bluuebunny/crossref_metadata_2025 huggingface dataset:
(A183) Umbrella” in a Small, Developing Country - A Case Report on Pandemic Influenza Preparedness in Bosnia and Herzegovina
Authors: Cornwell S. , Fejzic N.
Published: May 2011

Cooperation between veterinary and public health authorities in Bosnia and Herzegovina and their respective field services has historically been weak and inefficient. As is the case in many countries, animal health and public health fall under separate ministries with animal health the responsibility of the ministry of agriculture and public health the ministry of health. This model has promoted interagency competition for funding for disease surveillance and control. It has also resulted in poor information exchange, lack of efficient utilization of diagnostic resources, and poor harmonization of policies. Political decentralization, established in Bosnia after the Dayton peace agreement, resulted in the lack of a national-level responsibility for animal or public health. This was instead placed at mid-governmental levels. A state (national) veterinary office was created in 2000, but there still remains no national public health agency. The H5N1 Avian Influenza (AI) outbreak which began in Southeast Asia in 2003 and reached Europe in 2005 raised concerns about Bosnia and Herzegovina's (BiH) preparedness to combat pandemic disease. Accordingly, the state (national) veterinary service of Bosnia and Herzegovina (BiH) conducted exercises which resulted in increased monitoring of wild and domestic bird populations and the drafting and adoption of a contingency plan (CP) for AI. The activities prescribed by the CP were implemented in February 2006 when the H5N1 virus was diagnosed in wild swans. However, no cooperation was established with public health authorities during this incident, further underscoring the need for a one health approach to disease control activities. Adoption of the One Health concept is challenging, and there is no simple plan that can be applied across all cultures. To prevent it from simply existing as an idealistic theory, some revision is needed and practical guidelines must be developed. The authors will include suggestions as to how this might be achieved.
(A186) Edward via College of Osteopathic Medicine (VCOM) Honduras Dengue Outbreak Emergency Response Case Study
Authors: Sutphin D. , Tooke-rawlins D. , Willcox J. , Muller J.
Published: May 2011

In July 2010, the government of Honduras requested VCOM assistance with a widespread Dengue Outbreak. At the time of the mission trip, over 33,000 Hondurans had been hospitalized for Dengue Fever and a National State of Emergency declared. VCOM sent a team of medical students, faculty and volunteers to answer the call for help. The Honduran government selected five villages where the need for medical attention was greatest. The team provided medical exams, treatment or referral when necessary to approximately 200 patients in each of the five villages. General medical exams were provided in addition to screenings for Dengue Fever and subsequent supportive treatment including oral rehydration salts, Tylenol, vitamins and treatment of complications. National and local strategic partnerships to provide emergency medical response services included the Minister of Health, Minister of Defense, Minister of Transportation and Housing and office of the President of Honduras; Deans of the National and Catholic Medical Schools; President of the Board of Medicine and other governmental and non-governmental offices; Mayors and local officials, and often local media. At Marcala, the Minister of Public Transportation and Housing arrived by Helicopter from Tegucigalpa to greet the VCOM team and patients at the clinic; and at Santa Maria del Real, the Honduran President's son met the team personally. The Honduran support for VCOM's ongoing continuity of health and improved medical care efforts in the country was evident. The trip enhanced the skills and knowledge of participating students and faculty. Student Jenie Sales writes, “I not only enhanced my own clinical experience and knowledge, but I obtained a greater understanding for the people and culture of Honduras.” Student opportunities for reflective learning included case study writing, surveys and evaluations. The successful experience will lead to increased knowledge in the care of patients during a Dengue outbreak.
(A187) Red Cross Volunteers' Roles in Epidemic Control: Community-Level Interventions during Cholera Outbreaks in Zimbabwe and Haiti
Authors: Saaristo P. , Aloudat T.
Published: May 2011

Managing epidemics, or preferably, preventing them, is a priority for the International Federation of the Red Cross (IFRC). The IFRC response to the cholera outbreaks in Zimbabwe in 2009 and in Haiti in 2010 both included: the Emergency Response Unit system as the backbone, and the International Red Cross Movement helped the National Red Cross Society fulfill its humanitarian mandate during the emergency. Water and Sanitation units and Basic Health Care Units cooperated seamlessly to ensure consistency and effectiveness in the activities. A large part of the International Red Cross and Red Crescent Movement response is performed by community-based volunteers. During both outbreaks, the Red Cross put special focus on community-level interventions. In both countries, the National Red Cross Society, supported by the International Federation of the Red Cross, trained volunteer groups using a local adaptation and translation of the IFRC training package for emergency health and epidemic control. Research has shown that community volunteers frequently lack the background information necessary for a quick and efficient response to epidemics, especially when they are located in areas that do not benefit from the support and guidance of health professionals. This is particularly true in developing countries that often lack sufficient healthcare facilities and staff. To help fill those gaps, the IFRC launched a training package — Epidemic Control for Volunteers — more effectively involving volunteers in the epidemic management. It provides volunteers with a basic understanding of the diseases that can easily turn into epidemics. This training package is intended for volunteers and trainers in local branches of Red Cross and Red Crescent societies. It teaches them how they can help limit the number of victims, act quickly and effectively, and define their role in the community before, during, and after an epidemic.
(A189) The U.S. National Veterinary Stockpile: Science-Based Logistics Improving Animal Disease Response
Authors: Myers L.M.
Published: May 2011

Background

Agriculture emergency responders always will require equipment and supplies. A rapid and effective logistical response depends upon having the right item in the right quantity at the right time at the right place for the right price in the right condition to the right responder. Established in 2004 by U.S. Homeland Security Presidential Directive 9, the National Veterinary Stockpile (NVS) within the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service, Veterinary Services is the nation's repository of critical veterinary supplies, equipment, vaccines, and services appropriate to respond to the most damaging animal diseases affecting human health and the economy. An overview of the NVS program, its capabilities, training and exercise strategy, and outreach to stakeholders will be presented.

The NVS Program

The goals of the NVS program are to deploy countermeasures against the 17 most damaging animal disease threats within 24 hours, and to help states/tribes/territories plan, train, and exercise the receipt, processing, and distribution of NVS countermeasures. To meet these goals, the NVS program heavily relies upon science-based logistics to identify animal vaccines and other countermeasures to respond, and sound business processes to purchase, hold, maintain, and deploy the countermeasures. Significant resources also are dedicated to the NVS outreach activities, which interface directly with federal/state/tribe/territory animal health stakeholders. NVS team members work hand-in-hand with these leaders to help develop written NVS-specific plans for their jurisdictions, provide logistics training, and sponsor discussion-based and operations-based exercises in accordance with the Homeland Security Exercise and Evaluation Program.

Conclusion

The USDA NVS exists to provide states/tribes/territories the countermeasures they need to respond to catastrophic animal disease outbreaks created by either terrorists or nature. As logistical experts, the NVS team develops plans for logistical emergency response, manages their supply chain of countermeasures, and helps stakeholders improve logistical response capabilities.
(A170) Health Sector Coordination Following Civil Conflict in Sri Lanka, 2009
Authors: Wickramage K. , Ranasinghe T. , Vithana E.K. , Herath H.
Published: May 2011

Background

Three decades of internal conflict, displacing 300,000 civilians, in the Northern and Eastern Provinces of Sri Lanka ended in May 2009. Civilians affected by the fierce fighting in the proceeding months were ushered by the military into internally displaced persons (IDP) camps in an area called “Manik Farm” in Vavuniya District until they could be resettled. The Ministry of Health led the provision of health services to the displaced in coordination with the humanitarian health cluster at the national and field level immediately after of the war.

Methods

The Ministry of Health plans and reports were reviewed, along with reports from health sector partners and national and international guidelines on coordination in humanitarian relief operations. The way the Ministry of Health coordinated with health sector partners via the health cluster was different from other coordination models where military and civil administration were involved in providing humanitarian relief also was compared.

Conclusions

The review shows that the health sector coordination mechanism adapted in Sri Lanka had a clear leadership and guidance for health sector partners according to national plans and frameworks. It was indicated by better health outcomes like mortality and morbidity among displaced population in IDP camps in Manik Farm.
(A171) Daily Crude Mortality Rate (DCMR) as an Indicator to Measure the Success of Provision of Services to Internally Displaced Population (IDP) in Sri Lanka
Authors: Vithana E.K.
Published: May 2011

Background

Sri Lanka's 28 year protracted civil conflict between the government forces and Liberation Tigers of Tamil Eelam (LTTE) in the North of country saw dramatic end by May 2009 when the military forces succeeded in crushing the LTTE. Around 300,000 people were displaced due to the conflict and they were settled in welfare villages established in the North.

Discussion

The Government of Sri Lanka working in partnership with all other actors mounted a major humanitarian response to address the needs of the war displaced population. The Ministry of Health took a leading role in coordinating the health care programs for the Internally Displaced Population(IDP).

Observations

Higher morbidity and mortality observed during early phase of settlement of IDPs was due to the results of two scenarios, one being the conflict situation and its direct consequences that have caused injuries, disabilities and mental trauma among the population. The second being the result of the collapse of the health system in conflict affected areas, long period of displacement of people and the disruption of social structures that have led to the indirect consequences of increase of infectious diseases and worsening of chronic diseases. Ministry of Health used Daily Crude Mortality Rate (DCMR) to measure the success of the response. According to the Sphere Project guidelines that developed a set of minimum standards in a disaster situation, the DCMR should be 0.25 per 10 000 population for South East Asia. The emergency threshold level is 0.5 per 10 000 per day for this region.

Conclusions

Of the number of people reaching the IDP welfare villages in early stages of emergency phase in May, DCMR averaged to 0.7. The figure settled to less than 0.5 per 10000 in June 2009. Thereafter daily DCMR remained less than 0.5 indicating success of the provision of care for IDPS.
(A193) Concurrent Measles and Rubella Outbreaks in Transit Camps in Cote D' Ivoire
Authors: Kouadio I.K. , Oshitani H. , Kamigaki T. , Koffi A.K. , Attoh-Toure H.
Published: May 2011

Background

Measles still remains an important cause of morbidity and mortality among children in many developing countries, especially in refugee settings where fatality rates as high as 33% have been documented. From January to April 2004, concurrent measles and rubella outbreaks had occurred in four transit camps hosting 2,767 Liberian refugees in Cote d'Ivoire.

Objective

This study describes the epidemiology of concurrent measles and rubella outbreaks, and the investigation of a Disease Surveillance Team.

Methods

Patients meeting the case-definition (rash and fever > 38°C) were detected actively. Blood sample were collected for measles and rubella IgM antibody confirmation.

Results

Sixty rash and fever cases were identified. During weeks 8 to 13, measles IgM testing had resulted in 61.1% positive tests. The highest incidence (18.5%) was observed in children below 9 months. Ninety-three percent of children aged between 6 months and 12 years received a measles vaccination but the rash and fever cases continued to occur. This prompted a systematic test for both measles and rubella IgM antibodies. Rubella IgM testing had resulted in 74.0% positive tests. The highest incidence (3.88%) was found in children between 5–15 years. Supplemental immunization with a measles-mumps-rubella (MMR) vaccine was conducted, following which, no fever and rash cases were documented.

Conclusions

This study indicates the importance of an early serological testing for measles and rubella together or the use of the MMR vaccine rather than only measles vaccine in disasters settings. Good management of surveillance data will be an asset for effective immunization strategies in refugee settings.
(A197) Attitudes toward Public Assistance during a Disaster Among Patients with Rheumatoid Arthritis
Authors: Sato H. , Tomio J. , Mizumura H.
Published: May 2011

Background

Recently, the local governments in Japan implemented the measures for people requiring assistance during a disaster (PRAD). These measures aim to provide public assistance during a disaster for the citizens who registered themselves to the PRAD list in advance, by sharing their personal information among relevant local authorities. However, the needs for such assistance were not clear among chronic disease patients, and there are some concerns about privacy protection in relation to the PRAD list.

Objectives

The objective of this study is to describe the attitudes toward the registration to the PRAD list among rheumatoid arthritis (RA) patients.

Methods

Study subjects were the members of a nationwide RA patient group in Japan. Of about 20,000 members, 1,477 who lived in the municipalities affected by disasters from 2004 to 2006 were enrolled. Self-administered questionnaires were sent by mail. The subjects were asked their attitudes toward the registration to the PRAD list and categorized into three groups: (1) no need for assistance; (2) need assistance but will not register; and (3) need assistance and wish to register or already registered. Their concerns about privacy protection as well as socio-demographic and health status were also asked.

Results

Of 1,477, 664 (45%) responded validly, and 596 (40%) answered on their attitudes toward the PRAD list. Of these, 365 (61%) reported they need assistance, though 30% of them (108) did not wish to register. A majority of the subjects concerned about privacy protection among those did not wish to register (65%) as well as among those wished to register (55%). Patients who lived alone, and those with low income were more likely to wish to register.

Conclusions

There are substantial needs for public assistance during a disaster among RA patients although the privacy protection issue would be a barrier to be overcome for successful utilization of the list.
(A205) Management of Mass Casualties and Associated Health Effects Following Chemical or Radiological Agent Release: Results of the European Union Mash Study, 2008–2010
Authors: Baker D.J.
Published: May 2011

Although emergencies involving mass casualties following the release of chemical or radiological agents are rare, the risks are well-recognized and many countries have prepared national response plans. The MASH (Mass Casualties and Health) study, partially funded by the European Commission, examined preparations for mass-casualty management and associated health risks within the Member States of the European Union (EU). The objective of the study was to improve the overall capacity to manage mass-casualty incidents that may equally outstretch the resources of a single country or involve several states simultaneously. Through confidential questionnaires and other means, MASH investigated the current response capabilities and planning for chemical and radiological incidents within the EU and also explored, through a number of seminars, developments in information and communications technologies, together with relevant developments in biotechnology which could improve a unified response. Finally, a foresight study has identified a number of areas for improvement and identifies six strategic aims for EU Member States to cope with chemical and radiological mass casualties. This presentation will cover the main findings of the MASH study and consider its wider message for chemical and radiological incidents worldwide.
(A212) The 2008 Mumbai Terrorist Attacks and the Changing Pattern of Violent Injuries
Authors: Tanwar Y. , Kaushik V. , Roy N. , Sinha S. , Guru B.
Published: May 2011

Introduction

The 26–29 November 2008, terrorist attacks in Mumbai, have been referred to as “India's 9/11”. Violent events in Mumbai over the past six decades were researched to understand the changing pattern of violent injuries.

Methods

A complex, retrospective, descriptive study on terrorist events was performed, using event reports, legal reports, newspaper reports, and police and hospital lists. The distribution of victims to various city hospitals, the critical radius, surge capacity, and nature of interventions required were assessed. The profile of those killed in the attacks was noted by sex, nationality, and occupation. Besides the overall mortality and case-fatality ratio, the critical mortality was calculated based on the death rates among the critically injured.

Results

In 51 violent events in Mumbai over a 60-year period (1950–2009), 1,582 people were killed and 4,145 were injured. In the Mumbai terrorist attacks of 2008, the financial loss due to direct physical damage was INR 847,612,971 (US$18.5 million). Among those killed, the average age was 33.4 years, 80% were male, and 12% were foreign nationals. The case-fatality ratio for this event was 36.2% and the mortality among the critically injured (critical mortality rate) was 11%. Among the injured, 79% were male and the average age was 33.21 years (three months–85 years); 38.5% of patients arriving at the hospitals required major surgical intervention.

Conclusions

The injuries of violent events in Mumbai have been changing due to the use of heavy firepower and explosives. Strengthening the public hospitals for trauma care is a medical counter-terrorism response for future terrorist attacks. These attacks have affected the lives of the common person in Mumbai, in terms of increased security checks, alerts, and fear of further attacks. These are areas of further research.
(A221) Medical Preparedness for Expo 2010 Shanghai China
Authors: Liu Z.
Published: May 2011

Objective

EXPO 2010 Shanghai China attracted about 246 nations and international organizations as well as 73 million visitors from home and abroad. To provide good medical services to is a challenge.

Methods

Eight Level A hospitals are designated as EXPO Hospitals to provide advanced medical services to those who need critical care. There are five first aid stations in the EXPO park to provide first aid to EXPO visitors and staff. First aid at scene and emergency response are the emphasis. Practical, realistic, and systematic and forewarning emergency plans are made. An agile and efficient structure is organized. All EXPO staff members underwent first aid training, especially the CPR training and the use of AED. The public are trained for self rescue skills via different approaches and provided with first-aid kits. A medical rescue team is recruited; the team consists of Critical Care physicians, surgeons, anesthetists and nurses. The team is able to deal with different situations under all conditions. The team is a standing army, after the EXPO, the team will be responsible for providing medical services in the regional disaster rescue. Drills are performed periodically to practice the rescue skills, enhance the communication and cooperation among different government departments.

Results

By joint efforts, a safe, wonderful and unforgettable EXPO was presented to the world. During the 184 days, medical personnel provided medical services to the 73 million visitors.

Conclusions

The medical preparedness for World EXPO should be practical, realistic, and systematic and forewarning. The public should have the easy access to the information and resources. Develop the contingency plans according to the real situation, ensure its timely updating and deliver training to every one involved. Drills should be performed periodically to practice the rescue skills, enhance the communication and cooperation among different government departments.
(A237) Management of the Dead during Mass Casualty Disasters in South Asia: Perspectives of the First Decade of the 21st Century
Authors: Perera C.P. , Briggs C.
Published: May 2011

The first decade of the 21st century will go down in history as an era of major disasters. Disasters have occurred in all corners of the world and ranged from events such as the 11 September attack, the London bombings, the Asian Tsunami, Hurricane Katrina, earthquakes in India, Iran, Pakistan, China, and Haiti, and cyclones and floods in Bangladesh and Myanmar. The unavoidable common factor of all these disasters was the massive number of casualties and deceased witnessed within a short period. The effective intervention of governmental agencies to manage casualties during the immediate aftermath of a disaster often is restricted by many technical and circumstantial factors. However, it was observed during the last decade that during disasters, volunteer members of the affected and surrounding communities form a huge supportive force to meet most urgent tasks, including managing the dead. This was best witnessed in 2004, after the Asian tsunami disaster. The management of the dead during disasters is a multidisciplinary, multi-stage task and a medico-legal emergency that should be commenced during the immediate post-disaster period. Community first responders comprise an easily accessible, readily available task force in the field of managing the dead, especially in the recovery and transportation of dead during disasters. The first attempt to regularize the role of community first responders during disasters was made in 2005 with the post-Asian tsunami experience through a joined effort of many international organizations. Since then, south Asian countries have been more concerned about developing capacity of first responders via community-based disaster management schemes. The services of first responders could be greatly enhanced through training and integrating them into mass casualty management plans in less resourced countries as elaborated in this paper.
(A248) Médecin En Zone D'exclusion Lors D'un Accident Chimique
Authors: Ronchi L.A. , Decanlers C.
Published: May 2011

La doctrine classique, en cas d'accident catastrophique en contexte chimique, consiste á confier aux sauveteurs (porteurs d'une tenue d'isolation leur permettant de ne pas Être eux-mêmes contamines) l'extraction et la décontamination d'urgence des victimes. Le médecin n'intervient alors qu'après passage des victimes dans la chaine de décontamination. Ce concept est actuellement remis en cause au vu des retours d'expérience. La plupart des accidents catastrophiques référencés sont constitués d'accidents Á effet limité, et se situent dans une dimension d'espace et de temps réduite. La présence médicale en zone d'exclusion apportera au moins les Eléments favorables suivants: •Caractérisation plus rapide du toxique sur une analyse séméiologique fine

•

Pratique de gestes de survie (exsufflation d'un pneumothorax suffocant, intubation d'un trauma crânien inconscient, remplissage d'une hypo volhémie aiguë administration précoce d'un antidote)

•

Soutien des Équipes de sauvetage

•

Anticipation Évolutive au vu de la nature du toxique en cause (décision d'administration de l'antidote, méta-triage des victimes)

Il existe néanmoins certains inconvénients potentiels:

•

Une présence médicale en zone d'exclusion devra Être précoce et donc susceptible d'amputer les effectifs médicaux initialement présents sur le terrain

•

La présence d'un médecin implique de sa part une discipline et une intégration parfaites au sein des Équipes de secours, soulignant la nécessité d'un entrainement régulier

•

Le travail en tenue de décontamination comporte des conséquences ergonomiques certaines, ralentissant la pratique des gestes techniques, et imposant des relèves

•

Une présence médicale implique un renfort logistique (réapprovisionnement en drogues et matériel)

•

Le médecin devra constamment garder Á l'esprit le contexte d'accident catastrophique pour ne pas ralentir le processus d'Évacuation de la zone contaminée

L'analyse du rapport favorable/défavorable concernant la présence médicale en zone d'exclusion lors d'un accident catastrophique en contexte chimique incite Á recommander cette présence, recommandation reprise dans les textes officiels récents.
(A253) Integrated Community-Based Interventions to Overcome a Deadly Cholera Outbreak in Zimbabwe
Authors: Yao M.N.
Published: May 2011

An unprecedented cholera outbreak affected Zimbabwe from August 2008 to July 2009 with 98,592 cases and 4,288 deaths, in 54 out of 62 districts. The main strategy used to overcome the outbreak was an integrated community-based interventions package. The present work is a case study to describe the strategy and lessons learned for future humanitarian crises and preparedness. The methodology was based on the review of epidemiological reports, assessment and surveys' reports, minutes of joint Health and Water Sanitation and Hygiene (WASH) Clusters' meetings, and direct observation as Health Cluster Coordinator. Epidemiological data showed an increasing number of cases in rural areas with community deaths representing 66% of the 1,948 deaths from 61,304 cases on 31 January 2009. Risk factors identified in communities were: lack of awareness about the disease, cultural and religious behaviors, lack of potable water with weak sanitation, lack and inappropriate use of water purification tablets, and lack of soap and water containers for effective behavior change. There also was late arrival to cholera to the few treatment centers by rural populations. In addition to treatment centers, a package of interventions was implemented by multi-sectoral stakeholders. The package included: health and WASH education tools and practice sessions for healthy and hygienic behavior change and for an effective use of oral rehydration salt as first aid measure; community-based surveillance with an early warning system and response teams; and distribution of containers and water purification tablets with drilling of water points. Epidemiological data showed a significant decrease of cholera cases where the full package was implemented. This work showed that an integrated package of interventions jointly targeting risk factors can be effective on public health threats in rural communities. Community-based preparedness and response should then take into account an integrated joint intervention package to mitigate public health threats.
(A256) Public Health: A Portal to Peace
Authors: Vroegindewey G.V.
Published: May 2011

War, conflict, and complex emergencies are major contributors to the crisis of human suffering with impacts on health, public health infrastructure, food security, economic viability, community infrastructure, and social fabric as well as the environment. Conflict mitigation and resolution are essential to the recovery and restoration of the community and health. Public health can serve as a mechanism to mitigate the impacts of conflict, serve as a bridge to resolve conflict and provide community resilience. The role of health care professionals as a “Bridge to Peace” is a critical component of conflict resolution. Health as a Bridge for Peace was formally accepted by the 51st World Health Assembly in May 1998 as a feature of the “Health for All in the 21st Century” strategy and has been demonstrated across a wide range of conflicts. Public health has attributes that make it a valuable platform for conflict resolution: it is broad, population-based, affects all parties, benefits both individuals and society, valued by recipients, and supports Universal Values. Public heath can be utilized in pre-conflict, conflict, and post-conflict situations and has been used in more than 20 conflict scenarios with Humanitarian Cease-fires, Days of Tranquility, and Safe/Peace Corridors supporting programs such as childhood vaccination days in Afghanistan to Guinea Worm Eradication in East Africa.
(A258) Is It S.M.A.R.T. To S.T.A.R.T. To S.A.L.T. M.A.S.S. Casualty Victims?
Authors: Alson R.L.
Published: May 2011

Triage of disaster and trauma victims is challenging, especially when responders have limited resources and brief periods of time. Over-triage of victims results in the consumption of resources that would be better utilized on more critical patients, and under-triage can result in increased mortality and/or morbidity, as victims do not receive the appropriate care. In addition, the same patient may be triaged multiple times as they move through echelons of care. These different echelons may have different objectives in the triage process Over the years, multiple triage schemes have been proposed and used, both in exercises and real events. None of these schemes is based on well-defined research, due to the difficulty of carrying out a randomized control study in real events. There has been a concerted effort to apply research findings in a effort to more effectively use resources and thus, improve patient outcomes as well as apply information garnered from after action reports. This presentation reviews the current issues and state of triage for disasters and mass-casualty incidents, drawing on examples from prior events. The ultimate objective of this presentation is to help the responder to better understand the process of triage and apply it to their clinical practice, thereby delivering care in an effective and timely manner.
(A264) Does the Implementation of Start Triage Criteria in the Emergency Department Reduce Over- and under-Triage of Patients?
Authors: Kumar R. , Bhoi S. , Chauhan S. , Sinha T.P. , Adhikari G. , Sharma G. , Shyamla K.
Published: May 2011

Background

Appropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.

Methods

The study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.

Results

Of 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.

Conclusions

The START triage criteria reduce over- and under-triage of patients.
(A265) Emergency Services In Catastrophic Flooding In Poland (2010 Experience)
Authors: Gula P.W. , Szafran E.M.
Published: May 2011

Emergency Services in catastrophic flooding in Poland (2010 experience) Przemyslaw Gula MD PhD, Edyta Szafran Institute for Emergency Medicine Flooding, Natural Disasters, Rescue Operations Between 17th May and 22nd June Poland faced one of the most catastrophic natural disasters in past 100 years history. The overall area of 779300 sq km. has been flooded. The flood affected several large municipalities. Nearly 270.000 people suffered the direct effects of the flood and 31000 were evacuated from their homes, 22 people were killed. Total number of 19000 buildings were destroyed or seriously damaged. Responding services were mainly the Fire and Rescue Service, Police, EMS, Military Units as well as supporting NGO's. The rescue and relief operation focused on evacuation, providing temporary shelter, water supply, establishing medical treatment and vaccination, providing public security. One of the challenges was the threat of evacuation of the hospitals in the affected areas. The total number of 80000 of rescue personnel and 15000 of military was involved in the rescue operation. The medical emergency operation included helicopter and boat evacuation, organization of field medical posts and secondary medical transfers. 43 helicopters and 1.000 vehicles were used. One of the problem was the collapse of the telephone network that affected the 112 Emergency Dispatch System. The out coming conclusions presented the high vulnerability of local medical systems on the effects of flooding. However the logistic support of Fire and Rescue and Military recourses can give quick compensation. The role of HEMS and SAR helicopters in providing evacuation and medical assistance is essential. Special emphasis should be made on providing the coordination of multiservice response and replacing the affected local communication systems. The main conclusion after flooding was the need of stronger integration of civil and military services, procedures, communication systems and compatibility of the equipment.
(A268) Lessons Learned: Western Australia's Health Sector Resilience during a Severe Storm
Authors: Leclercq M.G. , Robertson A.G.
Published: May 2011

The impacts of disasters on the community are not necessarily determined by the scale of a disaster, but are influenced significantly by the preparedness of the community, including the health community. Resilience is a dynamic quality within a community that is developed and strengthened over time. Evidence of the Western Australian (WA) health system resilience was demonstrated on 22 March 2010 when two severe weather fronts crossed the Perth metropolitan area and severely impacted a significant number of hospitals, the State pathology service, radiological services in tertiary and secondary hospitals, as well as aged care, mental health and other key health facilities. This storm has resulted in more than 120,000 claims and the total estimated cost is expected to exceed 1 billion Australian dollars, making it the most costly disaster due to natural hazards in WA history. Damage to these facilities included: (1) flooding, ceiling collapse, and broken windows in intensive care units, emergency departments, and operating theatres; (2) loss of radiological services; (3) sewerage inflow into wards, resulting in evacuation of mental health inpatients; (4) infrastructure damage to aged care facilities requiring relocation of residents; and (5) extensive loss of electricity and communications throughout Perth, which impacted on home oxygen therapy clients. A public health response also was required due to sewerage overflow into Perth's main river systems. This presentation will provide an overview of the event, lessons learned and how these lessons learned will be used to further enhance the health community's resilience.
(A269) Lightning Injuries: A Case Series
Authors: Yih Chong Michael C. , Russelle B. , Hsin Kai G.
Published: May 2011

Background

Singapore, albeit a small country, has one of the highest lightning activities in the world. However, injuries related to this spectacular weather phenomenon are under-reported and rarely a subject of study. Most reported cases dealt with lightning-caused fatalities but lightning-caused accidents are not always fatal. Actual reported international data showed that about 80% of lightning victims survived, with or without after effects. This study reviewed the cases of lightning-related injuries who presented to Tan Tock Seng Hospital, Emergency department.

Methods

This is a case series of 5 patients. All 5 patients presented to Tan Tock Seng Hospital, Emergency Department after a thunderstorm. All were undergoing military training when the incident happened. The circumstances surrounding their injury and their presentation and symptomatology were reviewed.

Results

In our study, three possible mechanisms of injury were identified through a side flash which occurred when the lightning hit the tree and traveled partly down that tree before a portion jumped to the nearby victims; through the concussive effect of the shock waves produced by the lightning; and through step voltage mechanism wherein the lightning after hitting the tree traveled into the ground where victims were standing. Two patients were diagnosed with rhabdomyolysis, one suffered from sensory-neural hearing loss, and one patient had a mild conjunctivitis as a result of tissue inflammation. Other symptoms included retrograde amnesia, parasthesia, tinnitus, and a single episode of seizure which resolved spontaneously. All our patients survived the ordeal and were discharged well back to their premorbid states.

Conclusion

This paper supports existing evidence that lightning-caused accidents are not always fatal and that victims may survive with no or little side effects given proper medical treatment.
(A275) Experimental Crowd Packing Analysis in Mass Gathering
Authors: Wang S.J. , Choi H.Y.
Published: May 2011

Introduction

Medical assistance for mass gathering can be classified based on the characteristics of mass gathering into primary or emergency health care for individual patient vs. medical assistance for public in case of disastrous mass gathering. It is necessary to prepare primary and emergency health care in case of routine mass gathering, but when an accident or event occurs, different medical approach will be necessary. One of the representative types of accident or event is crowd packing which can make high pressure among mass gathering participants usually from crowd rush or surge. This study was performed for identifying the characteristics of crowd packing in mass gathering.

Methods

The literature survey was performed on mass gathering and crowd packing. Human model simulation was done as a pilot study and 2-dimensional pedestrian pressure experiment was performed with volunteer students and pressure sensing device by video recording and analysis. Lateral shoulder loading and frontal chest loading were analyzed per load cell and per packed condition.

Results

As pushing pressure increased, the body was rotated to 90 degree after some threshold pressure point. The maximal and average pressures among volunteers were extracted. Pedestrian injury criteria(PIC) curve was generated.

Conclusions

When crowd packing occurs, the body will be rotated about 90 degree after some threshold pressure point. And then interpersonal pressure will be increased to crush injury as crowd packing proceed. For defining the interpersonal pressure to mortality and critical injury, further research will be needed reflecting real human physiology and anatomy.
(A277) Assessing the Psychosocial Elements of Crowds at Mass Gatherings
Authors: Hutton A. , Arbon P.
Published: May 2011

The physicality of mass gatherings has been well described in the literature. The factors effecting the rate of illness and injury at mass gatherings have been well described and include the type and duration of the event, the type and age of crowd, and the availability of drugs and alcohol. In 2004 Arbon proposed a conceptual model that describes the relationship between the environmental, psychosocial and the biomedical domains of mass gatherings. However to date the science of mass gatherings has focussed on the environmental and biomedical domains. There is minimal evidence to support or describe the psychosocial domain. Current tools available to assess the psychosocial domain are scarce even though it is considered an integral part of a mass gathering event. Berlonghi (1995) and Zietz (2009) proposed two measurements, crowd type and crowd mood respectively. This paper reports on a pilot project undertaken to evaluate how effective these tools are to understand the psychosocial domain of a mass gathering event.
(A283) Hospital Security Planning for Patient Surge Incidents: A Comparison of Three National Systems in China, India, and Japan
Authors: Downey E. , Hebert, Chpa A. , Kim D.
Published: May 2011

Introduction

As the number of disasters caused by natural and non-natural hazards increase, so does the emphasis placed on healthcare security planning for the influx of patients that often accompany such events. This presentation expands on a previously published examination of national healthcare security systems and emphasizes the role of security in the hospital environment during disasters in China, India, and Japan. National emergency preparedness planning systems and disaster type are examined. Elements of planning for a mass-casualty incident (MCI) that most directly impact security planning include mass-notification alert systems, patient routing processes to hospitals (from an MCI scene) and within hospitals (emergency department flow), staffing, disaster triage, patient identification, tracking and discharge, volunteer tracking, and the adaptability and flexibility of space and processes.

Methods

Researchers conducted extensive literature reviews of country-specific health care and physical security elements of patient surge. The comparative analysis was augmented by communication with national healthcare security experts.

Conclusions

Positive associations exist between increased disasters and the level of priority and funding given to healthcare security measures in disaster planning. National characteristics of governance, landmass, disaster history, and population influenced the development of healthcare security systems and planning for patient surge incidents. Planning for the mental health impact of terrorism victims, and its subsequent impact to patient surge into hospitals was more relevant in the literature for both India and Japan.
(A285) Hospital Preparation for Mass Casualty Events
Authors: Margalit G.
Published: May 2011

Background

Hospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.

The Approach

The preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.

The Implementation

In an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).

Conclusions

Only precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.
(A296) Psychosocial Disaster Preparedness Program Form School Children
Authors: Raj E.A. , Sekar K.
Published: May 2011

The impact of natural disasters on individuals is substantial. Among the affected population in any disaster, children are identified as the most vulnerable group along with women, aged and disabled people. An estimated 77 million children under 15, on average, had their lives severely disrupted by a natural disaster or an armed conflict, each year, between 1991 and 2000 (Plan UK, 2003). Children are most affected since they loose the familiar environment, loss of parents, witness death of their loved ones, fear of reoccurrence of the disaster event. The impact of disaster on children of different age group is multiple times greater than that of the adults. This leads to various psychological problems in children (Dave et al., 2003). Disaster preparedness, through care givers, is one among the ways to reduce the distress of individuals followed by any disaster because it reduces the vulnerability factor that minimizes the impact of any disaster on the individual. A disaster preparedness program with special reference to psychosocial aspects was developed and implemented among the school children through teachers in Kanniyakumari District, Tamil Nadu, India, one of the severely affected areas in Tsunami. The current attempt was to standardize a disaster preparedness module focusing on preparing children to deal with their psychosocial issues before and after disaster in an effective manner. The outcome of disaster preparedness input through teachers and its reach out to the students was determined through an experimental research. The results reveal that the teachers and students from the experimental group gained significantly more knowledge on psychosocial disaster preparedness after implementation of the program in comparison to control group where the program was not implemented. The implications of the study points out the need to integrate psychosocial component of disaster preparedness in to the broader Community Based Disaster Preparedness (CBDP) programs.