bluuebunny/crossref_metadata_2025 huggingface dataset:
(A107) Victimbase: Disaster Victim Descriptions for Simulation, Training and Research
Authors: Debacker M. , Boosman M. , Van Norel W.J. , Tryan J.L.
Published: May 2011

Introduction

A 2006 survey showed that 27% of training institutions used computer-based training in disaster medicine and an additional 23% indicated that they will use it in the near feature(1). Victim descriptions are an important element of simulation exercises. Currently, the victim data utilized in computerized simulation exercises cannot be used in an interchangeable way.

Methods

The European Master in Disaster Medicine (EMDM) Academy, recognizing the need for access to reliable disaster victim data, initiated the Victim Base project in order to improve the availability and quality of disaster victim profiles for use in simulation, training and research. A standardized victim template was developed through a review of primary and secondary survey requirements with consultation from an international consortium of training experts in disaster medical management during two workshops.

Results

The victim template is composed of a description of the victim profile, a set of clinical conditions and triggers (time and interventions) to move from one clinical state to another. The parameters of a casualty condition are organized in sub-templates and arranged in the way the victim would most likely be assessed. Victim profiles can be delivered in different output formats on request of the users.

Conclusion

In order to evaluate the effectiveness or outcome of disaster response exercises or test operational plans, victim data must be robust, reliable and of high quality. Moreover, the data must be interchangeable in order to make comparisons between different response systems, regions or countries. VictimBase as an online library of disaster victims will contribute to achieve these objectives. 1. Delooz H, Debacker M, Moens G, Johannik K. and the ISEE Partnership. European survey on training objectives in disaster medicine. Eur J Emerg Med 2007;14:25-31.
(A108) Hospital Disaster Planning: The Structured Approach
Authors: Khalifa G.E.A.
Published: May 2011

Background

Disasters and incidents with hundreds, thousands, or tens of thousands of casualties are not generally addressed in hospital disaster plans. Nevertheless, they may occur, and recent disasters around the globe suggest that it would be prudent for hospitals to improve their preparedness for a mass casualty incident. Disaster, large or small, natural or man-made can strike in many ways and can put the hospital services in danger. Hospitals, because of their emergency services and 24 hour a day operation, will be seen by the public as a vital resource for diagnosis, treatment, and follow up for both physical and psychological care.

Objectives

Develop a hospital-based disaster and emergency preparedness plan. Consider how a disaster may pose various challenges to hospital disaster response. Formulate a disaster plan for different medical facility response. Assess the need for further changes in existing plans.

Methods

The author uses literature review and his own experience to develop step-by-step logistic approach to hospital disaster planning. The author presents a model for hospital disaster preparedness that produces a living document that contains guidelines for review, testing, education, training and update. The model provides the method to develop the base plan, functional annexes and hazard specific annexes.
(A112) Development of Model Medical Care Protocols for Alternate Care Sites during Pandemics and Public Health Emergencies
Authors: Markenson D. , Reilly M.
Published: May 2011

Introduction

Developing alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites which can serve as areas for primary screening and triage or short-term medical treatment, can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Maintaining consistent standards of care in these settings is essential to a uniform approach to the medical management of a public health emergency.

Methods

Subject matter experts in emergency and disaster medicine, public health, pediatrics, and various other medical specialties were convened at regular intervals over an 18-month period. Through a consensus-based process this working group created a universal standard of care along with model clinical protocols to manage patients in an out-of-hospital setting using medical and non-medical personnel.

Results

These protocols were designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting for a limited period of time and then return to their homes for convalescence. Of particular importance are that these protocols applicable to all public health emergencies and do not rely on the active presence of physicians at the alternate care site to render care.

Conclusion

The development of consistent standards of care and the ability to care for patients in an out-of-hospital setting during a pandemic or public health emergency is essential to preserve the sustained operation of acute care hospitals and the entire healthcare system. Diverting patients to a community- based alternate care site or encouraging the early discharge of patients to these locations can assist in managing the large numbers of casualties anticipated during a pandemic or public health crisis.
(A115) Disaster Preparedness and Learning Habits of the German Security and Rescue Forces: A Survey
Authors: Fischer P. , Christian J. , Wafaisade A. , Kees T. , Kabir K. , Müller M. , Rohner M. , Müller S.
Published: May 2011

Objective

Developing an e-learning platform addressing security and rescue forces to eradicate the lack of disaster preparedness underscored by diverse studies. In order to reach this aim the performance of a needs analysis is essential.

Methods

The audience of security and rescue forces was clustered in (emergency) physicians, fire-fighters, policemen, Paramedics and members of the Federal Agency for Technical Relief (THW). For each cluster a questionnaire was developed and corrected by specialists in disaster care. The questions were about previous knowledge, habits of studying; further training habits and internet requirements.

Results

The questioner was posted online during 4 months and was filled in by 1142 persons (141 physicians, 194 fire-fighters, 108 policeman, 444 rescue workers and 255 members of the THW). The biggest lacks in previous knowledge were shown in reacting on CBRN-incidents. 64, 1% thought they were not able to act correctly in case of chemical contamination. The most important learning tools were books, lectures, seminars and the principle of learning by doing. The reasons for using an e-learning platform were saving time, high quality of the tutorials (77% thought it important), quicker reach of information, multimedia formats of the taught facts and links to further information. 55, 2% were slightly unsatisfied with the actual pool of further trainings. The most frequently used sources of information were the internet (78, 8% use it frequently) and colleagues.

Conclusions

The survey shows that lacks in disaster preparedness in Germany definitively exist but it also reflects that most of the security and rescue forces are motivated to do further trainings and use therefore new technologies. But they require a high quality of teaching and a reasonable use of them. There is a need for using innovative Methods, and user-friendly web-based instruction and information modules to address all security and rescue forces in Germany.
(A120) Implementation of Advanced Technologies in Emergency Medicine
Authors: Aleksanin S. , Rybnikov V.
Published: May 2011

Increase in the number of emergency situations (ES), technogenic accidents and disasters and terrorist threats defines the need for implementation of advanced medical technologies. One of these technologies is to deploy an airmobile hospital (AH) in emergency situation to provide skilled medical care in case of a large number of casualties. AH is equipped with inflatable modules, deployment of which takes no more than an hour. Each module is equipped with specialized departments. AH consists of triage department, OR, intensive care department, outpatient department, X-ray and diagnostic department and inpatient department as well. The station is equipped with modern intensive care unit including ALV apparatus, defibrillator-monitor with built-in pacemaker, as well as endovideosurgery complex, laboratory and telemedicine equipment, radiation control monitors, communication and global positioning units. One of the advanced technologies of emergency medicine is implementation of telemedicine equipment. EMERCOM of Russia on the basis of our institution has opened a telemedicine center that provides videoconferencing, any audio-visual information both text (extracts from case histories), and instrumental studies (radiographs, echograms, ECG, etc.). EMERCOM of Russia specialists use airmobile medicine technologies including specially equipped aviation facilities with airmobile medicine modules (aircraft, helicopter). In addition, we have developed a hardware system of individual monitoring the functional state of a rescuer. It is designed to transmit to the senior officer of the division the data about functional status of 10 rescuers (heart rate, respiratory rate, temperature), motor activity and the current coordinates to detect deterioration and freezing (immobilization) of the rescuer. The complex is equipped with an emergency radio-beacon to accelerate the search for a rescuer.
(A83) Pediatric Disasters: Key Elements for Improving Care
Authors: Mace S.E. , Doyle C.T.J.
Published: May 2011

80% of children are seen in non-Pediatric Emergency Departments (EDs). In a disaster, most children and their caregivers will go to the closest or their regularly identified ED for treatment. In disasters, the preservation of the Pediatric Tertiary Infrastructure for the sickest and most injured children is critical. Surge capacity for pediatrics may involve both ante-grade and retrograde distribution of pediatric patients and health care staff to preserve Tertiary capacity. Reverse Triage of stable pediatric patients to other hospitals with adapted units and staff can decompress tertiary facilities. General hospitals can allow an expanded care for pediatric patients. Surge capacity needs to be addressed to allow non-pediatric facilities to surge for pediatric patients. Disaster Credentialing by immediate cross-credentialing of appropriate health care staff needs to be reciprocal and internet based to allow appropriate staff to attend pediatric patients. Pediatric consultants can augment healthcare staff to allow input into expanded care roles. Pre-hospital providers should have more pediatric training. Rotated regional caches of pediatric equipment would expedite safe pediatric disaster site care and pre-hospital transportation to definitive care. Pediatric patients should routinely be included in disaster drills and in all-inclusive disaster plans, rather than in separate drills and plans. Pediatric patients are usually accompanied by caregivers who may need care as well. Secure tracking and reunification of unaccompanied minors needs to be addressed to allow tracking across jurisdictional boundaries. Limited access to data on children, and credentialing of shelter staff would preclude access by anyone without a specific need to know. There are no clear uniform liability statutes for care in declared disasters as well as no uniform agreements for reimbursement for medical care. These issues are an important facet of disaster care that still needs to be addressed.
(A137) Prediction of Short-Term Functional Outcomes of Older People in the Emergency Department
Authors: Kumar P. , Dey A.B.
Published: May 2011

Background

Advancing age and co-morbid illness result in loss of the ability to perform activities for daily living (ADLs), and are important determinants of loss of independence and autonomy among older persons. Acute illness reduces the functional status of previously healthy older persons.The aim of the current study was to determine the change in ADLs due to acute destabilization in old age one month following discharge.

Methods

Older subjects admitted to the General Medical Wards from the emergency services of the All India Institute of Medical Sciences were included between August and February 2008. The Barthel index of ADL was assessed in a longitudinal design at the time of admission and one month post discharge. The values of the indices were compared using paired samples t-test.

Results

Of 108 subjects who presented to Emergency Geriatric Services at the hospital, 11 were excluded due to incomplete records, inability to trace on follow-up, incorrect telephone numbers, or had since died. Advancing age did not show a significant correlation with pre-morbid ADL score (r = −0.040; p = 0.749) or post-morbidity ADL score (r = −0.65; p = 0.636). A 45% decline in ADL score was noted one month following discharge after acute illness in older subjects (pre-ADL = 15.85; post-ADL = 8.78).

Conclusions

Older subjects are at a higher risk of poor functional outcome because they are less likely to recover function lost before admission and more likely to develop new functional deficits during hospitalization and after discharge.
(A138) Duration of Emergency Department Stay and Injury Profile of Homeless Patients in a Level-1 Trauma Center
Authors: Chauhan S. , Bhoi S. , Sinha D.T. , Rodha M. , Alexender L. , Kuamr R.
Published: May 2011

Background and Objective

Immediate resuscitation and early disposition to definitive care improves outcomes. Homeless patients are neglected in emergency department (ED). The duration of ED stay and profile of injury of homeless patients at a Level-1 Trauma center were measured.

Methods

The study was performed from October 2008 to September 2009. Homeless patients were defined as patients who had no attendant and did not have any shelter. Duration of ED stay was noted from the ED arrival time to entry time at the definitive care (intensive care unit/ward). Clinical and demographic details were recorded. Subjects who had: (1) an attendant; (2) were discharged from the ED; or (3) expired in the ED were excluded.

Results

Forty-one homeless patients were admitted. The mode of injury was road traffic crash in 73.2%; assault in 7.3%; fall from height in 7.3%; and in 12.2%, the mode of injury unknown. The average Injury Severity Score (ISS) was 6.76, with a maximum of 34 and minimum of 1. A total of 24 subjects (59%) had a Glasgow Coma Scale (GCS) score of ≤ 8 (severe head injury), 10 patients (24%) had GCS score 9–12 (moderate head injury), and seven subjects (17%) had GCS score 13–15 (minor head injury). Breath alcohol test was positive in 13%. The average duration of ED stay was 35 (3–173) hours in the homeless group and 12 (0.5–18) hours for patients with an attendant. Twenty-one subjects were admitted to neurosurgery (51.2%) with an average ED stay of 22.4 hours, five to surgery (12.20%) with average ED stay of 56.6 hours, and 15 to orthopedics (36.6%) with average ED stay of 45.3 hours.

Conclusions

The emergency department stay of homeless patients was 35 hours. Orthopedic trauma subjects had a prolonged disposal time. This addresses serious patient safety concerns and immediate remedial measures.
(A143) European Project SICMA (Simulation of Crisis Management Activities) for Medical Management of Maxi Emergency Trauma Patients
Authors: Magalini S. , Di Mugno M. , De Gaetano A. , La Posta G. , Sermoneta D. , Gui D.
Published: May 2011

Introduction

Modern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.

Methods

The European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.

Results

SICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel expertise, to ambulance and helicopter transportation depending on traffic and weather conditions. The system also simulates rescue doctrines (i.e. “Casualty Clearing Station” or “Scoop and run”), transportation priorities according to color codes, doctrines for assignment of new casualty to neighboring hospitals, hospital resources and involvement, final clinical outcome of individual casualties. Patient health status and physiological reserve of single casualty is based on the ABCD ATLS system, considering with a simple algorithm both level of damage and rate of worsening in time.

Conclusion

Utilizing this simulation system, managers who predispose organizational and logistic procedures may modify the main elements in order to identify the optimal resource allocation and the best procedures to save the most human lives.
(A144) Health Status Casualty Model for Simulation of Crisis Management Activities (EU SICMA Project)
Authors: Di Mugno M. , Magalini S. , De Gaetano A. , La Posta G. , Sermoneta D. , Gui D.
Published: May 2011

Introduction

The European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. The first step toward chain procedure modelling in the management of major emergencies is the representation of a traumatized patient whose health status can be followed in time during simulation. Since management of the trauma patient follows criteria of stabilization of main physiological functions, a trauma patient model was developed based on fundamental pathophysiological functions independently of specific lesion characterization. Methods: Each patient's health status was modelled according to 5 parameters (ATLS): A(airway), B(breathing), C(circulatory), D(disability), E(Exposure). Patient samples are extracted from a 10.000.000 patient database, generated by considering real anatomical lesions compatible with type and severity of considered scenarios (explosion, building collapse, fire, gunfight). Simulated lesion characteristics were then converted to pathophysiological parameters. Each physiological compensation parameter was represented by: (1) baseline value expressed as percentage of altered function; (2) function reduction rate over time, obtained by a mathematical approximation of clinical worsening. From level of function, rate of worsening and function-specific death thresholds, estimated time-to-death according to sustained damage is computed.

Results

This model allows simulation of evolution of patient health status both in absence of medical care, but also under therapy, in terms of immediate increment of each single parameter (“temporary” treatment), and of reduction or zeroing of parameter dec14rement rate (“definitive” treatment).

Conclusion

This model, based on evaluation of physiological parameters, presents an advantage over the consideration of single lesions, because simulating logical procedures that guide treatment choice in real situations can provide a more accurate assessment of casualities for those actors assigned to management of major emergencies.
(A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department
Authors: Ong M.E. , Sultana P. , Fook-Chong S. , Annitha A. , Ang S.H. , Tiah L. , Yong K.L.
Published: May 2011

Objective

To compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.

Methods

This is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.

Results

A total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).

Conclusion

A resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.
(A159) Core Competencies for Emergency Preparedness Education for Health Profession Schools
Authors: Markenson D. , Reilly M.
Published: May 2011

Background

The possibility of natural disasters and public health emergencies coupled with the possibility of terrorism clearly support the need to incorporate emergency preparedness and response material into the curricula for every health professional school in the nation.

Discussion

To date, the focus has been on the education of the existing healthcare workforce. Students' needs differ from those of practitioners in that there is a fundamental difference between educational competencies and occupational competencies. It is also important to recognize that to assure proper preparedness there must be a clear connection between departments of public health and all other healthcare entities. To this end we included public health students in the creation of competencies and have shown that non-clinical practitioners can, and indeed must, be included in this process.

Observations

We describe a process and present a list of emergency preparedness core competencies for health care professions and their applicability to Medical, Dental, Nursing and Public Health students. While we have designed this set of competencies using these disciplines, they may be easily adapted to other healthcare disciplines. The only variations would be in the assignment of proficiency levels and the decision of whether or not clinical competencies are appropriate. The core competencies have been divided into the following four categories which represent broad subject areas and the separation of the competencies related to direct patient care:

–

Emergency Management Principles

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Terrorism and Public Health Emergency Preparedness

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Public Health Surveillance and Response

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Patient Care for Disasters, Terrorism and Public Heath Emergencies.
(A163) Hospital Evacuation Plan
Authors: Khorram- Manesh A. , Nero C. , Ortenwall P.
Published: May 2011

Introduction

Hospitals, as one major cornerstone of contingency planning, are often expected to be fully functional during a major incident. However, the continuous streamlining of todays healthcare system with a constrained economy, lean production principles and increasing complexity together with changing levels of the threats may result in an evacuation, should hospitals themselves be the targets for a disastrous action.

Objective

The aims of this study were 1) to evaluate an appropriate risk and vulnerability analysis model as a basis for hospital evacuation plan, 2) to identify hazards triggering an evacuation 3) to evaluate the response needed in an evacuation situation and 4) to clarify the impact of such an evacuation plan on the ordinary emergency medical plan.

Material and Methods

A systematic online literature search based on the following keywords; evacuation/closure, hospitals/medical facilities, and disaster/hazards; alone or with planning, and also a risk and vulnerability analysis as a case study at the hospital in Lidkoping, Sweden, were conducted.

Results

Our findings indicate that hospitals are vulnerable to different risks such as technological dysfunctions, climate changes and terror actions, which can result in an evacuation of patients. In such a situation, well functional transport organization and availability of temporary facilities along with good communication are necessities to assure patient safety. Such functional abilities may be assessed by planning, education and continuous training.

Discussion and Conclusion

There is a need for an elaborated evacuation planning for hospitals. Such plan should continuously be drilled based on a risk and vulnerability analysis and be integrated in the ordinary medical emergency plan. Simulations of different scenarios are one way to determine risks and identify proper actions before a major incident or disaster strikes.
(A164) Emergency Preparedness Model for a Level-One Trauma Center
Authors: Rives T.E. , Hecht C. , Wallace A. , Gandhi R.
Published: May 2011

This Level-1 Trauma Center, with a service area covering a population of approximately four million people, treats approximately 80,000 patients per year. In 2010 it is anticipated that > 23,000 patients will be admitted, and > 850,000 patient encounters will occur within the network. This year was especially fruitful with the World Series, Dallas Cowboys, and other large crowd events simultaneously. The disaster plan prepares the hospital for the Super Bowl in February 2011, and its anticipated 250,000 extra people. The emergency preparedness program is a unique hybrid model integrating hospital accreditation guidelines, governmental guidelines, and regulations with the daily experiences at the trauma center. Emergency Preparedness is a program of the Trauma Department; this relationship provides a direct connection between the emergency preparedness program and direct execution of the plan. The emergency preparedness coordinator is responsible for directing the hospital command center at the time of a disaster requiring activation of the plan. The four phases of emergency planning: (1) Mitigation; (2) Preparedness; (3) Response; and (4) Recovery comprise the core of the plan. However, memoranda of understanding with local, regional, and state emergency operation professionals and organizations are enacted so depleted resources can be replenished. This integration provides for a flexible web that allows sharing of expertise and resources. Trauma Research is available for conducting measurable assessments of emergency preparedness drills and exercises, as well as actual disasters and emergencies where a paucity of research exists. Compliance with all relative agencies is important. A successful emergency preparedness plan directly incorporates daily experiences. This model allows for the continued provision of standards of care and continuity of service during disasters and emergency situations on a daily basis.
(A166) Disaster Risk Reduction - Extreme Heat Preparedness
Authors: Smyth V.A.
Published: May 2011

Background

South Australia is often referred to as the driest state in the driest continent on earth and the community expects summers to be hot. However since 2007 South Australia has experienced several periods of extreme heat which have challenged and required the emergency services including health to consider a new preparedness approach. Any extreme weather condition can cause disruption to the community and the effects of such events as extreme heat are not always immediately obvious. However these effects can silently cause death and an increase to the health burden of the community.

Discussion

In South Australia the term ‘Extreme Heat’ as opposed to ‘Heatwave’ has been quite deliberately chosen as this describes more accurately an unusual climatic situation characterised by higher temperatures and greater length of time than normally expected. A number of studies have been undertaken to consider the impact on the health of the South Australian community and its health services and specfic action plans and communication strategies have been developed to respond to extreme heat and encourage an increasing level of community resilience. This paper will describe recent events, some of the research undertaken and the preparedness, planning and response strategies implemented to reduce and manage the risk.

Conclusion

The response strategies introduced in South Australia have been recognised for their excellence and in 2010 SA Health was the recipient of several awards at both state and national level for this work.
(A167) Patient Tracking In Disaster Drills
Authors: Hilmi L.M. , Heerboth A. , Anthony D. , Tedeschi C. , Balsari S.
Published: May 2011

Introduction

Disaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.

Methods

Over eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.

Results

There was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.

Conclusions

Our group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
(A168) Medicine at Sea
Authors: Bradberry J. , Fisher J.
Published: May 2011

Cruising has become a major part of the tourist industry. In 2010, the total passengers carried worldwide was estimated at 18.4 million, on about 230 cruise ships. Large ships can hold up to 6,000 passengers and > 2,000 crew members. A large cruise ship is rather like an island, with two different communities: the well-trained crew, hopefully prepared for every eventuality and trying to make their guest's stay as pleasant as possible; and the guests, there to have fun. The guest population varies, with up to 40% under 21 years old during school breaks, and the average age is in the fifties or sixties on longer cruises to scenic places such as Alaska. Most of the time ships cannot be reached by helicopter and the medical teams need to cope with a wide range of emergencies from cardiopulmonary, trauma, and psychiatric issues. There are strict public health measures enforced and a range of legislation reducing the risks of cruising to a minimum. This paper reviews the training of the crew for medical emergencies, the incidence of disease, the incidence of medical disembarkation and major incidents on board, and the role of medical teams.
(A152) Is There a Need to Reconsider the Policy of Evacuating All Casualties from Remote Mass Casualty Incident (MCI) to the Closest Hospital? Lessons Learned from a Rural MCI
Authors: Adini B. , Cohen R. , Glassberg E. , Azaria B. , Simon D. , Peleg K.
Published: May 2011

Background

Inappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.

Objective

The aim of this study was to review the consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.

Methods

Hospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.

Results

31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.

Discussion

Over and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.

Conclusions

In MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
(A174) Epidemiology, Seasonality, and Geo-Distribution of Trap Gun Injuries in Anuradhapura Area
Authors: Dassanayake L. , Karunarathne A. , Illangasinghe T.
Published: May 2011

A trap gun (TG) is a locally manufactured, illegal barreled weapon with a simple trigger mechanism. Trap guns are frequent in agricultural areas of the country. Once the gun is set, it bursts automatically upon the triggering. Since there is no present person selecting the target, the gun injures both animals and humans. A retrospective study was carried out to identify geo-spatial distribution, seasonal variation and injury patterns of TG injuries brought to Teaching Hospital Anuradhapura during 2007 to 2009. A prospective study will identify those in a more detailed manner. The abstract discusses some findings of this ongoing study and the retrospective study. In 2007 there were 107 TG injuries, and 68 in 2008. In 2009 the number increased to 126. Of the victims, 97.5% were males. The mean age was 36.98 years (SD = 11.36), with an age range of 13–69 years and an Inter Quartile Range (IQR) of 29–43 years. The majority of the injuries were lower limb injuries. A significant percentage showed compound fractures and soft tissue injuries. Amputations due to vascular injuries were low (1.5%). Of the cases, 99.5% were from peripheral rural villages. Tap gun injuries are less common during the “Yala” farming season extending from May to September, during which Anuradhapura gets less rain. Yet number of TG victims steadily increases as the “Yala” progresses. This trend continues during the initial half of “Maha” season. It gradually deceases in the latter part of “Maha”. Trap gun injuries remain below average from February to July with the lowest number in April. The incidence of TG injuries is higher in Northwesterly administrative areas throughout the year, which share a common border with the “Wilpattu” game reserve. Further studies should be carried out to identify behavioral and socio-economical risks and economics of TG injuries.
(A175) Traffic Injury Severity Prediction by Algorithm of Automatic Crash Notification System
Authors: Wang S.J. , Choi H.Y.
Published: May 2011

Introduction

Since 2009 automatic crash notification system(ACNS) using event data recorder(EDR) and mobile communication have been developed for early detection of traffic accident and prediction of physical injury of victims for increase of survival rate via early medical treatment. For adequate prediction of injury, authors developed the guideline and algorithm from parameters related to accident and medical situation. Methods: Expert survey was done about the adequate parameters related to accident and medical situation. Medical record of traffic accident admission was analyzed in a trauma center of a university hospital in Seoul, Korea. Additionally epidemiology of traffic accident death in a region was done. Afterwards data of medical record was linked to data of traffic accident insurance companies.

Results

The important parameters for prediction of physical injury of victims were as follows: Intercept, deltav, belt, age, intrus, sex, multiple, roll, ejection, narrow, height, weight, steering defect, track loc.

Conclusions

Prediction of physical injury severity of victims on traffic accident spot and immediate transfer of related information to adequate medical institution by automatic mobile communication can help the traffic accident victims and upgrade the trauma care system of traffic accident.
(A178) Evaluating the Feasibility of Verbal Analogue Scale among Emergency Care Providers in Assessment and Management of Acute Pain in Trauma Victims
Authors: Adhikari G. , Bhoi S. , Chauhan S. , Sinha T.P. , Gautam P.
Published: May 2011

Background

Acute pain assessment and management in trauma victims is often overlooked in emergency department (ED). Visual analogue scale is the preferred scale for assessment and management of pain however, its role in a busy ED is limited. The objective of this study was to evaluate the feasibility of verbal and visual analogue scale among emergency care providers.

Methods

Emergency caregivers were instructed to use both pain scales wherever feasible for assessment, management, and monitoring of pain in 100 non-consecutive alert patients. A separate, pre-tested survey questionnaire addressing the feasibility of each pain scales was surveyed among emergency care providers (emergency physicians, nursing staff). A Likert scale (1 to 5) was assessed for cooperativeness, availability of time for assessment, the format, the peak period feasibility, the monitoring ease and the amount of work load. Binary scale (yes and no) was used to measure the overall utility in assessment and management of pain.

Results

Out of 100 patients enrolled, the verbal analogue score was used in all patients and visual analogue score was used in 30 patients. The average Likert scale score for verbal analogue score questionnaire was 1.7 and the average Likert scale score for visual analogue score questionnaire was 3.9. On the overall utility both scales were found to be useful in all patients.

Conclusions

Both the scales were found to be useful in overall assessment and management of pain. However, there was a favorable trend towards using verbal analogue scale among emergency care providers.
(A181) Process Improvement in Disaster Relief: Implementation of a Fast Track in a Haitian Tent Hospital
Authors: Bloem C. , Gore R. , Arquilla B. , Naik T. , Schechter J.
Published: May 2011

Study Objective

To determine if instituting an Emergency Department (ED) fast-track area would increase efficiency in patient flow, improve utilization of limited resources, and identify critical versus non-critical patients during disaster relief in Port au Prince, Haiti.

Methods

A survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center on a disaster relief mission following the 2010 earthquake. The following variables were obtained to assess ED effectiveness: number of patients, acuity level, chief complaints, critical interventions, waiting times, length of stay, specialty service coverage and physical plant space. Additionally, existing practitioners were surveyed regarding existing ED practices. ED operation flow maps were created.

Results

The assessment revealed a large volume of low-acuity patients mixed with high-acuity patients without identification of acuity level, time of arrival, or designated area for treatment. Although literature reports routine use of START triage, this was not being implemented in this setting. Results of implementing a fast track area included: (1) Improved identification of patients needing immediate treatment. (2) Increased flow of low acuity patients in designated fast track areas. (3) Improved triage protocols maximized appropriate use of resources, and expedited subspecialty consultation.

Conclusion

By instituting well-accepted, validated patient flow systems and reinforcing communication regarding resources available and the use of geographic space, better management of incoming emergency patients was achieved.
(A182) Model to Assess Geo-Temporal Spread of Disease by Air Travel from Major World Cities to the United States
Authors: Hwang G.M. , Wilson T.
Published: May 2011

With increasing numbers of international flights and air travelers arriving in the US annually, the rapid spread of communicable diseases has grown. Epidemics of novel infectious diseases have emerged and rapidly spread globally in association with air travel, including the severe acute respiratory syndrome (SARS) outbreak in 2003 and H1N1 in 2009. In order to anticipate and mitigate the consequences of future rapid disease spread, the MITRE Corporation, in collaboration with the (US) Centers for Disease Control and Prevention, developed a risk assessment tool using a Susceptible-Exposed-Infectious-Recovered model and detailed flight and population data. The emergence and spread of prototypic pandemic influenza was simulated based on a theoretical geographical point of origin and its communicability. More than 50 international metropolitan areas were analyzed as potential points of origin to simulate the rapidity of spread to the US. The basic reproduction number (Ro), defined as the average number of persons to whom one infected individual transmits disease in an immune naive population, was varied from 1.4 to 1.9. The starting numbers of infectious persons at each origin also were varied (100 or 500 persons, 5% infectious may travel). Waves were computed as aggregate across metropolitan areas modeled in the US. The visualization of the first pandemic wave was most apparent in simulations of Ro = 1.9, resulting from 500 infectious persons at each origin. More than 50% of origins indicated that aggregate waves peaked around Day 125, while 30% of origins peaked around Day 90. Additionally, the time, in days, from its origin in six continents into the US was compared, and a two-week delay was found from South America compared with other continents. This simulation tool better equips policy makers and public health officials to quickly assess risk and leverage resources efficiently via targeted and scalable border mitigation measures during a rapid global outbreak.
(A184) Survey of Knowledge, Attitudes and Risk Perceptions (KAP) of Healthcare Personnel, in the Event of an Outbreak of H1N1 Influenza, in Limited Resource Environment
Authors: Aditya K. , Gadgil A. , Joseph J. , Roy N.
Published: May 2011

Introduction

Little is known about the risk perceptions and attitudes of healthcare personnel, in the event of an epidemic of H1N1 influenza. It is acknowledged that perception of risks, as opposed to actual risks, alters behaviour. Indian data on KAP is needed as the scenario of working in limited resource environment, can have a different risk perception and attitudes amongst the healthcare workers. This will help in chalking out a ‘model response planning’ The study is designed to investigate the Knowledge and attitudes amongst healthcare workers in Mumbai, India during H1N1 pandemic of 2008–2009.

Methods

Questionnaire based interviews were given to healthcare workers, selected by their place of work, level of education and income group. This is based on the priori hypothesis that KAP differs amongst these groups. Surveys were distributed randomly to 20% employees from each of the above categories. Also healthcare officials, making policy decisions and guidelines, and the patients approaching these healthcare centres for treatment were interviewed for their perceptions of adequacy of the response measures. The questions designed included assessment of demographic characteristics, individual's knowledge about swine flu, perceived adequacy of training, perception of preparedness to tackle the epidemic situation and perception of risk to them and their families during epidemic conditions. The responses were graded as ‘adequate or inadequate knowledge’, perceived ‘high or low risk’ and ‘tendency to apathy’. Results were analysed using statistical software (SPSS17).

Conclusion

Understanding the concerns and responses of healthcare personnel to a major infectious disease outbreak is critical to maintaining response capacity.
(A169) Strategic National Stockpile: American Preparedness to a Domestic Biological Attack
Authors: Piombino A.E.
Published: May 2011

This session offers an overview of the Strategic National Stockpile (SNS) and the Cities Readiness Initiative (CRI), including CHEM PACK. Managed by the US Department of Health and Human Services Centers for Disease Control and Prevention (CDC), “push-packs” of this critical federal cache of pharmaceuticals and medical materiel are at sites located throughout the country. The CDC's CRI is a federally funded program designed to compliment the SNS and enhance preparedness in the nation's largest cities and Metropolitan Statistical Areas (MSA) where more than 50% of the US population resides. Through CRI, state and large metropolitan public health departments continue refining plans to respond to a large-scale bioterrorism attack by dispensing antibiotics to the entire population of an identified MSA with 48 hours. The SNS Technical Assistance Review (TAR) will be reviewed, as well as best practices and lessons learned from successful public health emergency preparedness and response programs throughout the US.