at that time.

Results:

There were enough data to calculate a Disaster Severity Scale score for 26 major events that caused death and economic damage, and occurred in Italy between 18 March 1944 and 11 November 1999, and for 82 minor events, that occurred between October 1982 and December 1999. There were some significant peaks varying from different types of events during particular seasons, but the cause for those with the highest incidence is not clear. Events related to natural hazards were the only type of event that reached the highest Disaster Severity Scale when considering the number of deaths, while no events associated with man-made hazards had a Disaster Severity Scale score >8.

Conclusion:

The Disaster Severity Scale score could be a reliable index for the assessment of events related to either natural or man-made disasters. Use of the Disaster Severity Scale allows researchers to classify previous hazards by scoring each disaster's severity. Further studies in other countries could be useful to further validate the Disaster Severity Scale.
Benchmarking for Hospital Evacuation: A Critical Data Collection Tool
Authors: Schultz Carl H. , Koenig Kristi L. , Heide Erik Auf der , Olson Robert
Published: August 2016

In events such as earthquakes or terrorist attacks, hospitals may be victims of disasters. They may need to transfer patients to outside facilities rather than continue to provide on-site care. Following the Northridge earthquake, eight hospitals in the damaged area were the foci of a United States National Science Foundation study that examined the status of the hospitals' pre-event planning, post-event evacuationdecision-making, and internal and external evacuation processes. Building on this experience, this paper offers a standardized data collection tool, which will enable researchers to record hospital evacuation information in a systematic manner so that comparable data can be accumulated, evacuation research methods can be improved, and consensus on methods can be reached. The study's principal subjects include: (1) hospital demographics; (2) description of existing disaster response plans; (3) an event's impacts on hospital operations; (4) decision-making and incident command; (5) movement of patients within the facility; (6) movement of patients to off-site institutions; and (7) hospital recovery.
Blackout 2003: Preparedness and Lessons Learned from the Perspectives of Four Hospitals
Authors: Klein Kelly R. , Rosenthal Marc S. , Klausner Howard A.
Published: August 2016

Introduction:

The blackout in North America of August 2003 was one of the worst on record. It affected eight United States states and parts of Canada for >24 hours. Additionally, two large United States cities, Detroit, Michigan and Cleveland, Ohio, suffered from a loss of water pressure and a subsequent ban on the use of public supplies of potable water that lasted four days. A literature review revealed a paucity of literature that describes blackouts and how they may affect the medical community.

Methods:

This paper includes a review of after-action reports from four inner-city, urban hospitals supplemented accounts from the authors' hospital's emergency operations center (emergency operations center).

Results:

Some of the problems encountered, included: (1)lighting; (2) elevator operations; (3) supplies of water; (4) communication operations; (5) computer failure; (6) lack of adequate supplies of food; (7) mobility to obtain Xray studies; (8) heating, air condition, and ventilation; (9) staffing; (10) pharmacy; (11) registration of patients; (12) hospital emergency operations center; (13) loss of isolation facilities; (14) inadequate supplies of paper; (15) impaired ability to provide care for non-emergency patients; (16) sanitation; and (17) inadequate emergency power.

Discussion:

The blackout of 2003 uncovered problems within the United States hospital system, ranging from staffing to generator coverage. This report is a review of the effects that the blackout and water ban of 2003 had on hospitals in a large inner-city area. Also discussed are solutions utilized at the time and recommendations for the future.

Conclusion:

The blackout of 2003 was an excellent test of disaster/emergency planning, and produced many valuable lessons to be used in future events.
Panel 2.3: Gender Dimensions and Human Rights Aspects to Responses and Recovery
Authors: Chunkath Sheela Rani , Sherratt Della , Chotani Rashid A. , Smyth Ines , Burns Katherine , Hidayat Melania
Published: August 2016

This is a summary of the presentations and discussion of the Gender Dimensions and Human Rights Aspects toResponses and Recovery of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to gender dimensions and human rights pertaining to the responses to the damage created by the Tsunami. It is pr presented in the following major sections: wing (1) gaps encountered and major issues; (2) limitations of response; (3) what could have been done better?; and (4) recommendations.
Panel 2.4: Funding Policies and Practices
Authors: Procacci Pasqualinoe , Mookerjee Arindom , German Tony , O'Dwyer Michael , Eppel Gerd
Published: August 2016

This is a summary of the presentations and discussion of Funding Policies and Practices of the Conference,Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to funding policies and practices as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) issues from the perspectives of (a) donors, and (b) recipients; (2) coordination; (3) conclusions; (4) the size of the response; (5) measuring the Consolidated Appeals Process (CAP) as a financial instrument; (6) other issues; (7) lessons learned; and (8) recommendations. Topics discussed in the other issues section include: (1) data; (2) sustainability; (3) capacity building; (4) unspecified funding; and (5) links to aid for development. Subsections of the lessons learned session include: (1) examining the WHO from the donor perspective; and (2) donor community practices.
Panel 2.6: Mental and Psychosocial Effects of the Tsunami on the Affected Populations
Authors: Chakrabhan M.L. Somchai , Chandra Vijay , Levav Itzhak , Pengjuntr Wachira , Bhugra Dinesh , Mendis Nalaka , Naj Amal , van Ommeren Mark
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.6, Mental and Psychosocial Effects of the Tsunami on the Affected Populations of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to mental and psychological aspects as pertaining to the damage created by the Tsunami. It is presented in the following major sections: (1) responses; (2) needs assessment; (3) coordination; (4) gap filling; (5) capacity building; (6) stakeholder agreement; and (7) conclusions and recommendations. In the responses discussion, issues included: (1) psychosocial support services; (2) mental health services; and (3) the Thai respoonse. Subsections in the stakeholder agreement section include: (1) public-private partnerships; and (2) preparedness.
Panel 2.12: The Health Sector Contribution to Disaster Reduction
Authors: Gordon Marc , Poncelet Jean Luc , Dubouloz Marcel , Briceno Salvano
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.12, The Health Sector Contribution to Disaster Reduction, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related the healt sector's contribution to disaster reduction as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) issues; (2) lessons learned; and (3) recommendations.
What Have We Learned? Filling Gaps in Available Services
Authors: Waldman Ronald
Published: August 2016

This is a synthesis of the presentations and discussions of the Conference in Phuket, Thailand relative to filling the gaps in available services. The topics discussed in this section include: (1) gaps in the early phases of relief, including food, water and sanitation, shelter, health services, field hospitals, mental health, and women's health; (2) what can be done better including the armed forces, the private commercial sector, and coordination; (4) the development of standards; and (5) conclusions and recommendations.
Report to the 58th World Health Assembly: Health Action in Relation to Crises and Disasters
Authors:   Secretariat of the World Health Organization
Published: August 2016

This Summary Report was prepared for Agenda item 13.3 for the meeting of the World Health Assembly convened at the World Health Organizationation (WHO) Headquarters in Geneva, Switzwitzerland on 20 May 2005. It was in part, prepared from the Reports generaged by the Conference, Health Actions in Relation to Crises and Disasters, convened by the World Health Organization in Phuket, Thailand, 04–06 May 2005.
Precision of In-Hospital Triage in Mass-Casualty Incidents after Terror Attacks
Authors: Ashkenazi Itamar , Kessel Boris , Khashan Tawfik , Haspel Jacob , Oren Meir , Olsha Oded , Alfici Ricardo
Published: August 2016

Introduction:

Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan.

Objective:

The objective of this study was to assess the precision of triage in mass-casualty incidents.

Methods:

The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS).

Results:

Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 ≤ISS<16), and 11 severe (ISS < 16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%).

Conclusion:

Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.
Health Conditions and Risk Factors of Sheltered Persons Displaced by Hurricane Katrina
Authors: Vest Joshua R. , Valadez Adolfo M.
Published: August 2016

Introduction:

During disasters, public health departments assume the role of maintaining the health of displaced persons. Displaced persons arrive with acute and chronic conditions as well as other risk factors. Descriptions of these conditions may aid future shelter planning efforts.

Methods:

Approximately 4,000 individuals from New Orleans, displaced by Hurricane Katrina, were sheltered in Austin, Texas. A stratified random sample of the population was selected using individual beds as the primary sampling unit. Adults were interviewed about their acute symptoms, chronic diseases, and other risk factors.

Results:

The results indicate a substantial proportion of adults arrived with some symptoms of acute illness (49.8%). A majority of the adults reported living with a chronic condition (59.0%), and the prevalence of some chronic conditions was higher than that of the general population. Also, several factors that could complicate service delivery were prevalent.

Discussion:

Acute illnesses present transmission risks within the shelter. Furthermore, chronic diseases must be managed and may complicate care of acute illnesses. Risks like activity limitation or substance abuse may complicate shelter operations. Defining the potential scope of the illness burden may be used to help public health departments better plan the services they must deliver to displaced populations.
Reasons Prehospital Personnel Do Not Administer Aspirin to All Patients Complaining of Chest Pain
Authors: Hooker Edmond A. , Benoit Taylor , Price Timothy G.
Published: August 2016

Introduction:

Aspirin is administered to patients with acute coronary syndromes (ACSs), but prehospital providers do not administer aspirin to all patients with chest pain that could be secondary to an ACS.

Objective:

To identify reasons prehospital providers fail to administer aspirin to all patients complaining of chest pain.

Methods:

A convenience sample of prehospital providers was surveyed as they transported patients with a chief complaint of chest pain to the emergency department. The providers were asked if they had given aspirin, nitroglycerin, or oxygen, or if they utilized a monitor. If the medications had not been administered, the paramedic was asked about the reason. The patient's age and previous cardiac history also was recorded.

Results:

A total of 52 patients with chest pain who were transported were identified over eight weeks, and all of the providers agreed to participate in the study. Only 13 of the patients (25%) received aspirin. Reasons given for not administering aspirin to the other 39 patients included: (1) chest pain was not felt to be cardiac in 13 patients (33%); (2) 10 patients already had taken aspirin that day (26%); (3) the medical provider was a basic-level emergency medical technician (EMT)-Basic and could not administer aspirin to six patients (15%); (4) pain subsided prior to arrival of emergency medical services (EMS) in these three patients; and (5) other reasons were provided for the remaining seven patients.

Conclusions:

The most common reason that paramedics did not administer aspirin was the paramedic's belief that the chest pain was not of a cardiac nature. Another common reason for not giving aspirin was the inability of EMT-Basic providers to administer aspirin.
In the Path of Disasters: Psychosocial Issues for Preparedness, Response, and Recovery
Authors: Amaratunga Carol A. , O'Sullivan Tracey L.
Published: August 2016

The psychosocial impacts of disasters are profound. In recent years, there have been too many reminders of these impacts and the dire needs of the people involved. The purpose of this article is to present the following themes from the psychosocial literature on disasters and emergency management: (1) differential impacts of disasters according to gender and age; (2) prevention efforts to reduce racial discrimination, rape, and other forms of abuse; (3) readiness for cultural change toward prevention and preparedness; and (4) the need to involve aid beneficiaries as active partners in relief strategies, particularly during reconstruction of communities and critical systems. Psychosocial needs change throughout the disaster cycle, particularly as social support deteriorates over time. It is important to anticipate what psychosocial needs of the public, emergency responders, support staff, and volunteers might emerge, before advancing to the next stage of the disaster. Particular consideration needs to be directed toward differential impacts of disasters based on gender, age, and other vulnerabilities.
Disaster Health Education and Training: A Pilot Questionnaire to Understand Current Status
Authors: Murray Virginia , Clifford Janet , Seynaeve Geert , Fisher Judith M.
Published: August 2016

In October 2004, a World Association for Disaster and Emergency Medicine (WADEM) Seminar was convened in Brusselsby the Education Committee to discuss Disaster Education and Training. During this seminar, it became apparent that there was no single tool available to assess knowledge, skills, and resources within this field. Therefore, a tool was administered to 50 of the delegates to assess if the tool would facilitate information-sharing and curriculum development in disaster health education.

The WADEM Education Committee devised a reference scheme for disaster health training and education based on seven educational levels within a framework based on the Bradt model. A questionnaire was developed to answer questions regarding current practices in disaster health education and training, and the perceived barriers to creating an international system of standards, guidelines, and accreditation. The questionnaire was sent to all of the delegates and the responses were analyzed.

The questionnaire was useful for information-sharing and curriculum development. Based on the respondents' experience, strategies were put forward for adopting better coordinated framework for disaster health education and training. This questionnaire should be updated and repeated annually within the WADEM. Wider use of the tool is recommended to help evaluate current educational resources in disaster health and in the wider educational field. It could facilitate the development and audit of current and future courses. An international system for education and training should lead to more efficient and coordinated health responses to disasters.
Prehospital Care of Tsunami Victims in Thailand: Description and Analysis
Authors: Schwartz Dagan , Goldberg Avishay , Ashkenasi Issac , Nakash Guy , Pelts Rami , Leiba Adi , Levi Yeheskel , Bar-Dayan Yaron
Published: August 2016

Introduction:

On 26 December 2004 at 09:00 h, an earthquake of 9.0 magnitude (Richter scale) struck the area off of the western coast of northern Sumatra, Indonesia, triggering a Tsunami. As of 25 January 2005, 5,388 fatalities were confirmed, 3,120 people were reported missing, and 8,457 people were wounded in Thailand alone. Little information is available in the medical literature regarding the response and restructuring of the prehospital healthcare system in dealing with major natural disasters.

Objective:

The objective of the study was to analyze the prehospital medical response to the Tsunami in Thailand, and to identify possible ways of improving future preparedness and response.

Methods:

The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research delegation to study the response of the Thai medical system to the 2004 earthquake and Tsunami disaster. The delegation met with Thai healthcare and military personnel, who provided medical care for and evacuated the Tsunami victims. The research instruments included questionnaires (open and closed questions), interviews, and a review of debriefing session reports held in the days following the Tsunami.

Results:

Beginning the day after the event, primary health care in the affected provinces was expanded and extended. This included: (1) strengthening existing primary care facilities with personnel and equipment; (2) enhancing communication and transportation capabilities; (3) erecting healthcare facilities in newly constructed evacuation centers; (4) deploying mobile, medical teams to make house calls to flood refugees in affected areas; and (5) deploying ambulance crews to the affected areas to search for survivors and provide primary care triage and transportation.

Conclusion:

The restructuring of the prehospital healthcare system was crucial for optimal management of the healthcare needs of Tsunami victims and for the reduction of the patient loads on secondary medical facilities. The disaster plan of a national healthcare system should include special consideration for the restructuring and reinforcement prehospital system.
Medical Response of a Physician and Two Nurses to the Mass-Casualty Event Resulting in the Phi Phi Islands from the Tsunami
Authors: Ammartyothin Surasak , Ashkenasi Issac , Schwartz Dagan , Leiba Adi , Nakash Guy , Pelts Rami , Goldberg Avishay , Bar-Dayan Yaron
Published: August 2016

The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600–700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation (“C”) problems, by con- trolling external hemorrhages. This decision was driven by the lack of equip- ment and personnel to deal with airway (“A”) and breathing (“B”) problems.

In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communica- tion facilities must be ensured; (2) clear, simple “evacuation plans” should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the dis- aster and emergency medicine capabilities.

This case report is an example for caregivers all over the world, of an amazing lesson of leadership and courage.
Paramedic Student Performance: Comparison of Online with On-Campus Lecture Delivery Methods
Authors: Hubble Michael W. , Richards Michael E.
Published: August 2016

Introduction:

Colleges and universities are experiencing increasing demand for online courses in many healthcare disciplines, including emergency medical services (EMS). Development and implementation of online paramedic courses with the quality of education experienced in the traditional classroom setting is essential in order to maintain the integrity of the educational process. Currently, there is conflicting evidence of whether a significant difference exists in student performance between online and traditional nursing and allied health courses. However, there are no published investigations of the effectiveness of online learning by paramedic students.

Hypothesis:

Performance of paramedic students enrolled in an online, undergraduate, research methods course is equivalent to the performance of students enrolled in the same course provided in a traditional, classroom environment.

Methods:

Academic performance, learning styles, and course satisfaction surveys were compared between two groups of students. The course content was identical for both courses and taught by the same instructor during the same semester. The primary difference between the traditional course and the online course was the method of lecture delivery. Lectures for the on-campus students were provided live in a traditional classroom setting using PowerPoint slides. Lectures for the online students were provided using the same PowerPoint slides with prerecorded streaming audio and video.

Results:

A convenience sample of 23 online and 10 traditional students participated in this study. With the exception of two learning domains, the two groups of students exhibited similar learning styles as assessed using the Grasha-Riechmann Student Learning Style Scales instrument. The online students scored significantly lower in the competitive and dependent dimensions than did the on-campus students. Academic performance was similar between the two groups. The online students devoted slightly more time to the course than did the campus students, although this difference did not reach statistical significance. In general, the online students believed the online audio lectures were more effective than the traditional live lectures.

Conclusion:

Distance learning technology appears to be an effective mechanism for extending didactic paramedic education off-campus, and may be beneficial particularly to areas that lack paramedic training programs or adequate numbers of qualified instructors.
Medical Preparedness Against Chemical and Biological Incidents for the NATO Summit in Istanbul and Lessons Learned
Authors: Kenar Levent , Pharm Turan Karayilanoglu
Published: August 2016

Introduction:

During the 2004 North Atlantic Treaty Organization (NATO) Summit, essential counter-measures, including medical preparedness, were taken to cope with any suspected terrorist case or events including the use of chemical or biological (CB) weapons.The Summit was held in Istanbul, a city that bridges two continents, and involved the participation of many Heads of State, Prime Ministers, and Defense Ministers from 26 NATO countries.

Methods:

First responders, including medical Chemical, Biological, Radiological, and Nuclear (CBRN) teams, received special training. Essential equipment, including drugs, antidotes, detectors, etc., was provided and stockpiled. Medical authorities augmented the capacity for identifying and con- trolling the injuries and any emerging CB incident through the set-up of decontamination units and the procurement of medical devices, antidotes, drugs, and personal protective suits. Additionally, a small part of the recently established NATO-CBRN battalion was welcomed to the Summit and was prepared to perform detection and identification of the agent found in suspicious appearing samples.

Results:

Although no CB incident was reported during the Summit, extensive experience was gained with respect to medical preparedness against CB terrorism. Sampling, detection, and analysis of toxic materials were taken into account in the medical management. Much laboratory-related work was conducted in the following time period. The laboratory work involved the stan-dardization of sampling and transportation procedures, development of both mobile and reference laboratories, and performing research activities aimed to make the CB analysis more efficient.

Although the training of the medical staff was advanced, training should be continuous and supported with educational programs, conferences, meetings, and tabletop and hospital medical exercises throughout the country.

Conclusion:

Multidisciplinary cooperation, training, and preparedness should be provided to basic medical care units and centers as part of the medical planning aimed at perfect detection and surveillance, laboratory analysis, and emergency response.
Terrorism and Mental Health in the Rural Midwest
Authors: Hawley Suzanne R. , Ablah Elizabeth , Hawley Gary C. , Cook David J. , Orr Shirley A. , Molgaard Craig A.
Published: August 2016

Introduction:

Since the terrorist attacks of 11 September 2001, the amount of terrorism preparedness training has increased substantially. However, gaps continue to exist in training for the mental health casualties that result from such events. Responders must be aware of the mental health effects of terror-ism and how to prepare for and buffer these effects. However, the degree to which responders possess or value this knowledge has not been studied.

Methods:

Multi-disciplinary terrorism preparedness training for healthcare professionals was conducted in Kansas in 2003. In order to assess knowledge and attitudes related to mental health preparedness training, post-test surveys were provided to 314 respondents 10 months after completion of the training. Respondents returned 197 completed surveys for an analysis response rate of 63%.

Results:

In general, the results indicated that respondents have knowledge of and value the importance of mental health preparedness issues. The respon-dents who reported greater knowledge or value of mental health preparedness also indicated significantly higher ability levels in nationally recognized bioterrorism competencies (p <0.001).

Conclusions:

These results support the need for mental health components to be incorporated into terrorism preparedness training. Further studies to determine the most effective mental health preparedness training content and instruction modalities are needed.
Rapid Needs Assessment of Hurricane Katrina Evacuees—Oklahoma, September 2005
Authors: Rodriguez Sara Russell , Tocco Jolianne Stone , Mallonee Sue , Smithee Lauri , Cathey Timothy , Bradley Kristy
Published: August 2016

Introduction:

On 04 September 2005, 1,589 Hurricane Katrina evacuees from the New Orleans area arrived in Oklahoma. The Oklahoma State Department of Health conducted a rapid needs assessment of the evacuees housed at a National Guard training facility to determine the medical and social needs of the population in order to allocate resources appropriately.

Methods:

A standardized questionnaire that focused on individual and household evacuee characteristics was developed. Households from each shel-ter building were targeted for surveying, and a convenience sample was used.

Results:

Data were collected on 197 households and 373 persons. When com-pared with the population of Orleans Parish, Louisiana, the evacuees sampled were more likely to be male, black, and 45–64 years of age. They also were less likely to report receiving a high school education and being employed pre-hurricane. Of those households of <1 persons, 63% had at least one missing household member. Fifty-six percent of adults and 21% of children reported having at least one chronic disease. Adult women and non-black persons were more likely to report a pre-existing mental health condition. Fourteen percent of adult evacuees reported a mental illness that required medication pre-hur-ricane, and eight adults indicated that they either had been physically or sex-ually assaulted after the hurricane. Approximately half of adults reported that they had witnessed someone being severely injured or dead, and 10% of per-sons reported that someone close to them (family or friend) had died since the hurricane. Of the adults answering questions related to acute stress disor-der, 50% indicated that they suffered at least one symptom of the disorder.

Conclusions:

The results from this needs assessment highlight that the evac-uees surveyed predominantly were black, of lower socio-economic status, and had substantial, pre-existing medical and mental health concerns. The evac-uees experienced multiple emotional traumas, including witnessing grotesque scenes and the disruption of social systems, and had pre-existing psy-chopathologies that predisposed this population to post-traumatic stress dis-order (Post-traumatic Stress Disorder).x When disaster populations are displaced, mental health and social service providers should be available immediately upon the arrival of the evacuees, and should be integrally coordinated with the relief response. Because the displaced population is at high risk for disaster-related mental health problems, it should be monitored closely for persons with PTSD. This displaced population will likely require a substantial re-establishment of financial, medical, and educational resources in new communities or upon their return to Louisiana.
Hawaii Physician and Nurse Bioterrorism Preparedness Survey
Authors: Kat Alan R. , Nekorchuk Dawn M. , Holck Peter S. , Hendrickson Lisa A. , Imrie Allison A. , Effler Paul V.
Published: August 2016

Introduction:

Physicians and nurses are integral components of the public health bioterrorism surveillance system. However, most published bioterrorism preparedness surveys focus on gathering information related to selfassessed knowledge or perceived needs and abilities.

Objective:

A survey of physicians and nurses in Hawaii was conducted to assess objective knowledge regarding bioterrorism agents and diseases and perceived response readiness for a bioterrorism event.

Methods:

During June and July 2004, an anonymous survey was mailed up to three times to a random sample of all licensed physicians and nurses residing in Hawaii.

Results:

The response rate was 45% (115 of 255) for physicians and 53% (146 of 278) for nurses. Previous bioterrorism preparedness training associated significantly with knowledge-based test performance in both groups. Only 20% of physicians or nurses had had previous training in bioterrorism preparedness, and <15% felt able to respond effectively to a bioterrorism event. But, >70% expressed willingness to assist the state in the event of a bioterrorist attack.

Conclusions:

Additional bioterrorism preparedness training should be made available through continuing education and also should become a component of both medical and nursing school curricula. It is important to provide the knowledge necessary for physicians and nurses to improve their ability to perform in the event of a bioterrorist attack.
A Four-Step Approach for Establishment of a National Medical Response to Mega-Terrorism
Authors: Leiba Adi , Blumenfeld Amir , Hourvitz Ariel , Weiss Gali , Peres Michal , Schwartz Dagan , Goldberg Avishay , Levi Yehezkel , Bar-Dayan Yaron
Published: August 2016

A simplified, four-step approach was used to establish a medical management and response plan to mega-terrorism in Israel. The basic steps of this approach are: (1) analysis of a scenario based on past incidents; (2) description of relevant capabilities of the medical system; (3) analysis of gaps between the scenario and the expected response; and (4) development of anoperational framework.

Analyses of both the scenario and medical abilities led to the recommendation of an evidence-based contingency plan for mega-terrorism. An important lesson learned from the analyses is that a shortage in medical first responders would require the administration of advanced life support (ALS) by paramedics at the scene, along with simultaneous, rapid evacuation of urgent casualties to nearby hospitals by medics practicing basic life support (BLS). Ambulances and helicopters should triage casualties from inner to outer circle hospitals secondarily, preferentially Level-1 trauma centers.

In conclusion, this fourstep approach based on scenario analysis, mapping of medical capabilities, detection of bottlenecks, and establishment of a unique operational framework, can help other medical systems develop a response plan to megaterrorist attacks.
Out-of-Hospital Resuscitation: Have We Gone Too Far?
Authors: Grudzen Corita
Published: August 2016

Americans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.
Casualty Collection in Mass-Casualty Incidents: A Better Method for Finding Proverbial Needles in a Haystack
Authors: Knotts Kristina E. , Etengoff Stuart , Barber Kimberly , Golden Ina J.
Published: August 2016

Introduction:

Mass-casualty incidents (MCIs) are on the rise. The ability to locate, identify, and triage patients quickly and efficiently results in better patient outcomes. Poor lighting due to time of day, inclement weather, and power outages can make locating patients difficult. Efficient methods of locating patients allow for quicker transport to definitive care.

Objective:

The objective of this study was to evaluate the methods currently used in mass-casualty collection, and to determine whether the use of the Simple Triage and Rapid Treatment (START) triage tag system can be improved by using easily discernable tags (glow sticks) in conjunction with the standard triage tags.

Methods:

Numerous drills were performed utilizing the START triage method. In Trial A, patients were identified with the triage tags only. In Trial B, patients were identified using triage tags and glow sticks. Four rounds of triage drills were performed in low ambient light for each Trial, and the differences in casualty collection times were compared.

Results:

Casualty relocation and collection times were considerably shorter in the trials that utilized both the glow sticks and triage tags. An average of 2.58 minutes (31.75%) were saved during the casualty collections. In addition, fewer patient errors occurred during the trials in which the glow sticks were used. Between the four rounds, an average of four patient errors occurred during the trials that utilized the triage tags. However, there was an average of only one patient error for the drills when participants utilized both the triage tags and the glow sticks.

Conclusions:

The use of the highly visible glow sticks, in conjunction with the START triage tags, allowed for more rapid and accurate casualty collection in suboptimal lighting. The use of the glow sticks made it easier to relocate previously triaged patients and arrange for expeditious transport to definitive care. In addition, the glow sticks reduced the number of patient errors. Most importantly, there was a significant reduction in the number of patients that initially were triaged via the START method, but were overlooked during casualty collection and transport.
Qualitative Study of Homeowners' Emergency Preparedness: Experiences, Perceptions, and Practices
Authors: Diekman Shane T. , Kearney Sean P. , O'Neil Mary E. , Mack Karin A.
Published: August 2016

Introduction:

Considerable morbidity, mortality, and costs are associated with household emergency situations involving natural hazards and fires. Many households are poorly prepared for such emergency situations, and little is known about the psychosocial aspects of household emergency preparedness.

Problem:

The aim of this study is to promote a better understanding of homeowners' experiences and perceptions regarding household emergency situations and related preparedness practices.

Methods:

A brief survey was administered and three focus group sessions were conducted with homeowners (n = 16) from two metro Atlanta homeowners'associations.The survey inquired about basic demographic information, personal experience with a natural hazard or fire, and awareness of preparedness recommendations. The focus group discussions centered on household emergency preparedness perceptions and practices.

Results:

Participants defined household emergency preparedness as being able to survive with basic supplies (e.g., water, flashlights) for 48 hours or longer. While most participants had sufficient knowledge of how to prepare for household emergency situations, many did not feel fully prepared or had not completed some common preparedness measures. Concern about protecting family members and personal experience with emergency situations were identified as strong motivations for preparing the household for future emergencies.

Conclusions:

The focus group findings indicate that most participants have prepared for household emergency situations by discussing the dangers with family members, stockpiling resources, and taking a CPR or first-aid class. However, to the extent that behavior is influenced, there is a gap between maintaining preparedness levels and internalizing preparedness recommendations. Prevention efforts in Georgia should focus on closing that gap.
Estimation of External Blood Loss by Paramedics: Is There Any Point?
Authors: Williams Brett , Boyle Mal
Published: August 2016

Objectives:

There are many patient assessment challenges in the prehospital setting, especially the estimation of external blood loss. Previous studies of experienced paramedics have demonstrated that external blood loss estimation is highly inaccurate. The objective of this study was to determine if undergraduate paramedic students could accurately estimate external blood loss on four surfaces commonly found in the prehospital environment.

Methods:

This prospective, observational, blinded study used a convenience sample of undergraduate students studying at Monash University during 2006. Students were provided with four clinical vignettes using four different surfaces and varying simulated blood amounts.

Results:

Accurate estimation occurred with the vinyl simulation (100 ml), with a mean value of the estimations of 98 ml (95% Confidence Interval (CI) 84–113 ml). Carpet and concrete surfaces were both associated with large under-estimations.The carpet simulation (1,000 ml) had a mean value for the estimations of 347 ml (95% CI 320–429 ml). The concrete simulation (1,500 ml) had a mean value for the estimations of 885ml (95% CI 771–999 ml). Conversely, the clothing simulation (500 ml) emphasized over-estimation, with a mean value for the estimations of 1,253 ml (95% CI 1,093–1,414 ml). There was no relationship between increased accuracy and clinical experience, exposure, educational qualifications, or age of students.

Conclusions:

External blood loss estimation by undergraduate paramedic students generally is too inaccurate to be of any clinical benefit. Particularly, absorbent and impermeable surfaces precipitated inaccuracies by undergraduate paramedic students.
Childhood Crash Injury Patterns Associated with Restraint Misuse: Implications for Field Triage
Authors: Bulger Eileen M. , Kaufman Robert , Mock Charles
Published: August 2016

Introduction:

Restraint misuse is a common problem leading to increased morbidity and mortality for children involved in motor vehicle crashes. The purpose of this project was to describe the injury patterns associated with restraint misuse in the pediatric population, with particular focus on clues to significant injury that can be identified by the prehospital provider that may impact subsequent triage decisions.

Methods:

This is a case series presentation that illustrates the injury patterns associated with various types of restraint misuse in infants (ages 0–1 years), toddlers (age 1–4 years), young children (ages 4–8 years), and pre-teens (ages 8–14 years). Cases were identified from the Crash Injury Research and Engineering Network (CIREN) database.

Results:

Six cases are presented that illustrate the injury patterns associated with misuse of rear-facing infant car seats (0–1 years), forward-facing child seats (1–4 years), booster seats (4–8 years), and shoulder belts (8–14 years). Prehospital assessment of appropriate restraint use is described.

Conclusions:

Restraint misuse in children is a common problem. Emergency medical services providers need to be aware of these issues when assessing children and determining appropriate triage to a trauma center. Ongoing educational efforts also are vital to inform parents regarding the risks of inappropriate restraint use and can encourage legislators to better define appropriate restraint use for older children.
Compliance with Seat Belt Use in Benin City, Nigeria
Authors: Iribhogbe Pius Ehiawaguan , Osime Clement Odigie
Published: August 2016

Introduction:

Trauma is a major cause of death and disability worldwide. A quarter of all fatalities due to injury occur due to road traffic crashes with 90% of the fatalities occurring in low- and medium-income countries. Poor compliance with the use of seat belts is a problem in many developing countries. The aim of this study was to evaluate the level of seatbelt compliance in motor vehicles in Benin City, Nigeria.

Methods:

A five-day, observational study was conducted in strategic locations in Benin City. The compliance rates of drivers, front seat passengers, and rear seat passengers in the various categories of vehicles were evaluated, and the data were subjected to statistical processing using the Program for Epidemiology.

Results:

A total of 369 vehicles were observed. This consisted of 172 private cars, 64 taxis, 114 buses, 15 trucks, and four other vehicles. The seat belt compliance rate for drivers was 52.3%, front seat passengers 18.4%, and rear seat passengers 6.1%. Drivers of all categories of vehicles were more likely to use the seat belt compared to front seat passengers (p = 0.000) and rear seat passengers (p = 0.000). Drivers of private cars were more likely to use seat belts compared to taxi drivers (p = 0.000) and bus drivers (p = 0.000). Front seat passengers in private cars were more likely to use the seat belt compared to front seat passengers in taxis (p = 0.000) and buses (p = 0.000). Rear seat pas-sengers in private cars also were more likely to use seat belts compared to rear seat passengers in taxis (p = 0.000) and buses (p = 0.000).

Conclusions:

Compliance with seat belt use in Benin City is low. Legislation, educational campaigns, and enforcement of seat belt use are needed.