bluuebunny/crossref_metadata_2025 huggingface dataset:
(P1-79) Regional Medical Command and Control Management of Influenza A (H1N1) Mass-Vaccination in the County of Östergötland, Sweden
Authors: Jonson C. , Nilsson H. , Lundin R. , Rüter A.
Published: May 2011

Introduction

On 11 June 2009, an Influenza A (H1N1) pandemic was declared by the World Health Organization (WHO). The Major Medical Incident Regional Command and Control Protocol in the County Council of Östergötland, Sweden was activated. After vaccinations were competed, it was decided that the operation should be evaluated in a retrospective study. This study aims to increase knowledge regarding regional management of a pandemic flu.

Methods

All protocols from regional command meetings were studied together with central data regarding, logistics, vaccination site reports, incident reports, and all written correspondence between involved departments. Information from results of a questionnaire that was distributed to all vaccination site managers were summarized and studied. In addition, an interview was performed with the chief of medical operations.

Results

Out of the approximately 426,000 inhabitants of the county, a total of 224,780 (53%) were vaccinated during a five and a half month period. The mean pace was 1,246 vaccinated per day (range 0–9643). Regional command had 41 recorded meetings resulting in a collected number of about 740 working hours. Three hundred sixty-six employees were involved in the vaccination, working 38,741 hours. Twenty-eight safety and 52 security incidents were reported. Uncertainty about vaccine delivery and keeping the public's interest were reported to be of concern for the management.

Discussion

Even with the large scale of the operation, there were only a few security and safety issues. Although the goal of vaccinating 75–80% of the inhabitants was not reached, it could be assumed that the pandemic was dampened. Given the public's high initial interest, it could be considered that vaccination should not start until a large number of doses have been delivered.

Conclusion

The medical incident command structure and protocol successfully can be adapted to a mass vaccination event. Information from the Östergötland County Council operation yielded significant experience for future mass vaccinations.
(P1-80) Issues and Challenges in Preparedness and Response to Infectious Public Health Emergencies in Hospitals of Developing Countries
Authors: Devnani M. , Gupta A.K. , Goel S.
Published: May 2011

India has witnessed many major infectious public health emergencies (PHE) during 21st century. They include outbreaks of Severe Acute Respiratory Syndrome (SARS) 2002–03, avian flu in 2006, chikungunya in 2006–07, and the H1N1 pandemic in 2009. Periodic dengue and Japanese Encephalitis epidemics also are common. The premier institute of the country, PGIMER Chandigarh, always has received a huge inflow of patients from North India during such emergencies. These patients pose special challenges to hospital administration in terms of effective and efficient management of crisis situation, and require special measures. The authors' experience has shown that the major challenges faced are allocation of scares resources, capacity building, motivation of employees, infection control, and inter-sectoral coordination. The response during the initial phase is erratic due to a lack of clear guidelines and prior preparedness. Learning from these experiences, a contingency plan was prepared after consultation with all stakeholders. It was implemented during 2009 influenza pandemic. The contingency plan identifies: (1) area responsibilities; (2) disaster and screening areas for the handling of patients; (3) isolation and critical care facilities; (4) deployment of manpower; (5) allocation of drugs, consumables, equipment, and sterile supplies; (6) communication and reporting system; (7) awareness, education, and training; and (8) decision-making hierarchy and effective inter-sectoral collaboration. Also, a disaster plan has been prepared that includes standard operating procedures (SOPs) to be followed during infectious PHEs. A hospital infection control manual also has been prepared to address the issue of hospital acquired infections. The contingency plan and SOPs were effective during recent 2009 influenza pandemic in streamlining the response.

Conclusion

A well-documented contingency plan prepared in consultation with concerned stakeholders and implemented by a motivated and committed administration is essential in ensuring uninterrupted services during PHEs. It emphasizes that sound PHE plan is never an accident; it is always a result of high intentions, sincere efforts, intelligent direction, and skillful execution.
(P1-83) Infectious Diseases Following Natural Disasters: Prevention and Control Measures
Authors: Kouadio I.K. , Kamigai T. , Hitoshi O.
Published: May 2011

Communicable diseases represent a public health problem in developing countries, especially in those affected by disasters, and necessitate an appropriate and coordinated response from national and international partners. The importance of rapid epidemiological assessment for public health planning and resources allocation is critical. This review assesses infectious disease outbreaks during and after disasters caused by natural hazards and describes comprehensive prevention and control measures. The natural hazard event that causes a disaster does not transmit infectious diseases in the immediate aftermath of the disaster, nor do dead bodies. During the impact phase, most of the deaths are associated to blunt trauma, crush-related injuries, burns, and drowning rather than from infectious diseases. Most pathogens cannot not continue to survive in a corpse. The remaining survivors are the ones from which infectious diseases can be transmitted under appropriate conditions created by the natural disasters. Among several diseases, diarrheal diseases, leptospirosis, viral hepatitis, typhoid fever, acute respiratory infections, measles, meningitides, tuberculosis, malaria, dengue fever, and West Nile Virus commonly were described days, weeks, or months after the disaster event in areas where they are endemic. Therefore, diseases can also be imported by healthy carriers among a susceptible population. The objective of the public health intervention is to prevent and control epidemics among the disaster-affected populations. The rapid implementation of control measures should be a public health priority especially in the absence of pre-disaster surveillance data, through the re-establishment and improvement of the delivery of primary health care and restoration of affected health services. Adequate shelter and sanitation, water and food safety, appropriate surveillance, immunization and management approaches, as well health education will be strongly required for the reduction of morbidity and mortality.
(P1-87) Preparedness of Healthcare Facilities for an Influenza Pandemic - Protecting the Healthcare Workers
Authors: Hollingworth A.L.
Published: May 2011

Aim

To assess the preparedness of hospitals with respect to protecting health care workers (HCWs) during a pandemic.

Methods

A self-administered questionnaire was performed between November 2009 and January 2010, and a scoring system was developed to provide a quantifiable measure of preparedness.

Results

A total of 12 hospitals in NSW, Australia, were approached – six regional hospitals (RHs) and six tertiary referral centres (TRCs). The study was extended to assess three hospitals in England, allowing a limited comparison between the hospitals in Australia that had faced the initial wave of the H1N1 (“swine flu”) pandemic and the hospitals in the UK that had more time to prepare for the outbreak. Response rates were 66% from the TRCs, 33% from the RHs, and 100% from the English hospitals. The overall preparedness scores were relatively high, with a median TOTAL score (adjusted) of 50.75 out of 70. The demographic that scored the highest Total was tertiary referral centres in Sydney. All English hospitals scored below the median. However, the range of scores across hospitals was quite narrow (45.1 – 57.1 adjusted). Scores were generally high for the areas of Preparedness, Infection control, Education and Training. Scores for Vaccination were more variable. The category that consistently demonstrated the lowest scores was that of Psychosocial Welfare and Assistance, despite this being found in previous research to be an integral part of that which HCWs have identified as important.

Conclusions

Given their integral role in pandemic response, protecting HCWs must be a priority as part of any pandemic preparedness plan. This goes beyond protection from infection, extending into aspects of physical and psychological wellbeing. Identifying these issues and addressing them is the key to maximising staff support and morale, and minimising staff absenteeism at such a crucial time.
(P1-92) Safety Function Action: Current and Future Directions
Authors: Allen A. , Shultz J.M.
Published: May 2011

Introduction

SAFETY FUNCTION ACTION for Disaster Responders (SFA) trains a framework for achieving and maintaining a high level of disaster health. Within SFA, disaster health is defined as, “maximal safety, optimal function, and effective action in preparedness for, and response to, emergencies, disasters, and extreme events.” A set of six strategies forms the backbone of the framework with two strategies each for SAFETY (safeguard and sustain), FUNCTION (comfort and connect), and ACTION (advise and activate).

Methods

During 2008, a total of 2,553 participants were trained throughout the State of Florida. Participants were drawn from public health, healthcare, mental health, and professional/volunteer emergency responder workforces. During 2009, an additional 861 participants were trained as “SFA facilitators.” Facilitators were provided with guidance and training materials to return to their worksites and train peers on the SFA modules. Facilitators were in direct contact with a team of 5 DEEP Center “coaches” who supported their training efforts. To assess the training's effectiveness, pre/post-assessment data on the 2,533 SFA participants and 861 SFA facilitators were collected.

Results

Live-training evaluation data showed highly favorable quality ratings for the course, materials, presenters, and all individual course components. Pre/post comparisons of the data indicated consistent gains in self-reported confidence ratings for all 7 “facilitator skills” (recruiting, motivating, training colleagues; teaching SFA skills, working with coaches) and 15 SFA “strategies and response skills” (applying the six SFA strategies to responders (self, family, team) and disaster survivors). Consistent gains were evident for 12 scales asking facilitators to self-report their comfort in dealing with disaster survivors exhibiting distress or suffering trauma and loss.

Future Directions

SFA has been launched as an online training course and a cell phone “app” is in progress. SFA has recently been trained in South America and Europe. Experiential components of SFA are being refined and expanded.
(P1-94) Psychosocial Care for Children Affected by Tsunami - Through Child Care Activity Centers
Authors: Kavitha P. , Sekar K.
Published: May 2011

Psychosoical Care For Children Affected By Tsunami-Through Child Care Activities Centers Kavitha. P*, Sekar Kasi** Tsunami of 26 December 2004 shattered the lives, hopes and dreams of the people living in the coastal belts especially that of children where 37-39% of total death reported were children. Sad faith of children continued as many became orphans, single parented, lost their friends, school and happy environs where they enjoyed their life with their parents and friends. Displacement to the temporary shelters snatched away the emotional from family members, the unhygienic conditions resulted in the epidemics beyond their coping. A need assessment conducted among 1120 children in Kanniyakumari, Nagapattinam and Karaikkal revealed that impact is seen in all the children survided, 2/3 parents reported of probable problem behavior and conduct problem in children, 1/10 children were identified by teachers to have conduct problem, 1/10 children were identified by parent and child to have emotional problem due to the impact, 1/100 children impacted were behaviorally disturbed, 1/ 100 children is definitely behaviorally disturbed and has a probability of mental health problem. Children are young and in experienced to understand, comprehend or verbalize the trauma. An integrated approach model was initiated through community level workers using art as a medium. Psychosocial care was provided to children through seven mediums: Facial expressions, Thematic cards, Drawing, Family portrait, Writing, Story and Clay, in stages repeatedly. The results of the intervention revealed that the intervention was effective in reducing the trauma among children as mean for the impact has reduced from 31 to 26 after the intervention. The behavior problem reported among children reduced form 65% to 45% after intervention confirming the effectiveness of psychosocial mediums in reducing trauma among children affected by disaster. *Ph.D. Scholar, Department of Psychiatric Social Work, NIMHANS, Bangalore, India **Professor, Department of Psychiatric Social Work, NIMHANS, Bangalore, India.
(P1-100) Monitoring the Mental Well-Being of B-Fast Caregivers during Disaster Relief after the 2010 Haïti – Earthquake
Authors: Van Der Auwera M. , Debacker M. , Danschutter D. , Gijs G. , Hubloue I.
Published: May 2011

Introduction

During disaster relief, personnel's safety is very important. Mental well-being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.

Methodology

The study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6 + Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.

Conclusions

The study proved the ability to monitor mental well being and detect psychological distress, by self administered validated tools, during a real disaster relief mission. For practical reasons however some tools should be adapted to the specific use in the field. This study opens a whole new research area within the mental well-being and monitoring field.
(P1-102) Developing Methodologies to Assess Resource Needs and Ability to Provide Interventions and Care for Children in Disasters, Terrorism and Public Health Emergencies
Authors: Markenson D. , Reilly M.
Published: May 2011

Introduction

In emergency preparedness there is the need to prospectively develop an approach to which interventions can be provided with available resources and the maximal amount of clinical effectiveness which can be attained by staff.

Methods

A panel of pediatric emergency preparedness experts employed our previously validated evidence based consensus process with a modified Delphi process for topic selection and approval. Interventions were chosen such that resources and staff efficiency would not exceed previously published data for non-disaster emergency care but allowing for standard emergency preparedness planning alterations in standards of care such as the assumption that usual numbers of staff would care for a disaster surge of four times the usual number of patients.

Results

Using standard emergency preparedness assumptions of limited resources and staff efficiency, the panel agreed upon both methodologies for resource allocation and feasible interventions. A number of standard interventions would not be feasible and included detailed recording of vital signs, administration of vasoactive agents, prolonged resuscitation and central venous access.

Conclusion

By employing this approach to resource utilization described combined with the unique aspects of pediatric care, we can improve our planning and responses. This can be accomplished by understanding the needs of the population being served, learning how to focus on both pediatric needs and the expectations of the community with regard to care of children, adopting what has been learned in prior events in the United States and abroad, and developing prospective recommendations regarding essential interventions which can be performed in a disaster.
(P1-109) Humanism in Disaster Medicine
Authors: Kipor G.V. , Pichugina N.K. , Goncharov S.F.
Published: May 2011

The main trends in the development of the ideology of humanism in disaster medicine can be formulated in the following theses: 1. Responsibility of governmental bodies for providing medical safety of a human being in emergencies; 2. Responsibility of public health in the society; 3. Main tasks in nuclear threats connected as applied to disaster medicine are the responsibility of United Nations; 4. History of humanitarian medicine and the development of the World Health Organization's activities in providing medical humanitarian assistance; 5. Ethics of modern physical investigations in the light of development of nuclear and thermonuclear hazards; 6. Roles and trends of humanitarian medicine in modern society; 7. Philosophical and humanitarian approaches and ethics in the modern scientific investigations in the whole; 8. Ethics in modern medicine, biology, and disaster medicine; 9. Rights of victims to receive humanitarian medical assistance in local military conflicts; and 10. Threat of acts of terrorism with the use of chemical, biological, radiological, or nuclear agents and technologies; The paradox of the modern age is that the “principal basis and aim of disaster medicine are humanitarian by their primordial nature”, but the reduction of common human values can lead to a global disaster. On the other hand, emergencies should lead mankind to unity, to the deep understanding of biosocial aspects of survival when the best qualities of human nature are revealed. International disaster medicine problems should be considered as tools for providing an optimal basis for the development of human relations. The development of humanitarian and disaster medicine should be realized with consideration of deep-laid moral positions, on the basis of ethic principles and high moral values, among which, the primordial values are individual existence of everybody and survival of mankind as a species.
(P1-110) Key Elements of Successful Disaster Health Management Policy
Authors: Du W. , Fitzgerald G. , Clark M. , Hou X.
Published: May 2011

Introduction

Disaster health management policies are being developed and implemented by various government and non-governmental organizations. However, there has been a lack of studies to comprehensively identify the key elements in the successful disaster health management policies.

Methods

A survey of experts was used to identify key elements of successful disaster health management policy arrangements. This research conducted 10 face-to-face interviews, together with 22 e-mail surveys to identify the key elements. The experts were selected based on the person's background and expertise in disaster health management and policy analysis.

Results

Key elements of disaster health management policies were identified and introduced in four parts, including the characteristics of conceptual policy framework of disaster health management (risk assessment and recognition, strategic view, resilience community, inclusive and accountable, good structure with clear authority, fault tolerant, good communication, rigidity and flexibility, education and training, mutual understanding, effective funding), elements of policy development (adequate leadership, extensive consultation, clear goals and terms, easy to access and implement, locally owned and accepted, standard and flexibility, linkage with other policies, keep updated, involve all the stakeholders, regular drills as part of the policy), elements of policy implementation (well defined structure and agencies, professional disaster management body, delegate the power and coordination, maintain interests and involvement, communication, recognition of disaster risks, policy familiarity, full participation of health elements, financial support, specific measurement), and elements of policy effectiveness evaluation (advisory committee, evaluate true disasters, evaluate policies in exercises and drills, test people's knowledge, evidence of stakeholders contributing, practice and procedural change, evaluate operating procedural, scientific evidence).

Conclusions

Key elements must be considered in developing, implementing, and evaluating of disaster health management policies to ensure the success of these policies.
(P2-1) Large Civilian Jets Configured for Aeromedical Use: Implications for Disaster Health
Authors: Curnin S.
Published: May 2011

Background

Australia is a vast and isolated country and often the only viable option of transporting multiple casualties is using fixed wing aircraft. A number of civilian aeromedical services and the military are responsible for the evacuation of casualties, both nationally and internationally. Due to Australia's increased operational commitments, the military can no longer be expected to provide a rapid aeromedical deployment. This situation, coupled with the limited surge capacity of Australia's civilian fixed wing aeromedical services, highlights the need for Australia to improve preparation and readiness for a large scale civilian aeromedical response.

Discussion and Observations

Historically, the use of large jets configured for aeromedical use has been exclusively the domain of the military. Yet in recent years the use of large civilian jets configured for aeromedical capability has been suggested as a solution. The purpose of this paper is to explore the role of large civilian jets configured for aeromedical use in the event of a disaster with multiple casualties. This study involved an extensive literature review and an international study tour of aeromedical services that are at the forefront of using large jets in aeromedical evacuation. The findings identified that standard civilian jets can easily be reconfigured for transporting multiple casualties. It is argued that this strategy can be an inexpensive and effective option and should be included in emergency preparedness arrangements. The aim of this paper is to prompt disaster health agencies in Australia to consider the use of a civilian jet system that can be used for a disaster requiring a large scale aeromedical response.
(P2-7) Patient Distribution during a Mass-Casualty Incident: The 25 February 2009 Turkish Airlines Crash in Amsterdam
Authors: Postma I.L.E. , Weel H. , Heetveld M. , Bloemers F. , Bijlsma T. , Goslings J.C.
Published: May 2011

Background

Difficulties have been reported in patient distribution during mass-casualty incidents (MCIs). In this retrospective, descriptive study, the regional Patient Distribution Protocol (PDP) and the management of the patient distribution after the Turkish Airlines airplane crash on 25 February 2009 near Schiphol Airport in Amsterdam were analyzed.

Methods

Analysis of the of PDP involving the 126 surviving victims of the crash, by collecting data on Medical Treatment Capacity (MTC), number of patients received per hospital, triage classification, Injury Severity Scale (ISS) score, secondary transfers, distance from the crash site, and critical mortality rate.

Results

The PDP holds two inconsistent definitions of MTC. The PDP was not followed. Four hospitals received 133–213% of their MTC, and five hospitals received one patient. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); thre hospitals within 20 km of the crash did not receive any patients. Major trauma centers received 89% of the “critical” casualties and 92% of the casualties with ISS score ≥ 16. They also received 10% of “minor” casualties and 29% of casualties with ISS score < 8. Only three patients were secondarily transferred, and no casualties died in, or on the way to, the hospital (critical mortality rate = 0%).

Conclusions

Patient distribution was effective, as secondary transfers were low, and the critical mortality rate was zero. The regional PDP could not be followed during this MCI. Uneven casualty distribution was seen in the hospitals. The regional PDP is inconsistent, and should be updated in a new cooperation between Emergency Services, surrounding hospitals and vSchiphol Airport, a high risk area, for which area-specific PDPs must be designed.
(P2-27) Simulation of Transport During a Major Incident
Authors: Jezek B. , Vaněk J. , Antos K. , Prochazka M.
Published: May 2011

Transportation capacities belong to the key factors of the response to a major incident. Available resources, both in terms of personnel and equipment, must be transported, usually by ambulances, to the incident location. In the other direction, casualties must be transported to hospitals and other health care facilities for further treatment. For this reason, the efficiency of the response is greatly determined by ambulance travel times and the ability of health care facilities to absorb large numbers of patients. We propose methods to compute the travel times to and from the incident location based on a classified road network. The methods take into account different attributes that depend on ambulance type and capacity, road quality, time of day, weather or actual traffic density. Correctly computed travel times are crucial not only for optimal deployment of all resources within the analyzed region, but also for the evaluation of the readiness of the emergency health care system for a major incident. We have included the methods in an agent-based simulation of transport during the response. From the simulation outputs and with the help of geographical information systems and information visualization methods we have synthesized maps that represent the capability of a region to absorb a major incident defined by a scenario. When combined with risk maps and maps of population density the synthesized maps allow emergency management authorities to find critical points and gaps in the emergency health care service.
(P2-32) Emergency Medical Ambulance Services: Anti Terrorist Response in the 21 Century, Supporting Police Firearms Units with Specially Trained Critical Care Paramedics
Authors: Newton A.
Published: May 2011

Tactical Emergency Medical Services (TEMS), is a relatively new area of pre-hospital care. It requires specific attention to planning, including selection, training, equipment, procedures and continuing professional development, CPD to maintain competence. This session will describe the development of a small team of Critical Care Paramedics, who undertake a short, but intense programme, based at the Metropolitan Police Specialist Training Centre, MPSTC in England. CCPs are trained to work alongside firearms teams, who respond to criminal and terrorist incidents involving the use of firearms. The task of CCP's is to reduce the time between wounding and advanced resuscitative care, ensuring that Police Officers, members of the public and others receive a high standard of care without incurring unnecessary delays. They work outside the “hot zone”, but further forward than traditional ambulance operations. When these capabilities are available within the Emergency Ambulance Service, they are likely to improve patient care and firearms teams mission success. Delegates will be able to: (1) Identify the rationale, threat, risk and policy considerations driving the development of specially trained Paramedics working in a Police Firearms support role; (2) Describe the anticipated spectrum of incident types that might be encountered by CCPs in respect of tactical support; (3) Consider the range of triage, treatment and other capabilities, that can be provided in the field, including a review of associated education and training models; (4) Review the specialist personal protective and response equipment that is required to carry out this role; and (5) Reflect upon the viability of such capabilities within their own EMS environments.
(P2-34) Experiential Learning in Disaster Response for Veterinary Students and Veterinarians
Authors: Mcconnico R.S. , Wolfson W. , Taboada J. , Poirrier R.A.
Published: May 2011

Training for disaster responsiveness for veterinarians includes Incident Command System (ICS) and National Incident Management System (NIMS) comprehension, euthanasia, bio-security, all-hazards emergency preparedness, business continuity training, responder training, and incident de-briefing, Public and emergency management officials at all levels agree that saving animal lives saves human lives. Despite the recognition of the importance of veterinarians and other animal caretakers in animal disaster response and incident de-briefing, there has been less than adequate targeting of these groups for training opportunities leaving many veterinarians and other animal care takers vulnerable and unsure of their role when presented with a call to action in the midst of a disaster scenario in their home communities. The Louisiana State University School of Veterinary Medicine (LSU-SVM) has taken advantage of its physical presence amidst a disaster prone region of the United States to form response teams made up of students, faculty, and staff for actual training events termed disaster response experiential learning. Through a solid partnership with the Louisiana State Animal Response Team (LSART) and other response groups, the LSU-SVM has developed a disaster response program that includes animal response planning, evacuation, sheltering, emergency triage, and technical rescue expertise. Five specific response activities that occurred between 2001 and 2010 where LSU-SVM partnered with local and regional emergency responders enabled veterinary students and veterinarians to provide the work force and engage in experiential learning in a “hand-over-hand” environment with certified emergency responders. The response activities and partnerships demonstrate a successful model for veterinary student and veterinarian training in disaster response, have provided robust training experiences for hundreds of veterinary students and veterinarians, and have resulted in the subsequent development of courses to address identified gaps in veterinary disaster response training.
(P2-35) Loose Livestock in Disaster and Emergency Situations, Risks to the Public and Emergency Responders
Authors: Herthel W.F. , Madigan J. , Graham T.W.
Published: May 2011

Introduction

The general public's association with livestock (cattle, sheep and horses) raises a need for public safety. During emergency/disasters, animals are accidentally/intentionally released from containment structures. Loose livestock become agitated with unpredictable behavior which is a risk to both humans and animals. Specific training/protocols for responders are necessary for dealing with livestock.

Problem

Livestock running loose in populated areas raises risks to people, especially during capture attempts. Untrained personnel subject themselves to undue danger when assisting with livestock capture. Capture plans should be in place in advance and training should be provided to first responders on safety issues regarding animals.

Methods

A review of a loose livestock event brought forth the following considerations: (1) Evaluate the risks of a loose livestock/public event; (2) Inspect containment facility and identify secondary containment barriers, including fencing, buildings, rivers, etc.; (3) Develop plan for capture and containment within the immediate facility and surrounding area; (4) Provide training: training exercises, animal capture, basic animal behavior, and Incident Command System for first responders; (5) Arrange for emergency care or humane euthanasia for injured animals; (6) Coordinate capture and transport activities with local livestock experts.

Results

Production of a comprehensive loose livestock plan can prevent injury and/or death to both people/animals. Agencies involved in safety and emergency response should have a well written plan that can be used by all appropriate local agencies involved in loose livestock response. The utilization of a loose livestock worksheet (template) with professional training is essential for emergency response agencies.

Conclusion

Disaster managers should develop a comprehensive plan and training program with other local agencies in advance of an event to respond effectively to capture loose livestock.
(P2-39) Public Health Safety for Traditional Mass Gatherings in India: A 10-Year Analysis
Authors: Sanyal S. , Madan A.
Published: May 2011

Introduction

In the past decade, India has witnessed many lapses in crowd safety during mass gatherings. The high casualty rate in stampedes during traditional mass gatherings has prompted the study of these events. Wide variations exist in casualty rates for similar events, and key issues in healthcare services in these special situations were addressed in the Indian context.

Methods

From 2001–2010, Mass gathering data were collected from news items reported in the archives of newspapers, “The Times of India”, “The Hindu” and “The Indian Express”. The keywords used were: “stampede”, “mass gathering”, “mass-gathering events”, “mass-gathering incidents”, “crowd”, and “crowd management”. The study included triggers for the incident and the number of casualties (dead and injured) in each incident.

Results

In 27 separate mass gatherings in India, there were 936 dead and 540 injured casualties. The unique characteristics of mass gatherings in India included a predominance of old and vulnerable people in traditional mass gatherings, in contrast to the young and middle-aged groups who gather for music and sporting events elsewhere. Further, alcohol/substance abuse, brawls, and violent behavior were absent at traditional Indian mass gatherings. Non-traditional mass gatherings accounted for a lesser number of incidents in India, and were located in movie theatres and railway stations.

Conclusions

In a populous country like India, traditional mass gatherings predominate, and ensuring the health, safety, and security of the public at such events will require an understanding of crowd behavior, critical crowd densities, and crowd capacities in the Indian context. However, planning for mass gatherings can be developed using the existing body of knowledge of mass-casualty preparedness, food safety, and health promotion.
(P2-40) Patient Allocation to Hospitals During Mass-Casualty Incidents
Authors: Ruettger K. , Lenz W.
Published: May 2011

Due to the limited resources of specialized hospital departments, the allocation of patients to different hospitals according to severity is an extraordinarily complex and time-critical problem. The emergency capacity was determined for all medical centers (n = 135) in the State of Hessen, Germany, for patients of various triage categories (red, yellow, green) during normal working hours, and during weekends and nights and included logistic specifications of a potential helicopter landing. These data were entered into a state register. Using the data from the “acute-care-register”, a Ticket System was developed that allows operations management to assign patients according to the severity of their condition, urgency, and specialization requirements (e.g., neurosurgery, ophthalmology, pediatrics) to a hospital without exceeding the admission and/or treatment capacity of the hospital/facility. During a non-critical period, the order of allocations depending on the distance from the clinic is planned in advance so that no further modifications are necessary during the acute intervention phase of an emergency response. Additional notification of hospital capacities for severe casualties provided during the emergency response can be easily and immediately supplemented. Due to the relatively low frequency of such emergency responses, a cost-effective concept that is easily adaptable to the respective fields of application was decided upon. The system is a sticker set customized for the respective rescue teams. The sets will be carried permanently in the rescue equipment by the organization manager of the rescue service team. The equipment is not dependent on electronic components. The cost per sticker set is approximately US$50. Keeping track of the patient allocations is assured.
(P2-41) Emergency Medical Response Systems in a University Athletic Program: A Descriptive Analysis
Authors: Wendell J.C. , Bitner M.D. , Ossmann E.W. , Greenwald I.B.
Published: May 2011

Introduction

Unpredictable environmental conditions, crowd dynamics, and a variety of medical emergencies create logistical and clinical obstacles when planning emergency medical response coverage for mass-gathering events. In a collaborative endeavor between a university athletics program and an academic division of Emergency Medicine, a stadium emergency medical response system was created consisting of hospital-based healthcare providers and pre-hospital healthcare providers.

Objectives

Provide descriptive statistics relevant to the nature and frequency of injury/illness, location of treatment within stadium confines, and resources used in the care of students, event staff, and spectators during collegiate football operations, to assist in future planning of mass-gathering events.

Methods

A continuously updated, quality assurance database of de-identified, aggregate statistics was utilized to analyze trends regarding aspects of medical operations.

Results

During a 7-game home football season, there were a total of 399 patients encounters, including 1 cardiac arrest (0.25%), 12 “life-threatening” (3.01%), 121 urgent (30.33%), and 266 routine (66.67%). Total season attendance was 201,248 attendees (28,749/game and 19.83 patients encounters per 10,000 in attendance). Twenty-eight patients were transported (1.39 per 10,000), with eight resultant hospital admissions. Encounters varied by complaint, with skin (42%) comprising the largest number of encounters. Other categories included: (1) heat-related (23.5%); (2) allergic (15%); (3) neurologic (10.3%); (4) cardiopulmonary (3.5%); (5) gastrointestinal (3.6%); (6) musculoskeletal (5%); and (7) other (5%). Encounters increased noticeably when the heat index was greater than 80 °F– (29.4 vs. 10.5 per 10,000 attendees).

Conclusions

The collaborative effort by a multi-level provider model adequately covered presenting medical conditions. Consistent with previously literature, a strong correlation existed between heat index and number of patient encounters deemed urgent and routine. Interestingly, the number of “life-threatening” encounters did not appear to vary much with the heat index. Further studies of medical presentations and provider/resource utilization could provide for predictive modeling of future staffing and supply models.
(P2-49) Longitudinal Study of Health Conditions After the Sichuan Earthquake in China - The First and Second Year's Results
Authors: Yamamoto A. , Hu X.Y. , Cheng Y. , Li J. , Luo Y.
Published: May 2011

Objective

The objective of this study was to identify the daily lives and health conditions of survivors of the Sichuan Earthquake after two years.

Methods

The study was conducted for the survivors ≥ 18 years of age who experienced the earthquake. The questionnaire included the survivors' socio-demographics, impact of the disaster, and their health status after the disaster.

Results

Approximately 65% of respondents said that their conditions were healthy in the second year after the earthquake. The changes of daily lives among the survivors were increased from 1st year to 2nd year, as follows: diet (1st year; 24.5%–2nd year; 14.1%), sleep (29.4%–23.6%), entertainments (9.6%–15.1%). As health conditions, the following symptoms were increased; diabetes (2.8%–3.5%), cardiac disease (2.9%–5.0%), functional disturbances of body's joints and muscles (18%–21%). In contrast, the following symptoms were decreased; obesity/skinny (5%–3.5%), kidney disease (4.4%–1.6%), asthma and allergy (7.2%–5.6%). The current health conditions of the survivors included: headache, eyestrain, hand, foot, and/or joint's ache, sleep disorder. With regard to the psychological condition, the mean value of IES-R score was 22.2 ± 11.8. Compared with the 1st year results, the mean value IES-R score significantly decreased (1st year; 30.8 ± 16.8, p < 0.001, by paired t-test).

Conclusions

The survivors' physical and psychological conditions have improved compared to 1st year results. However most of the survivors still had some health problems in their health.
(P2-55) The Role of Nursing in International Disasters: Lessons Learned
Authors: Burke S.M. , Briggs S.
Published: May 2011

A disaster may result from a serious or sudden catastrophic event that has the potential for massive loss of infrastructure and significant mortality and morbidity. Disasters may be caused by natural or man-made events. With either type, the forces of the event overwhelm the first responders and health organizations in the stricken community and outside assistance is required. Developing countries have the highest burden with limited available resources. Today's complex disasters have increased the need for mobile medical/surgical response teams to provide disaster care. The United States (US) Government created the International Medical Surgical Response Teams (IMSuRT), which, on short notice, deploy a multidisciplinary team of doctors, nurses, and other health professionals to disasters around the world. IMSuRT has a rapidly deployable, fully equipped field hospital. Historically, Massachusetts General Hospital (MGH) in Boston, Massachusetts, US, has played a significant role in responding to humanitarian efforts both within the US and internationally. The MGH nurses play key roles in several response teams, including IMSuRT. Disaster nursing has many unique challenges. Nurses practice daily under controlled situations and become expert in one specialty; however, in the disaster setting this is not possible. Disaster nursing requires a fundamental change in the care of patients. During disasters, nurses work in areas that are not their primary specialty. Disaster nurses must be prepared in the essentials of disaster response- this requires planning, preparation, and training with multiple simulation drills focusing on patient scenarios, equipment utilization, teamwork, triage, decontamination, and scene safety. We must be creative, adaptable, and flexible to the needs of the disaster. Most importantly, cultural sensitivity, and communication are important factors in the delivery of disaster care.
(P2-63) An Evaluation of 57 Tick Bite Cases
Authors: Ortatatli M. , Gumral R. , Uckardes H. , Eroglu M. , Kenar L. , Eyi Y.E. , Arziman I. , Durusu M.
Published: May 2011

Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal zoonotic viral infection. The agent belongs to the Nairovirus of the Bunyaviridae species. The virus naturally recycles in vector-vertebrate-vector. This study aimed to evaluate cases of tick bites admitted to Infectious Diseases and Emergency Departments in 2008, and to develop management recommendations of such cases. Fifty-seven patients who admitted to a hospital due to tick bites in 2008 were included in the study. A 10-day clinical follow-up was performed to assess for symptoms including fever, fatigue, abdominal pain, headache, nausea/vomiting, diarrhea, disseminated somatic pain, and other hemorrhagic signs. During this period, laboratory analyzes, including white blood cells, thrombocytes, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, creatinine phosphokinase (CK), and pentylenetetrazol were performed. Personal data of the patients, location of the bite, and the removal of the tick were recorded.

Results

Of the 57 patients, 37% were from the city, and 63% were from rural areas. The tick was removed by health staff in 25 (44%) of the cases. The bites occurred on body areas including the head/neck, trunk, upper extremities, and lower extremities in 14%, 24%, 27%, and 13% of the cases, respectively. During the follow-up period, none of the patients exhibited any of the signs or symptoms listed above. Laboratory tests did not reveal any abnormalities, except for high levels of CK in 15 patients. Thus, 57 cases did not develop CCHF.

Discussion and Conclusion

Since 2002, CCHF has caused an increased mortality in Turkey, and has resulted in high anxiety and concern among the Turkish public regarding tick bites. This has resulted in a rise in the number of patients admitting to emergency departments with tick bites. Due to CCHF's incubation period, patients with tick bites should be evaluated for 10 days using a multidisciplinary approach involving both clinical and laboratory evaluations in order to prevent the unnecessary administration of ribavirine.
(P2-66) Experience of 14 Cases Exposed to Hydrazine
Authors: Tuncer S.K. , Durusu M. , Arziman I. , Eyi Y.E. , Bayir A. , Kaldirim U. , Yildirim A.O. , Eryilmaz M.
Published: May 2011

Hydrazine, a highly toxic agent is mainly used as a high-energy rocket propellant or reactant in military fuel cells, in nickel plating, in the polymerization of urethane, for removal of halogens from wastewater, as an oxygen scavenger in boiler feedwater to inhibit corrosion, and in photographic development. Short-term exposure to high levels of Hydrazine may cause irritation of eyes, nose, and throat, headache, nausea, dizziness, pulmonary edema, seizures, and coma. Acute exposure can also damage liver, kidneys, and central nervous system. Dermatitis may develop by skin contact. In this article we aimed to present our experience belongs to 14 cases exposed to Hydrazine. Cases were evaluated retrospectively based on demographic data, exposure type, approximate exposure time, clinical features, lab analyzes and results of follow-up. Cases were all male personnel. Mean age and standard deviation were 30,28 and 6,73 respectively. All cases were exposed to Hydrazine in an open place during the monitorization of aircraft for a couple of seconds. Personnel were presented to feel an odor similar to garlic in their nasopharynx. Retrosternal burning was the preponderant symptom in 6 of the cases. The vital signs and physical examination provided no valuable data. Evaluation of Whole Blood Count, Arterial Blood Gas, Biochemical Parameters, Urine Tests, ECG and Chest Radiograph took place in diagnosis period. Respiration function tests were performed on the 6 of the cases who had respiratory complaints. All tests revealed unremarkable data. All cases were subjected to reevaluation in the end of next 48 hours. No complications were encountered on the next examination. Our cases presented no mortality and complication due to having information about Hydrazine and short-term exposure and exposure in open place. Of personnel working in such places including Hydrazine, having information about Hydrazine, is the leading factor in preventing mortality and complications of Hydrazine.