bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges and Opportunities for Interprofessional Collaboration within the Post-disaster Psychosocial Support Network in a Terrorism Scenario in the Netherlands: A Network Analysis
Authors: Jacobs Jurriaan , Maessen Jacklien , Dückers Michel
Published: May 2019

Introduction:

Post-disaster psychosocial support (PSS) is an indispensable element of disaster management. A variety of studies contributed to the development of guidelines, information about guideline implementation, and evidence-based practice, as well as the status of local PSS planning and delivery systems in different European regions. However, the multi-disciplinary nature of the organization of post-disaster PSS requires interprofessional and inter-organizational collaboration, but is presently insufficient institutionalized on individual, organizational, and governmental levels, locally, within the region, and nationally.

Aim:

Objective of this research is to map the existing post-disaster PSS network in the Netherlands in the context of a terrorism scenario, and to identify probable collaboration problems rooted in weak ties and lack of alignment between actors at different levels.

Methods:

Focus groups were organized in Belgium, France, Norway, and the United Kingdom to learn from the inter-agency response to recent terrorist attacks. Next, social network analysis methods were used to analyze the structure of the collaborative network for post-disaster PSS in the Netherlands. A scenario-based questionnaire was distributed amongst relevant stakeholders through snowballing methods. Respondents were asked to identify organizations they collaborate with on different PSS activities during the preparedness, acute, and recovery phase.

Results:

The international focus groups resulted in valuable lessons for the Dutch PSS network. Data collection for social network analysis is currently in progress. Based on previous research we expect limited ties between disciplines during the preparedness phase and during the “registration of affected persons” in the acute phase. Most of the interactions between agencies will be linked to one-stop-shop service delivery, and less to commemorations and health monitoring.

Discussion:

Lessons from the focus groups, verification of whether or not the expectations are supported by the social network data, and reflections on opportunities for improvement will be presented at the conference in Brisbane.
Comprehensive Safe Hospital Implementation in Rural Area of Indonesia
Authors: Alim Ahmad , Santosa Budi , Husein Rahmawati , Nurkholis Arif , Nihayati Zuhdiyah , Rintawan Corona , Afik Al , Inayah Iin , Arliono Tri , Haedar Ali , Alim Syahirul , Syamsu Danang , Supartini Eny , Nurjuman Husnan
Published: May 2019

Introduction:

Located on the Pacific Ring of Fire, Indonesia has to cope with the constant risk of many disasters. Hospitals in Indonesia are very vulnerable. Around 1,300 hospitals suffered damage since the Aceh tsunami (2006), with losses reaching 3 billion USD. Muhammadiyah is an Indonesian non-governmental organization (NGO) that has more than 300 hospitals. It is one of the forerunners in the Safe Hospital Initiative in Indonesia and has implemented a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED), which strengthened PKU Muhammadiyah hospitals in Bima (West Nusa Tenggara), the only hospital in Bima City, and in Palangkaraya (Central Borneo), funded by the Australian government.

Methods:

HPCRED improved the hospital through implementing two trainings (Hospital Disaster Management and Disaster Medical Officer), three workshops (Disaster Risk Management Policy, Hospital Emergency Response Plan, and Forming Hospital Disaster Management Committee and Disaster Medical Team), four exercises (Medical Skill Drill, Table Top, Command Post, and Full Scale). The improvement was evaluated through Muhammadiyah Safe Hospital Standard and Assessment Tool, which assessed four standards based on WHO Comprehensive Safe Hospital Framework (2015): (1) Management, (2) Human Resource, (3) Structure and Infrastructure, and (4) Integration and Cooperation.

Results:

After two years of program, both hospitals improved significantly. The PKU Muhammadiyah Palangkaraya index improved from 53 to 331 while the PKU Muhammadiyah Bima Hospital index improved from 83 to 374.

Discussion:

Before the program, hospitals were not ready to face disasters. The PKU Muhammadiyah Bima Hospital collapsed during a flash flood in December 2016. PKU Muhammadiyah Palangkaraya was overwhelmed during a haze disaster that occurred in April 2016. After the program, the hospitals were safe and ready to face similar disasters. They also already had the ability to respond to disasters on other islands, such as the earthquake in Lombok and Palu (2018).
Medical Coordination Rescue Members’ and Ambulance Nurses’ Perspectives on Emergency Mass Casualty and Terrorism Preparedness in the Netherlands - A Qualitative Study
Authors: De Cock Johan , Berben Sivera , Vloet Lilian
Published: May 2019

Introduction:

Mass casualty incidents, specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, and ambulance care. Recently in the Netherlands, a new model for emergency preparedness for large-scale mass casualties and a specific approach dealing with terrorist attacks was introduced (2016).

Aim:

To provide insight into the first experiences with this approach in order to identify strengths and pitfalls.

Methods:

The study had a qualitative design and was performed between January 2017 and June 2018. A semi-structured interview included topics that were selected based on available literature. All interviews were typed out verbatim and were analyzed using a structured approach of labeling and clustering of the response.

Results:

The main issues raised by the respondents included the following:

The interpretation of definitions introduced in the new model for the mass casualty preparedness model and the terrorist attack approach differed among respondents.

All respondents supported the six points of departure in the CRBN and terrorist attack approach.

Awareness of optimal personal safety (‘safety first principle’) specific for CBRN and terrorism is lacking.

Respondents reported that several rescue workers did not feel competent to perform specific newly introduced tasks, such as the command and control of the first ambulance arriving at the scene and the coordination task of emergency transport by the dispatch nurse.

Current regional differences in preparedness may complicate interregional collaboration.

Discussion:

As the approach is new and experience is primarily based on the outcome of exercises, the systematic planning and evaluation of exercises, and sharing of opinions and knowledge, as a result, is important to ensure an unambiguous approach in a real situation.
Implementation of Periop Disaster Response Exercise Program at Gold Coast Health
Authors: Donohue Andrew , Lamdark Tenzin , Lavin Jo , Hupalo Natalia , Wullschleger Martin
Published: May 2019

Introduction:

With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.

Aim:

This study assesses this model of response and evaluates it within the context of periop disaster exercises.

Methods:

The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.

Results:

Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.

Discussion:

Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.
Efficacy of Novel Commercial Tourniquet Systems in Extremity Hemorrhage Control - An Ultrasound and Generated Force Study
Authors: Ellis Joshua , Morrow Melissa , Sztajnkrycer Luke , Belau Alec , Wood Jeffrey , Kummer Tobias , Sztajnkrycer Matthew
Published: May 2019

Introduction:

Tourniquets (TQ) save lives. Although military-approved TQ are more effective than improvised TQ in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers.

Aim:

The purpose of the current study was to compare the efficacy of 3 novel commercial TQ to a military-approved TQ.

Methods:

A convenience sample of EM residents was utilized. Four different TQ were evaluated: Gen 7 Combat Application Tourniquet (CAT; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery occlusion was determined using a ZONARE ZS3 ultrasound. Steady-state maximal generated force was measured for 30 seconds with a thin-film force sensor (Singletract). Opinions were solicited at the conclusion of the study.

Results:

Nine residents participated in the study (7 male, 2 female). Success rates for complete arterial occlusion were 89% CAT, 67% SWAT-T, 89% RATS, and 78% TK (H 0.89, p = 0.83). Mean (± SD) times to achieve occlusion were 10.4 ± 1.7 sec CAT, 23.1 ± 9.0 sec SWAT-T, 11.1 ± 3.8 sec RATS, and 20.0 ± 7.1 sec TK (F 9.71, p < 0.001). Steady-state maximal forces were 29.9 ± 1.2 N CAT, 23.4 ± 0.8 N SWAT-T, 33.0 ± 1.3 N RATS, and 41.9 ± 1.3 N TK. Participants felt that the CAT was easiest to apply (61%), followed by the RATS (33%). Participants were most likely to select the TK (44%) for EDC, followed by the RATS (33%).

Discussion:

In this small convenience sampling, all novel TQ systems were non-inferior to the military-approved CAT TQ. Mean application times were less than 30 seconds. The size and unique nature of these novel TQs may make them more conducive to lay-provider EDC, thereby improving the response to high threat events.
Remote Highschool Hemorrhage Control (RHHECON) - Methods of a Randomized Control Trial
Authors: De Jager Elzerie , McCarty Justin , O’Sullivan Sarah , Rahim Fatima , Ezeibe Chibuike , Caterson Edward J. , Haider Adil , Levy-Carrick Nomi , Goralnick Eric
Published: May 2019

Introduction:

Uncontrolled bleeding is a leading cause of preventable death in trauma. The “Stop the Bleed” campaign has trained over 130,000 lay people in the US to act to control bleeding. Current hemorrhage control courses, the most well-known being the American College of Surgeon’s Basic Bleeding Control (ACS B-con) course, require in-person training. Scaling this course nationwide is time and resource intensive. Furthermore, groups have advocated that young people, who are disproportionately affected by physical trauma, be universally trained in hemorrhage control.

Aim:

Compare the effectiveness of teaching the ACS B-con course to high school (HS) students utilizing three different delivery mechanisms: in-person live, video-recorded, and virtual-live training.

Methods:

432 students (aged 15-18) will be recruited from two HS settings: 300 from a local HS and 132 from a national online HS platform. Local HS students will be randomized into two arms: a control arm (in-person live training) and virtual training through a pre-recorded lecture. Online HS students will undergo virtual-live training. The primary outcome is correct tourniquet application following training. Secondary outcomes are the acquisition of personal resilience-associated traits using a validated instrument, motivation for further training, and perception of the importance of live training. Tourniquet application data will be assessed using a non-inferiority design using two pairwise comparisons of the intervention arms to the control (in-person). Pre- to post-training survey data will be assessed using paired univariates tests. Sub-analysis of the impact of demographic variables on these relationships will be assessed.

Discussion:

In addition to integration of cardiopulmonary resuscitation courses into HS curricula, there is momentum to develop effective programs to educate HS students to provide care for the injured and control bleeding before first responders arrive. This trial will help determine the most effective delivery mechanism to teach a hemorrhage control course to HS students at scale.
A Fresh Look at Whether the Human Appendix Should Be Considered “Friend or Foe” in the Context of Long-duration Remote Expeditionary Medicine (Benivolem aut Insidiator?)
Authors: Christiansen Rowena
Published: May 2019

Introduction:

Traditional belief holds that the human appendix is a vestigial organ devoid of any purpose, and consequently, surgical appendectomy has been the “gold standard” treatment for suspected appendicitis. Prophylactic (preventative) appendectomy remains the policy of the Australian Antarctic Division for wintering medical practitioners and has been discussed in the context of long-duration non-orbital space flight.

Aim:

New research around appendiceal function, increasing adoption of non-surgical treatment modalities for acute appendicitis, and emerging research on the long-term consequences of appendicectomy have recently enabled researchers to challenge this paradigm.

Methods:

This novel project set out to test the hypothesis that a “one size fits all” prophylactic appendectomy policy may not be in the best interest of individual expeditioners, and utilized a “mindmap” to identify several key areas for a scoping literature review. This enabled disparate research to be drawn together in an innovative way.

Results:

A growing body of research has discovered that the appendix plays an important role in the gut immune system and maintaining gut health. It acts as a reservoir of good bacteria that repopulates the gut after pathogenic challenge. This is particularly important for people with impaired immune systems, such as those that occur in extreme environments. Appendicitis can often be successfully treated with intravenous antibiotics. Prophylactic appendectomy is not without risk, as 1:4 to 1:3 people will encounter some sort of postoperative complication. After an appendectomy, there is an increased risk of many serious medical conditions, including intra-abdominal adhesions, ischaemic heart disease, inflammatory and irritable bowel diseases, rheumatoid arthritis, and many others.

Discussion:

The increased morbidity and mortality associated with appendectomy is costly for individuals (the burden of disease) and society (health economics). It also poses a currently unappreciated health risk for long-term off-world expeditions.
Application of Game-Based Learning in the Teaching Process of Disaster Medicine for Medical Students
Authors: Hu Hai
Published: May 2019

Introduction:

Classroom instruction of disaster medicine for medical students is complicated and lacks attraction. Nowadays a novel method, which is named Game-Based Learning (GBL), has been used in other fields and received good feedback.

Aim:

To apply GBL to the teaching process of disaster medicine and discuss the effect of its application.

Methods:

A computer game was devised based on a syllabus of disaster medicine and employed it in classes of disaster medicine for medical students. Then a questionnaire about the application of GBL in education was used inquiring the demands of medical students for the designing of GBL in disaster medicine, including their platform and game mode preferences. Feedback was collected and data was analyzed after the class.

Results:

201 questionnaires were issued, and the valid rate was 100%. From the responses, 77% of medical students considered the application of GBL in education on disaster medicine was necessary, and 73% of the respondents thought it was practical. Furthermore, over 90% of medical students expressed their expectation for the adoption of GBL. According to another survey of 51 medical students we conducted, after attending a class about knowledge of injury classification with one board game adopted, most of the students believed GBL was better than traditional methods of teaching.

Discussion:

There is a high approbation degree among medical students to the adoption of GBL in the teaching process of disaster medicine, which suggests a great possibility for the application of GBL in medical education. It is concluded that GBL can be used in the teaching process of disaster medicine.
Are They Qualified and Trained to Manage Disasters?
Authors: Rowe-Rowe Kevin
Published: May 2019

Introduction:

In the South African environment, the possibility of lack in the disaster response education and training fraternity was attempted to be mitigated with legislation. The National Disaster Management Framework (2005:162-169) states that national, provincial, and municipal organs of state need to plan, organize, and implement training programs relevant to their respective areas of responsibility. The South African Disaster Management Act (South Africa, 2002:19) encourages a broad-based culture of risk avoidance and the promotion of disaster management education and training throughout South Africa.

Aim:

As an organ of the state and a role-player in disaster management the Free State Emergency Medical Services (FS EMS) is responsible for making strategic decisions. Managers and supervisors are obliged to be trained and educated in disaster management. The study ascertained whether managers and supervisors are being trained and educated in disaster management as required by legislation.

Methods:

The project made use of quantitative data whereby fifty EMS managers and supervisors in the Free State Provincial Government (FSPG) were assessed by using a questionnaire.

Results:

The study found that 66% of the respondents did not receive training to equip them to fulfill their disaster management functions. The remaining 34% indicated that they did receive aspects of disaster management training.

Discussion:

Based on the quantitative scores for the different indicators, the research found that there are shortcomings in disaster management qualifications and training among the EMS supervisors and managers in the FSPG EMS. However, the findings make it clear that there are several positive aspects in the already established practice of disaster management education and training in the FS EMS. The results indicated that there is an opportunity for revision and improvement that will contribute and empower the FS EMS managers and supervisors to meet legislative requirements towards disaster management training and education.
Awareness, Perspective, and Reasons Behind Patients’ Rejection of Emergency Medical Services in Thailand
Authors: Sirisamutr Teera , Wachiradilok Porntip
Published: May 2019

Introduction:

Emergency Medical Service (EMS) increases survival rates and reduces possible disability among emergency patients. However, the number of requests is relatively low in Thailand.

Aim:

To inspect the awareness, perspective, and reasons behind the rejection of EMS by patients or their relatives who visit the emergency room.

Methods:

Responses were analyzed in 45 government, university, and private hospitals from December 2015 to February 2016. The hospitals were scattered in 7 provinces with the sample group including 2,028 patients, whereby 646 patients visited using EMS and 1,368 did not. The key reasons for self-visit or other means are the convenience of personal transportation (76.0%), not wanting to wait for an ambulance (31.0%), and anxiety caused by the emergency situation (28.9%). Most misconceptions about the service include; 1) Ambulances are used only for casualties from accidents and 2) Ambulance service are not free. In terms of perspective, most patients or relatives hold a negative view towards the emergency medical service, especially the idea that they can help themselves when the condition is not severe or if there are medications or relief devices available. Another view is that the service will delay them from getting to the hospital. These perspectives are from non-users.

Discussion:

The study indicated that the cause of non-user involved misunderstandings, poor perspectives, lack of awareness, and the ignorance of the threat of the particular emergency condition. Thus, they do not realize the benefit of using EMS. As a result, regional agencies, the National Institute of Emergency Medicine, and the Ministry of Public Health should discuss the solutions to raise public awareness and improve the perspective towards emergency medical services to promote more usage.
Basic Principles in Complex Humanitarian Emergency: A Pilot Course
Authors: Bajow Nidaa , Alawad yousef , Aloraifi Samer
Published: May 2019

Introduction:

The international and national response team faces many challenges during a complex humanitarian emergency. These include difficult organization, an unprepared national disaster plan, and a disrupted political system. Previous studies showed a reactive approach in earlier disasters in Saudi Arabia and the need for greater involvement of health professionals in disaster management. As a result, several medical education and training institutes began to introduce courses which were mainly about Major Incidents Response, but with less attention to Humanitarian Assistance and Disaster Relief.

Aim:

The course provides Basic Principles in Complex Humanitarian Emergency for healthcare providers in the kingdom and is focused on the aspect of community awareness for disaster and humanitarian relief.

Methods:

The interactive competencies-based course in Basic Principles of Complex Humanitarian Emergency was implemented. The course was designed by 5 experts in disaster medicine and humanitarian relief and was piloted over five days at officers club of Minister of Interior in Riyadh, sponsored by King Fahd Security College. The participants (n=30) were from different health disciplines. They completed the pre- and post-tests and presented three pilot workshops for disaster community awareness.

Results:

The overall scores were 44.19% for the pre-test and 62.85% for the post-test (Wilcoxon test for paired sample: z = 3.729, p<0.001). There were no significant statistical differences among professions of healthcare providers for both pre- and post-tests.

Discussion:

Delivering competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help in the improvement of knowledge and skills for humanitarian assistance and disaster relief in Saudi Arabia, which is important for disaster preparedness augmentation in the kingdom. The next course for the same group may be recommended for achieving the level that will train them to participate in the National Disaster Assistance team.
Chemical Response Emergency Medical Information System in Chemical Disaster
Authors: Wang Soon-Joo , Yoon Seongyong
Published: May 2019

Introduction:

There are many database sets and websites which provide chemical information, but they do not perform an adequate role for emergency medical support in a chemical disaster.

Aim:

To make the basis of a chemical emergency medical information system.

Methods:

We reviewed the database sets, mobile applications and websites in the world which provide chemical database and emergency medical response information from a chemical accident or disaster site to hospitals. Also, we examined chemical accident cases which developed during disasters. A chemical database set for emergency medical response was proposed and the algorithm for elicitation of chemicals suitable for emergency medical response and information providing. We performed a survey about chemical emergency medical information system to related personnel.

Results:

By four steps of elicitation of chemicals, the number of chemicals more than 100,000 was decreased to less than 1,000. The standard of steps includes accident preparedness, toxicity and circulating amount and expert consultation. Algorithm for elicitation of chemicals was made and 82% of related personnel supported the chemical emergency response algorithm. The emergency medical real-time consultation system for chemical disaster was placed under control of the call center.

Discussion:

When mass exposure by toxic chemicals occurs, the chemical emergency medical information system will be helpful for acute identification of chemicals, protection of related personnel and emergency medical response. Also, it can be possible to guide citizens immediately in case of a chemical disaster.
Comparison of Traumatic Brain Injury Patients by Age Group in Emergency Department
Authors: Huh Kwang-Real , Kim Jung-youn , Yoon Young-Hoon , Moon Sung-Woo , Lee Eu-Sun , Shim Bosun
Published: May 2019

Introduction:

Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.

Aim:

The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.

Methods:

Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.

Results:

A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.

Discussion:

Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.
Cooperative System between NGOs and the Private Sector for Disaster Relief in Japan
Authors: Yamashita Kimiko
Published: May 2019

Introduction:

Disasters disturb the balance of medical supply and demand. Because normal supply chains break down in the wake of disasters, it is difficult to deliver daily necessities to affected areas. In addition, without a reliable supply of medical equipment and medicines, the number of sick and injured patients increases.

Aim:

We propose that emergency medical teams should bring medical equipment and daily necessities when responding to disasters.

Methods:

The Social Emergency Management Alliance (SEMA) was established in 2017. SEMA is a cooperative system between NGOs and the private sector for disaster relief in Japan. Humanitarian Medical Assistance (HuMA) utilized this system to provide emergency medical assistance during the Western Japan Floods in 2018.

Results:

After the flooding, increased amounts of dust caused many cases of conjunctivitis. There were also numerous cases of heat stroke and dehydration, especially in the elderly. We requested SEMA to bring eye drops to wash out dust and isotonic drinks to prevent dehydration and heat stroke to Mabi Town, Okayama. SEMA coordinated with the private sector to provide eye drops and isotonic drinks via a forwarding agent, and we were able to distribute them to affected people and prevent worsening disease.

Discussion:

NGOs working within affected areas can assess the exact needs of affected people in order to avoid waste. Such collaboration through SEMA will allow for more effective disaster relief in the future. It is our hope that more private companies join SEMA to reduce the suffering of disaster victims.
Description Analysis of Primary Care Issues in Puerto Rico after Hurricane Maria: Results from Federal Medical Shelter Manati
Authors: Ghosh Arnab , Daniel Pia
Published: May 2019

Introduction:

In September 2017, Hurricane Maria devastated Puerto Rico’s health care infrastructure. To meet the demands of ongoing primary care and medical emergencies, Federal Medical Shelters (FMS) were set up to serve local communities for the weeks after the hurricane. A team of health professionals from New York assisted federal authorities in the provision of healthcare in the FMS.

Aim:

To describe the population of patients requesting medical care in the aftermath of Hurricane Maria at FMS Manati and to categorize the range of problems faced by patients after the hurricane, and examine how this changed longitudinally over the course of the operation.

Methods:

Researchers collected basic data of patients at presentation to the FMS. Descriptive analyses were performed of the patient population and nature of presenting illnesses. Chi-squared analysis was performed to compare the change over time of presenting complaints. Ethics approval was granted by Columbia University.

Results:

Data was collected for a two-week period approximately three weeks after the hurricane made landfall. The FMS saw 2,154 patients over a 14-day period. The population of patients (median age = 43 years [IQR 39 years]) assessed was bimodal in distribution, with one peak in children at 1 year. A second peak occurred at age 53 years. 60.2% of presenting complaints were infection- or chronic disease-related. Musculoskeletal complaints were the third most common. Chi-squared tests revealed no statistically significant change in the frequency of specific types of complaints between the start and end of data collection.

Discussion:

In the weeks after Hurricane Maria, infants and elderly were seen to predominantly seek medical care. Likely related to the collapse of the healthcare infrastructure, there was a high prevalence of infection-related and chronic medical conditions. The data support the need to focus resources to treat vulnerable populations, infectious issues, and chronic medical conditions.
An Evaluation of the Self-Reported Knowledge Base of Disaster Management Core Competencies of Australian Paramedics
Authors: Horrocks Peter , Tippett Vivienne , Aitken Peter
Published: May 2019

Introduction:

Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.

Aim:

To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.

Methods:

Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.

Results:

The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.

Discussion:

Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.
Experience of Activation of the J-SPEED(MDS) in Japan
Authors: Kubo Tatsuhiko , Tomioka Joji , Kondo Hisayoshi , Koido Yuichi
Published: May 2019

Introduction:

The Emergency Medical Team (EMT) Strategic Advisory Group of the World Health Organization has endorsed the EMT Minimum Data Set (MDS) as the standard methodology for EMT daily report. The MDS had been developed on a similar methodology called J-SPEED which developed in Japan. Thus, lessons learned from the J-SPEED can be applied to the MDS.

Aim:

To review previous J-SPEED activations and to extract lessons learned.

Methods:

Cases of the J-SPEED activation at the Kumamoto earthquake in 2016, West Japan Heavy Rain in 2018, and Hokkaido Earthquake in 2018 were reviewed.

Results:

The first large-scale activation of the J-SPEED at the Kumamoto earthquake revealed a significant burden in aggregations of submitted paper forms at the EMT Coordination Cell (EMTCC). To strengthen this function of the EMTCC, electronic system and human capacity development have been identified as key issues. To fulfill this gap, a smartphone app so-called J-SPEED+ has been developed. Also, the J-SPEED offsite analysis support team, which is a team to support analysis of data from outside of an affected area has been established. These two functions contributed to significant improvement of J-SPEED data flow at the West Japan Heavy Rain and Hokkaido Earthquake. These two responses reinforced the necessity of strengthening the capacity of J-SPEED onsite coordinator working at the ETMCC, and national education and training for all EMTs.

Discussion:

In order to strengthen the mechanism to run the J-SPEED, nationwide training for all EMTs, onsite coordinators, and the off-site analysis support team have been established. The authors regard this structural approach as a requirement for other countries to run the MDS.
Focused Ultrasound: Applications and Implications for Education
Authors: Moore Cameron , Rowntree Pamela
Published: May 2019

Introduction:

Focused or point of care ultrasound applications have been integrated into prehospital assessments, triage capacities, military applications, trauma, and emergency health care settings, and medical school curriculums. Often, the inclusion of focused ultrasound is to answer specific clinical questions. However, the value is ultimately determined by the experience, skills, and training of the operator performing and interpreting the examination. Ultrasound was reserved for traditional imaging providers as little as two decades ago. However, as the application of ultrasound expands within clinical medicine, there is an increasing necessity for associated education and training.

Aim:

To highlight the applications and uses of focused ultrasound in the current diverse health care landscape while identifying the associated educational considerations, including the undergraduate tertiary education sector.

Methods:

A search of peer-reviewed published literature was undertaken to determine the range of current usage of ultrasound imaging across professions, and to identify the education and training available.

Results:

The results discussed within this presentation will highlight identified trends, ultrasound applications, educational considerations, and potential future practices based on the content of the literature explored.

Discussion:

Technology is rapidly advancing in the field of medical ultrasound with handheld ultrasound scanners now smaller, less expensive, and more accessible than ever before. Paralleled with these advances and the more generous use of ultrasound come the expectation and pressures of competent skill diversity among healthcare staff and specialists. Significantly, sonography is still considered by many as the most technically demanding and operator dependent medical imaging modality available. Therefore, as the application of ultrasound expands within clinical medicine, educational considerations must also align with this expansion to maintain diagnostic accuracy. This means an increasing demand for associated education and training, including in the undergraduate tertiary education sector.
How Antibiotic Resistance Impacts Responses to Public Health Emergencies and Strategies to Mitigate the Impacts
Authors: Robnett Kathrine
Published: May 2019

Introduction:

Antibiotic resistance is when bacteria change and adapt in response to antibiotics, becoming able to defeat these drugs when used to treat infections. A direct consequence of this adaptation is an increased difficulty in treating multiple diseases. Because of increased antibiotic resistance, the World Health Organization has declared it a significant threat to public health.

Aim:

One frequent consequence of natural disasters is infections, as seen in the December 2004 Indian Ocean tsunami. Survivors sustained a variety of wound infections that ranged from common pathogens to rarely seen organisms including fungi.

Methods:

This research analyzes the microbiology observed in wound infections associated with exposure to freshwater, seawater, soil, fecal, and other contamination after Hurricane Harvey in 2017 and Hurricane Florence in 2018.

Discussion:

Therapies for infections will also be discussed in addition to how the utilization of rapid detection technology for antimicrobial resistance and correct treatments require antimicrobial susceptibility knowledge to improve health outcomes, lower economic costs, prevent further spread of multi-drug resistant outbreaks and assist with antimicrobial stewardship.
How to Shorten the Rescue Time in Marathon by Using BLE Communication Devices: A New Study for the EMS System in Taiwan
Authors: Chang Kuo-song , Chun-I Sun , Huang Jung-Tang , Weng Shih-Chi , Chien Meng-Fan
Published: May 2019

Introduction:

More than one million runners have joined the marathon games since 2007 in Taiwan. There were over 150 marathon games held in Taiwan in 2018. The increase rate was 21% as compared to that of 2014. The medical encounter rate was 1.33% in 2015 and increased to 1.41% in 2017. The most common type of injury was muscle spasm. The second most common was abrasion due to falls. The treatment for muscle spasm was RICE only. Cardiac arrest of marathon runners was reported occasionally and time is critical for rescue.

Aim:

To shorten the rescue time of the runners in an emergency. Base on the prodromal research, BLE communication technology is further used to improve the rescue positioning communication technology in the marathon.

Methods:

After rescue notification devices have been set up in each 0.5 km on the runway of the marathon, the runner can send a rescue signal through the rescue notification devices in case of emergency. The rescue signal, periodically advertisement SN# with rescue mark, of the runner can be precisely located and the rescue can be started very soon.

Results:

In the simulation, the rescue signal can be located in 7.5 minutes, fastest in 3 seconds. The precision rate of timing is ±160ms/6σ that under IAAF accuracy requirement. The location error is less than 20 meters, and the rescue time can be shortened to one half as before.

Discussion:

The rescue time of runner is correlated with the quality of marathon EMS. It is critical to the runner, especially in cardiac arrest. By using BLE communication devices, the runner can be located faster and more precisely. As rescue time shortened, CPR & AED can be given sooner. The quality of marathon EMS will be improved substantially.
The Impact of the New European Union General Data Protection Regulation (GDPR) on Data Collection at Mass Gatherings
Authors: Scholliers Annelies , De Fré Dimitri , D’haese Inge , Gogaert Stefan
Published: May 2019

Introduction:

As of May 2018, a new European privacy law called the General Data Protection Regulation (GDPR) is in order. With this law, every organization operating in the European Union (EU), needs to adhere to a strict set of rules concerning collection and processing of personal data.

Aim:

To explore the consequences of the GDPR for data collection at mass gatherings in the European Union.

Methods:

Since the law was published on April 27, 2016, a thorough reading of the law was conducted by 4 persons with a background in mass gathering health. The GDPR consists of 99 articles organized into 11 chapters. There are also 173 recitals to further explain certain ambiguities. Key articles and recitals relating to healthcare and scientific research were identified. Possible pitfalls and opportunities for data collection and processing at mass gatherings were noted.

Discussion:

Under article 4, key definitions are noted. There is a clear definition of “data concerning health”. According to the GDPR, health data is a special category of personal data which should not be processed according to article 9(1). However, there is an exception for scientific research (article 9(2)(j)). There are a few safeguards in place, as laid out in article 89. One interesting point is that according to article 89(2), certain derogations can take place if the law interferes with scientific research. The GDPR has major consequences for data collection and processing in the EU. However, with the use of certain safeguards (e.g., pseudonymization) there are still ample opportunities for scientific research. It is important to review one’s method of data collection to make sure it complies with the GDPR.
Influenza Vaccine Uptake and Associated Factors in Aged Care Facilities
Authors: Kunasekaran Mohana , Trent Mallory , Lai Elisa , Tan HaoYi , Chughtai Abrar , Poulos Chris , MacIntyre Raina
Published: May 2019

Introduction:

Influenza vaccine is recommended for high-risk populations in Australia (including those aged over 65 years) but is less effective in the elderly due to a progressive and predictable age-related decline in immune function, referred to as immunosenescence. Aged care facilities (ACF) are known to be at high risk of explosive outbreaks of influenza (even in highly vaccinated populations) and may reflect a higher intensity of transmission within the closed setting of ACF, as well as lower immunity and immunosenescence in the frail elderly.

Methods:

To measure the impact of influenza in aged-care staff (ACS) and residents as well as vaccine effectiveness, a prospective observational epidemiological study was conducted in collaboration with an aged-care provider with multiple sites from March to October 2018. Weekly active surveillance on influenza-like symptoms and questionnaires were used to collect data on two groups: ACS and residents. A range of variables was examined against their 2018 influenza vaccination status in statistical analysis.

Results:

Vaccination rates were high in residents and consistent with other studies. Vaccine rates in aged-care staff were lower and consistent with other studies.

Discussion:

Residents and relatives are unlikely to change their minds about vaccination from year to year unless there is targeted effort to persuade them to so, and negative perception of the vaccine is likely to persist. Workplace influenza vaccination programs targeted at staff could be an effective method of raising vaccine uptake.
The Integration of a Unique QR® Code and Video to Improve the Correct Application of a Hemorrhage-control Tourniquet by a Naïve Population - A Feasibility Study
Authors: Rega Paul , Vallejo Shaun , Accumanno John , Fink Brian
Published: May 2019

Introduction:

The use of tourniquets by the civilian population has been deemed a critical aspect of the initial response during an active shooter situation. Tourniquet deployment in public-access must be accompanied by education. Studies indicate that the act itself is not an intuitive process and enclosed instructions may be inadequate. However, civilians for diverse reasons may not avail themselves of accepted training programs.

Aim:

To develop an alternative means of “Just-In-Time” education to enable a naïve responder to apply a commercial tourniquet efficaciously.

Methods:

A video (~40 seconds long) was created highlighting the actual application of a C-A-T® (Combat Application Tourniquet) on a human model. It was uploaded to YouTube on a public channel. A QR® code was generated using https://www.qr-code-generator.com, embedding the link for the YouTube® video. An appropriately-sized QR® code was printed and applied with packaging tape (Scotch®) to the exterior wrapping of a C-A-T® device. The C-A-T® with code was then accessed with the iPhone®.

Results:

With the iPhone® camera app activated and focused on the C-A-T’s QR® code, a request popped-up to open “YouTube.com” in Safari. When pressed, the full-screen video appeared immediately with audio of excellent quality.

Discussion:

The use of a QR® code and its video link is a feasible option to provide “Just-In-Time” training to a naïve civilian population who are responding to an active shooter situation. This offers the naïve responder two options of immediate education: the enclosed instructions and the QR® code. Redundancy in communications is essential in any emergency response. An important limitation of this innovation is the inability to obtain Internet® access and therefore, the availability of the enclosed instructions is still critical. Research to prove that this innovation will allow the application of a tourniquet to proceed expeditiously with few errors is currently underway.