bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting and Accompanying Young People After the Lac-Mégantic Train Derailment (Quebec, Canada)
Authors: Généreux Mélissa , Maillet Marie-Claude , Nault-Horvath Elise , Stewart Cindy
Published: May 2019

Introduction:

In July 2013, a train transporting oil derailed and exploded in Lac-Mégantic, causing major human, environmental, and economic impacts. A community-based survey of people aged 10-25, conducted in 2017, revealed that many young people suffer in silence and report feeling isolated. These observations led to the conclusion that we must make room for young people, and that opportunities for engagement and participation must be provided within the community.

Aim:

The Public Health Direction of Estrie aimed to identify strategies to promote health and wellbeing for young people living in and around Lac-Mégantic.

Methods:

A collective reflection half-day was hosted with sixty key stakeholders (school board, other education institutions, health and social services, community sector, municipal/political sector, parents, youth). Throughout the event, participants were invited to build on and learn from accomplishments and experiential knowledge, and develop a common vision of the solutions to be pursued or implemented. All qualitative data sources (verbal and written data from large- and sub-group activities) were analyzed through a content analysis.

Results:

Several themes (i.e. potential solutions) emerged from the analysis: common venue, diversified activities, communication, collaboration, involvement, support for at-risk youth, intergenerational component, etc. Participants agreed on four priorities for action: 1) creating a gathering place, 2) establishing a Youth Committee, 3) supporting adults working with youth, and 4) fostering a better flow of information.

Discussion:

Several positive outcomes of the collective reflection half-day were observed, including the mobilization of the participants who greatly appreciated the event, and many promising ideas launched by stakeholders. A social worker is now fully dedicated to supporting youth wellbeing and engagement in Lac-Mégantic. A Youth Committee has been established and projects by and for youth are being implemented. Bottom-up approaches to identify solutions to complex situations are not only effective but also respectful of the local culture.
Towards Practical Guidelines for Mental Health and Psychosocial Support after Emergencies in the Western Pacific Region
Authors: Te Brake Hans , Reiffers Relinde , Steen Charlie , Dückers Michel
Published: May 2019

Introduction:

The Western Pacific Region, comprised of 37 diverse countries and areas, is one of the world’s areas most prone to be affected by disaster. Seven of the top ten countries most at risk of a natural disaster are in this region. The Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 in the Western Pacific identifies mental health in disasters and emergencies as a priority area and calls for a social movement for action on mental health and well-being. To increase understanding of and need for mental health and psychosocial support in emergency situations, regional guidelines are necessary. It is unclear to what degree international guidelines are applicable in this region.

Aim:

To synthesize the contents of available evidence-based guidelines and assess their potential to address the mental health and psychosocial needs of people in emergency settings in the Western Pacific Region.

Methods:

A systematic literature review of existing guidelines for mental health and psychosocial support in disasters and emergencies was conducted. Using the Appraisal of Guidelines for Research and Evaluation II instrument, the quality of each guideline was determined covering the following: (1.) scope and purpose, (2.) stakeholder involvement, (3.) rigor of development, (4.) clarity of presentation, (5.) applicability, and (6.) editorial independence.

Results:

The results provide an overview of the quality, number, and specificity of available guidelines. A framework was developed to categorize these guidelines on each stage of the disaster management cycle (prevention, preparedness, response, and recovery) while considering their guidance regarding coordination, monitoring, communication, human resources, and connection with regular health services.

Discussion:

The framework and its implications for further research and development are presented at the conference. We will specifically focus on the question, “What is needed to move from a reactive to a more proactive stance in policy and practice?”
Public Information, Education, and Communication (IEC) of Health: Active Participation of Health Practitioners in Urban Radio in a Low Resource Setting
Authors: Bonney Joseph , Osei-Tutu Lawrence , Selormey Richard , Hammond Bernard , Bonsu Patricia
Published: May 2019

Introduction:

Over the last two decades, Frequency Modulation (FM) radio has been established as the only form of sound broadcasting in Ghana. Radio is the most accessible of mass media. There are more than 40 operational radio stations in the Ashanti region of Ghana. Most stations are commercial, broadcasting in the local language (Asante-Twi). Many urban radio health slots discuss various diseases and their treatments mainly for the benefit of patients. Complementary and Alternative Medicine (CAM) practitioners who are able to pay for airtime dominate as ‘experts’ in most of these shows.

Methods:

We identified an IEC gap regarding policies governing healthcare delivery, healthcare financing, training, ethics and research, and environmental issues. In June 2015, orthodox medical practitioners collaborated with a private, local, English-speaking radio station to produce and host a weekly health show whose content was aimed at holistically discussing health from the viewpoint of practitioners, clients, policy makers, administrators, and financiers in a simplified language for the general public, including healthcare trainees.

Discussion:

The show dubbed “Staying Alive” first aired on Tuesday, July 7, 2015, at 20:00 GMT and continues to air to date, appealing to a wide range of active listeners. “Staying Alive” to the best of our knowledge remains the only show with a holistic approach to health. Over the last 23 months, we have experienced challenges in sustaining sponsorship to fund the cost of production and airtime for the show, and the cost of effectively assessing the public health impact of the show. Orthodox medical practitioners can employ mass radio as an effective tool for advocacy, information dissemination, and education of clients or health trainees in low or middle-income urban settings through effective collaboration with media stations.
Implementation of a Disaster Coordination and Communication Plan in Nepal: Hub and Satellite Concept
Authors: Bajracharya Sumana , Shrestha Ashis
Published: May 2019

Introduction:

One lesson learned from the 2015 Nepal earthquake was the need for a more coordinated effort between hospitals to improve disaster response. To improve the coordination, the concept of a hub and satellite system was introduced.

Aim:

Describe the implementation of a hub and satellite system in the disaster management plan to improve coordination and communication between hospitals and the health system during a disaster.

Methods:

A standard hospital disaster management plan was developed and validated with governmental and non-governmental agencies. Twenty-five hub hospitals within Nepal were identified. Smaller hospitals surrounding hub hospitals were identified as satellite hospitals. A plan was made to address communication and coordination between hub-satellite hospitals and ministry of health involving resource sharing, capacity analysis, and development of deployment teams in each hub. An output-based workshop was planned. Each hospital’s existing plans were evaluated before the workshop with a checklist containing essential components of disaster management. Each hospital was oriented and allowed to fill up a standardized template of a disaster management plan, after which their disaster management plan was reevaluated. The newly developed plan was then tested with a tabletop exercise function. The trainings were conducted from September 2017 to October 2018.

Results:

Disaster management plans were made in 110 hospitals, including nine hub hospitals and 101 satellite hospitals in three of seven provinces in Nepal. Evaluation of a pre-workshop score for the existing disaster plan was 18/32, and the score of the disaster plan post-workshop was 30/32 on average. The average score for hospitals for the tabletop exercise was 68.2% (53.8% to 84.6%).

Discussion:

A hub-satellite system-based disaster management plan has been developed and implemented in more than 100 hospitals in Nepal. Workshops for these hub and satellite hospitals improved their communication, coordination, and planning to improve disaster preparedness and future response.
Life Expectancy Negatively Correlates with Disaster Risk Index
Authors: Egawa Shinichi , Nakamura Yayoi , Suda Tomomi , Sasaki Hiroyuki
Published: May 2019

Introduction:

Sendai Framework for Disaster Risk Reduction 2015-2030, for the first time, describes how disaster affects the health of people. Japan is prone to natural hazards, but at the same time, Japan has achieved one of the highest life expectancies (LE) in the world. After experiencing many disasters, Japan seems to have achieved resilience against disasters. Thus, we tested a hypothesis that high LE correlates with low disaster risk.

Methods:

We compared LE from the World Health Organization's (WHO) Global Health Observatory and the Index for Risk Management’s (INFORM) disaster risk index, or World Risk Index (WRI), of each country using JMP software. INFORM risk index varies from 0-10, while WRI varies from 0-1, where a higher value means higher disaster risk in both systems. INFORM risk index considers hazard and exposure, vulnerability, lack of coping capacity, and lack of reliability. WRI considers exposure, susceptibility, lack of coping capacity, and lack of adaptive capacity, including logarithmized LE as a part of adaptive capacity.

Results:

The overall INFORM risk index was negatively correlated with LE (p<0:0001). Although natural hazard did not correlate with LE (p=0.7), the human hazard, vulnerability, and lack of coping capacity negatively correlated with LE (p<0.0001, respectively). Health-related indicators, which confirm the vulnerability and lack of coping capacity, were negatively correlated with LE. Cluster analysis of LE and INFORM risk of six categories resulted in four clusters of countries, suggesting that health development and disaster risk reduction are independent determinants. WRI also correlated with LE, but there are many outliers compared to the INFORM risk index.

Discussion:

High LE can be a good complementary indicator of low disaster risk. Strategies to achieve better health that contribute to high LE are also effective and important strategies for disaster risk reduction.
The Use of Simulation Games and Tabletop Exercises in Disaster Preparedness Training of Emergency Medicine Residents
Authors: Rodriguez Rivera Lourdes , Rodriguez Rivera Cynthia , Zabala Soler Alberto , Pagan Rivera Rey , Rodriguez Luis , Garcia-Gubern Carlos
Published: May 2019

Introduction:

Emergency physicians play a frontline role in hospital disaster responses and require appropriate training.

Aim:

The aim of the current study was to pilot and compare the effectiveness of two emergency preparedness teaching interventions: the first employing traditional lecture-based instruction (LEC) and the second utilizing interactive simulation/game-based teaching (SIM).

Methods:

A two-group randomized pre- and post-test design was implemented into the didactic curriculum of the Emergency Medicine (EM) Residency Training Program at the San Lucas Episcopal Hospital in Ponce, Puerto Rico. Residents (n=23) completed either a LEC (control) or SIM teaching module (single day, one to two hours) focusing on emergency preparedness concepts, disaster-related clinical decision-making, and physician responsibilities during hospital disaster protocols. Knowledge-based multiple-choice exams and scenario-based competency exams were administered at three different time points: one-week pre-intervention, immediately post-training, and two-weeks post-training. Test scores were compared between groups at each time point using the Mann-Whitney U test.

Results:

Following the teaching interventions, no significant differences were found between the LEC group versus the SIM group in knowledge-based exam performance (LEC 81.1%[9.4] vs. SIM 74.9%[12.1]; U=42.50, p=0.15) and scenario-based exam performance (LEC 80.0%[9.7] vs. SIM 80.2%[9.2]; U=62.00, p=0.83), suggesting both teaching methods were similarly effective. Indeed, knowledge-based exam scores improved two-fold and scenario-based exam scores improved by over 50% immediately following training relative to baseline exam scores. Two-weeks post-training, a significant decrease in scenario-based exam performance was found in the LEC group relative to the SIM group (LEC 63.1%[11.6] vs. SIM 75.4%[11.5]; U=91.50, p=0.036), suggesting residents who train with simulations show greater retention of scenario-based concepts compared to those who train with lecture-based training alone.

Discussion:

The current study highlights the potential dual value of incorporating simulation training in EM emergency preparedness curriculums in improving both knowledge and concept retention of physician disaster responsibilities.
Exploring the Feasibility of Wearable Technologies to Provide Interactive Telepresence Sub-Specialist Support to Remote Clinicians Treating Patients with Traumatic Injuries
Authors: Santomauro Chiara , McCurdie Tara , Pollard Cliff , Shuker Matthew
Published: May 2019

Introduction:

Some patients presenting to rural or regional hospitals may be deteriorating so rapidly that emergency procedures might be necessary before transfer to specialist facilities. Such interventions might include placement of an ICC, establishing a surgical airway, evacuation of an EDH, laparotomy, or intra-abdominal packing. The treating clinician may have had little or no experience in the procedure. Interactive telepresence technology offers further point of care support to the treating clinicians through the virtual presence of a specialist from a major trauma center.

Aim:

To explore the feasibility of wearable interactive telepresence technology that can provide sub-specialist support to remote clinicians treating patients with traumatic injuries.

Methods:

Thirty-seven wearable near-field display devices and annotation software applications were tested against a set of pre-specified technical and user experience requirements. A shortlist of three devices and two software applications underwent usability evaluations with a convenience sample of 24 junior clinicians and sub-specialists. The junior clinicians trialed the wearable devices and the sub-specialists trialed the annotation applications in three simulated trauma scenarios. Measures included participants’ ratings of acceptance and workload, technical issues encountered (e.g. frequency of call drop-outs), and anecdotal comments.

Results:

Participants’ subjective ratings of the solutions and anecdotal feedback were positive. However, there was no clear solution that satisfied the functionality and ease-of-use requirements for all participants. For example, the solutions that were rated more favorably by the junior clinicians were rated less favorably by the sub-specialists, and vice versa.

Discussion:

This work provided preliminary evidence of the feasibility and usefulness of interactive telepresence technology in healthcare. A second phase of usability testing is currently underway to explore additional device and software combinations, including those with augmented reality functionality. Future phases of the project will evaluate the solutions under higher-fidelity conditions followed by in-situ trials across selected regional centers.
Hospital Information Technology Considerations for No Notice Disasters
Authors: Little Charles
Published: May 2019

Introduction:

Modern hospital systems are highly dependent on computerized information technology (IT) systems. The integration of laboratory and radiology ordering and resulting cannot be easily replicated with a “paper” processes. This poses challenges for no-notice events, where the rapid registration of patients is a must for effective clinical care. This weakness in hospital response has been demonstrated in events such as the Boston Marathon bombing, the Aurora Theater (to be discussed), and Las Vegas shootings.

Aim:

To discuss lessons learned in configuring IT systems for disasters.

Results:

A integrated system of IT system preparation was implemented at the University of Colorado Hospital. This system has been demonstrated to be effective in multiple real-world events.

Discussion:

Four areas of IT preparedness are needed for hospital IT response to disasters. First is rapid disaster registration with prepared disaster medical record numbers and packets. The medical records must be active in the hospital IT environment, and a visit or case number must be preassigned or rapidly generated. The medical record number alone in the IT environment will allow the initiation of test ordering. The packet should include preprinted labels, a demographic data sheet, and downtime charting and ordering forms. The second item for response is templated order sets to allow rapid ordering of multiple studies such as laboratory, and especially radiology, without having to reenter clinical information. The third is a method of patient care charting scalable, from paper to electronic, depending on the patient volume, acuity, and workstation access. The fourth is a method for patient care in the IT downtime in a disaster setting. Simple inexpensive measures will allow rapid placement of patients in the IT environment and therefore allow rapid and accurate test ordering and resulting.
Tracking Patients in an Earthquake Response: The Bad, the Better, and the Best
Authors: Grainger Paula
Published: May 2019

Introduction:

Tracking patients through health systems is fundamental to coordinated care provision. However, it is an inconsistent element of emergency preparedness. This presentation presents findings of a study undertaken after the 2011 Christchurch Earthquake, and the resultant nationally implemented changes.

Aim:

The intent was to investigate options to improve patient tracking in a mass casualty event. By looking at one scenario involving a mass casualty presentation with the central responder disabled by electricity loss, standards of practice were outlined and made scalable to meet the needs of various events.

Methods:

Clinical and clerical staff involved in the event’s patient tracking were interviewed. Data were analyzed using thematic analysis and reported using the structure, process, and outcomes framework.1

Results:

Structures were material and human resources. Material resources were identification number systems, technological requirements, disaster-specific documents, minimum data for entry, digital/paper/hybrid registration systems, and digital-paper integration. Human resources were role allocation, and familiarity of plans, roles, processes, tools, and facilities. Process identified the activities to manage unidentified patients, triage, registration, and ongoing tracking processes. Outcomes were management of patient flow, patient-care provision, and patient-family reunification.

Initial implementation was local. Structures and processes were agreed upon, with varying response levels according to the incident scope, while staying as close to business as usual for familiarity. National implementation followed via a Ministry of Health working group involving different district health boards. The group developed a consensus on the minimum data to be entered and the process to merge patient identities of initially unidentified patients. Written tools were shared for standardization.

Discussion:

With inter-agency and inter-organization emergency response, standardized processes and information are required. Collaboration prior to events can mitigate issues when an event occurs.
Efficacy of Video-Based Instructions for Laypeople Bleeding Control Education
Authors: Jonson Carl-Oscar , Andersson Felix , Prytz Erik
Published: May 2019

Introduction:

The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.

Aim:

The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.

Methods:

A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.

Results:

Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.

Discussion:

Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.
A Framework for Planning for High-Volume High-Acuity Traumatic Mass Casualty Incidents
Authors: Maslanka Meghan , Mouille Ann , Aiken James , Elder Jeffrey
Published: May 2019

Introduction:

In response to the Pulse Nightclub and Las Vegas mass shootings, staff from our Emergency Department (ED) at University Medical Center New Orleans designed a mass casualty incident (MCI) protocol aimed at preparing the entire hospital for high-volume, high-acuity incidents of unprecedented proportions. As we researched this effort, we discovered that no publically available framework currently exists to assist hospitals with creating their own comprehensive, functional MCI protocol.

Aim:

To develop a framework to assist hospitals with creating MCI plans tailored to fit the needs of their individual facility.

Methods:

Our hospital spent several years creating and refining an MCI protocol that is both comprehensive in addressing each service’s needs and efficient for the staff expected to use it. Upon achieving the desired outcome of a well-functioning and tested protocol, the main contributors of the project met to create a consensus document on how we would approach the task with the benefit of hindsight.

Results:

Our document is meant to serve as a framework for hospitals looking to build their own plan. It is not a template, but rather a guide on how to build an individualized plan that includes critical components that are key for success. It breaks the process down into manageable steps that are presented in an order that maximizes efficiency and includes important points to consider for each step. It encourages the user to tailor the protocol to their own unique needs.

Discussion:

By sharing a framework based on our own best practices and lessons learned, we hope to make it easier for other hospitals to create MCI protocols and to open a dialogue with hospitals that have additional or differing opinions to share. Most importantly, we hope to inspire hospitals to work together as we race to prepare for worst-case scenarios of increasing magnitude.
Lessons from the Brussels Terrorist Attack
Authors: Möhler Andreas
Published: May 2019

Introduction:

On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.

Methods:

A field perspective and experience feedback from the Emergency Medical Response.

Results:

The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.

Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.

Discussion:

Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.
Disaster Planning for the Urban Homeless Population in the United States
Authors: Morris Stephen , Bartlett Emily
Published: May 2019

Introduction:

Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1

Methods:

A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.

Results:

Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.

Discussion:

Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.
2018 Natural Disaster Response in Japan
Authors: Kondo Hisayoshi , Koido Yuichi , Uesgi Hirotaka , Kohayagawa Yoshitaka , Takahashi Ayako , Kawashima Yuzuru , Misaki Miho , Chishima Kayako , Toyokuni Yoshiki
Published: May 2019

Introduction:

Japan experienced several major disasters in 2018.

Aim:

Evaluation of medical response was conducted and problems determined to solve for future response.

Methods:

An evaluation conducted on DMAT responding report of Northern Osaka Earthquake, West Japan Torrential Rain Disaster, Typhoon Jebi, and Hokkaido Iburi East Earthquake.

Results:

DMAT responded 58 teams for Osaka Northern Earthquake, 119 teams for West Japan Torrential Rain Disaster, 17 teams for Typhoon Jebi, 67 teams for Hokkaido Iburi East Earthquake. At the Osaka Northern Earthquake, by comparing the report of seismic diagnosis, results and, a magnitude of each region, hospital damage was evaluated. At the West Japan Torrential Rain Disaster, a flood hazard map was used to expect inundation at hospitals. At the Hokkaido Iburi East Earthquake, information of hospital generator was gathered and planned assistance for loss of power. Water supply cessation in the West Japan Torrential Rain Disaster and loss of power in the Hokkaido Iburi East Earthquake influenced hospital functionality. More precise preparation for hospital management in the event of a loss of power and water supply situation required in not only in local government but also each hospital. For the West Japan Torrential Rain Disaster, we experienced the same type of major disasters in the past, but could not manage accordingly. For the Hokkaido Iburi East Earthquake, we applied what was learned from the West Japan Torrential Rain Disaster.

Discussion:

Disaster medical operation was supposed to be managed with information from the Emergency Medical Information System (EMIS). However, 2018 disasters provided lessons that require a full understanding of disaster prior information and expected disaster damage information to manage disaster assistance. To accomplish effective disaster assistance, information must be gathered of supplies and assistance required by hospitals. An effective system to facilitate lessons learned needs to be developed
The 14th Asia Pacific Conference on Disaster Medicine in Kobe, Japan: A Brief Overview and a Proposal
Authors: Nakayama Shinichi , Ukai Takashi , Kozawa Shuichi , Kawase Tetsunori , Ishihara Satoshi , Kai Kai Soichiro , Kayano Ryoma , Kai Tatsuro
Published: May 2019

Introduction:

The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.

Aim:

To give a rundown of the 14th APCDM and a proposal for WADEM.

Methods:

Retrospective analysis of participants, the category of presentations, and deliverables.

Results:

With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.

Discussion:

Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.
Analysis of Emergency Situations in the Russian Federation
Authors: Aleksanin Sergei , Evdokimov Vladimir
Published: May 2019

Introduction:

Emergency situations (ES) are situations within a certain territory, which have arisen because of an accident, a dangerous natural phenomenon, natural disaster, or other that may cause or have caused human casualties, damage to human health or the environment, significant material losses, and unbalance of living conditions of people. Important characteristics of ES are suddenness and involvement of a significant number of victims who need first aid and emergency medical care. These characteristics determined the organization of the Unified State System for Emergency Prevention and Elimination of the Russian Federation.

Aim:

To study the structure of ES in Russia. By the scale of spread and damage caused, ES can be local, municipal, inter-municipal, regional, interregional, or federal, by the source of origin – technogenic, natural, biological, or social. The terrorist acts are usually allocated in a separate group of ES. The structure of ES, according to the EMERCOM of Russia in 2005-2017, is as follows:

1.

Technogenic (59.61%)

2.

Natural (29.42%)

3.

Biological and social (9.91%)

4.

Major terrorist acts (1.06%)

Methods:

Statistical analysis was conducted. According to the EMERCOM of Russia, every year in 2005-2017 there were 422.5 ± 46.5 ES, resulting in the death of 796 ± 56 people. Polynomial trends in the number of ES and deaths, according to the EMERCOM of Russia, (with significant coefficients of determination R2 = 0.85 and R2 = 0.64, respectively) show a decrease in the number of ES and deaths.

Discussion:

The resulting analysis of the structure and number of ES, the number of deaths, the risk of being in an emergency, and the individual risk of death in an emergency can predict the forces and means necessary for the elimination of the consequences of ES.
Are We Ready for Bioterrorism? Health Personnel were Affected by Contaminated Meat Cooked at a Daily Routine Hospital Kitchen
Authors: Ülker Volkan , Erdoğan Özcan
Published: May 2019

Introduction:

Salmonellae are gram-negative motile bacilli. The transmission of salmonellae to a susceptible host usually occurs from the consumption of contaminated foods. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts four to seven days, but can be severe enough to require hospitalization.

Aim:

Describe a hospital kitchen based mass foodborne infection.

Methods:

Descriptive analysis of the foodborne infection event.

Results:

310 health personnel were contaminated from lunch that was cooked at our hospital kitchen. On that day 70 patients came to the emergency department for complaints of vomiting, fever, and diarrhea. During the next two days, we canceled all planned surgical operations. At the second day, we followed 80 patients and third day 150 patients came to our emergency services. Our emergency services and ıntensive care units were blocked because of personnel illness. We examined all patients, got blood tests and stool stains and cultures. Because of this mass casualty contamination, our infection control committee gave formal information that suspicious of Salmonellosis. 13 of 310 infected health personnel were hospitalized. They got intravenous saline and electrolytes support like calcium and potassium. After two days we got Results of stool cultures, there was inoculation of Salmonella types. None of them died.

Discussion:

We realized that we are not ready for mass casualty incidents like this contamination. Because our patient flow was really blocked. We had to call in new doctors and nurses from different hospital staffs. The event was similar to bioterrorism conditions and we suddenly have to put in place hospital disaster plans at the beginning of decontamination. This situation made us to recognize bioterrorism agents like Salmonella types. We have to raise awareness of the community about chemical, biological, radiological and nuclear agents attacks.
Availability of Essential Medical Equipment for Prehospital Trauma Care on Public Ambulances in Ukraine
Authors: Gaievskyi Stanislav , Meghoo Colin
Published: May 2019

Introduction:

The public ambulance system in Ukraine is the primary deliverer of prehospital care for trauma patients in this Eastern European country, but no national assessment has previously been made to ensure the presence of essential medical equipment on these ambulances.

Aim:

Working with the Ukraine Ministry of Health, our aim was to assess the availability of public ambulances of medical equipment essential for managing traumatic injury using an internationally recognized standard for prehospital care.

Methods:

We identified 53 Advanced Life Support (ALS) ambulances from randomly selected cities for evaluation. We performed an inventory of available medical equipment and supplies on these ambulances against a matrix of essential equipment for prehospital providers developed by the World Health Organization (WHO).

Results:

Essential medical equipment in the categories of personal protection, patient monitoring, hemorrhage control, and immobilization were generally available in the ALS public ambulances surveyed. Deficiencies were noted in equipment and supplies for basic and advanced airway monitoring and management.

Discussion:

Public ALS ambulances across Ukraine are adequately equipped with many essential medical supplies to manage traumatic injury, but have deficiencies in both basic and advanced airway management. Correcting these deficiencies may improve prehospital survival of the traumatically injured patient. The results of this study will enable the Ukraine Ministry of Health to develop requirements of essential medical equipment for all public ALS ambulances in the country, to inform resource allocation decisions, and to guide public health policy regarding prehospital trauma care.
Behavioral Health Resource Utilization of Emergency Department Patients Presenting from Mass Gathering Events
Authors: Hebert Charles , Peksa Gary , DeMott Joshua
Published: May 2019

Introduction:

Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.

Aim:

To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.

Methods:

Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.

Results:

209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.

Discussion:

Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.
The Birth and Growth of the National Ambulance Service in Ghana
Authors: Kingsley Mawuli
Published: May 2019

Introduction:

This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.

Methods:

Data routinely collected by the Ghana NAS from 2004–2014 were described, including: patient demographics, reason for the call, response location, target destination, and types of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.

Results:

In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%–80% and 10%–57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.

Discussion:

The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services.
Collaboration between a Hospital and the Surrounding Communities in an Emergency and Disaster
Authors: Alim Ahmad , Santosa Budi , Setiawan Budi , Husein Rahmawati , Nurkholis Arif , Nihayati Zuhdiyah , Rintawan Corona , Inayah Iin , Afik Al , Arliono Tri , Haedar Ali , Alim Syahirul , Samsu Danang , Supartiny Eny , Nurjuman Husnan
Published: May 2019

Introduction:

Muhammadiyah, the Indonesia non-governmental organization (NGO), has more than 300 hospitals. It is one of the forerunners of the Safe Hospital Initiative in Indonesia beginning in 2008. Muhammadiyah realized that hospital strengthening must be done in collaboration with community strengthening. From 2016 to 2018, Muhammadiyah ran a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED) that was carried out through strengthening two hospitals and their surrounding communities in Palangka Raya, Central Kalimantan, and Bima, West Nusa Tenggara (NTB). This program was funded by the Australian Government and is in line with the Safe Hospital Comprehensive Framework of the World Health Organization (WHO).

Aim:

To strengthen hospitals and the surrounding communities to prepare for emergencies and disasters.

Methods:

HPCRED completed 92 activities in two areas consisting of the following: 10 training, 26 workshops, 12 exercises, four monitoring and evaluation meetings, and seven technical sessions/seminars. The exercises consisted of tabletop exercises, skill drills, command post exercise, and full-scale exercise.

Results:

There were positive changes in the hospitals and communities particularly on disaster management, policy, procedures, staff and community skills, knowledge, and behavior. The integration and collaboration between the hospital surrounding communities were established and can be examined by documents, agreements, and activities done together between the hospital and community during and after the program.

Discussion:

Before the program, hospitals were not ready to face disasters. PKU Bima Hospital collapsed during a flash flood in December 2016. The community, to save housing from water, hollowed the hospital wall out causing water entrance into the hospital. It meant there were no communication and coordination between the hospital and its community. HPCRED not only made them communicate and coordinate but also collaborate and cooperate to reduce risks and response disasters such as responding Lombok Earthquake in July 2018.
Comparison of the Effects of Sacco and START Triage Methods in the Death Risk Assessment of Mass Trauma Patients after Earthquake
Authors: Aoyu Wang , Run Lin , Yaqi Chen , Mengjiao Tao , Hai Hu
Published: May 2019

Introduction:

Compared with traditional START Triage Method, the Sacco Triage Method is a new way to access death risk in disaster scenes. However, due to the difficulties in disaster medical research, there is still no evidence to prove which one is more effective.

Aim:

To assess and compare the value of START Triage Method and Sacco Triage Method in the death risk assessment of transport and the one-month death risk assessment of the earthquake mass trauma patients.

Methods:

A retrospective analysis was conducted on 1,612 patients who were transferred to the West China Hospital by assigning to different triage levels by Sacco Triage Method and START Triage Method respectively. Both of the triage methods were evaluated based on death cases on either during transport or in the emergency department, using the area under the receiver-operator curve.

Results:

For death during the transport and in the emergency department, the receiver-operator curve of two groups reflected as 0.721 and 0.649. For death in a consequence, the receiver-operator curve of the two groups was revealed as 0.667 and 0.519.

Discussion:

As an accurate triage method, the Sacco Triage Method may be used in a mass casualty incident. It is a more effective way than the START Triage Method for the evaluation of death risk assessment of the mass trauma patients.