bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical Concepts in Disaster Medicine for Saudi Arabian Emergency Residency Programs: A Delphi Study
Authors: Alossaimi Bader , Molloy Michael , Hart Alexander , Voskanyan Amalia , Sarin Ritu , Ciottone Gregory
Published: May 2019

Introduction:

Saudi Arabia, the largest country in the Middle East, has suffered numerous terrorist attacks and is the location of Hajj, one of the world’s largest annual mass gatherings. Healthcare providers’ pre-incident knowledge and understanding of basic disaster medicine (DM) concepts are crucial for a unified and effective health-system response. Introducing healthcare providers to best practices is a stated vision of the Saudi Commission for Health Specialties. Standardizing DM curriculum taught to physicians during their residency training will assist this goal.

Aim:

To produce expert consensus on the most critical DM topics for the residency curriculum in emergency medicine (EM) in the Kingdom of Saudi Arabia.

Methods:

Utilizing a Delphi approach, a panel of Saudi Arabian experts in DM and EM residency directors were surveyed regarding potential DM topics for EM residency curricula. The first round comprised of open-ended questions seeking lists of suggested DM curriculum topics. In subsequent rounds, each participant received a questionnaire asking them to review the items contributed in the first round, summarized by the investigation team. The participants rated each item on a five-point Likert Scale to establish preliminary priorities and added their comments. In further rounds, participants reviewed and prioritized subjects until they reached a consensus of >=80%.

Results:

The study is ongoing and full data will be available in the new year.

Discussion:

This expert consensus from major stakeholders can be used to improve the foundation of the DM curriculum. The Delphi Method gives an evidence-based approach to identification and prioritization of subjects, which should be integrated within the Saudi Arabian Emergency Medicine Residency Curriculum. It also can be used as a cornerstone for implementation in other medical education programs across the Kingdom in the future.
Developing a Knowledge Program for Large Scale Prehospital Assistance During Disasters and Big Incidents
Authors: Van Roessel Will , Cools Carian
Published: May 2019

Introduction:

In the Netherlands, we started in 2016 with a new procedure for large scale medical assistance during a crisis. The normal daily assistance in the Netherlands is organized on a regional level, and we have 25 regions. These regions are far too small to handle big incidents, and cooperation is needed on a higher level to generate enough capacity. However, the Aim is that most emergency workers continue to do their own work in standard procedures, we also need more coordination, information management, transition of “stay and play” to “scoop and run” and deploying volunteers and citizens.

Aim:

We developed the model practice-based, however, we have little big incidents. We feel the urgency to compare this practice to international knowledge.

Methods:

The goal is twofold: validation of the starting points of our model, but also further improvement: speeding up the transport and treatment of patients, improvement of capacity, safety of the ambulance staff – especially with terrorist attacks or contamination, civil participation. We held the first survey on scientific literature in English, related to items in our prehospital assistance model. (the article is not yet published).

Results:

The conclusion was, that scientific articles are rare, however, a lot of information is given about the practical course of incidents. Scientific research to explore these experiences is rare, partly due to a missing universal terminology on disaster medicine.

Discussion:

We want to contribute to enlarging the scientific knowledge on large scale prehospital assistance. We expect that a lot of practical experience can be unlocked by bringing together experts in this field. We want to present the Dutch model, with a focus and invitation to compare this with the models in other countries, to compare experiences, to deepen them and to stimulate international research. We want to commit ourselves to facilitate this.
Development and Effect of a Pandemic Disaster Training Program for Healthcare Providers from Designated Hospitals for Infectious Patient
Authors: Noh Jiyoung , Chung Hyun Soo , Jin Hye Mi , Hur Jayoung , Kim Min Ji , Kang Chan Mi , Lee Ga Hyun
Published: May 2019

Introduction:

South Korea experienced Middle East Respiratory Syndrome (MERS) outbreak in 2015. To mitigate the threat posed by MERS, the Ministry of Health and Center for Disease Control designated hospitals to be responsible for managing any suspected or confirmed infectious patient. These hospitals receive mandatory training in managing infectious patients, but many of the trainings lack practical skills practice and pandemic preparedness exercise.

Aim:

To develop and evaluate a training course designed to train healthcare providers from designated hospitals to enhance their competencies in managing emerging infectious diseases and potential outbreaks.

Methods:

A two-day course was developed by the Center for Disaster Relief, Training, and Research in collaboration with the Korea Health Promotion Institute using Kern’s 6-step approach. The course consisted of didactic lectures, technical skills training, tabletop simulation, and scenario-based simulation. Table-top simulation exercises consisted of cases involving a single infectious patient detected in the outpatient clinic and outbreak in the emergency department. Scenario-based simulation exercises involved managing a critically ill infectious patient in an isolated ward. A post-survey questionnaire was used to evaluate the course and assess the perception changes of the participants. All pre-to-post differences within subjects were analyzed with paired t-tests.

Results:

A total of 121 healthcare providers participated in three separate courses. The competencies for pandemic preparedness knowledge, skills, and attitude improved from pre- to post-course. The differences were all statistically significant (p<0.05). Overall course satisfaction in average for expectation, time, delivery method, and contents were 9.5, 9.2, 9.4, and 9.2, respectively.

Discussion:

There needs to be tests and exercises to recognize gaps of systems in place for pandemic preparedness. Simulation exercises are ideal tools for this purpose. Although this was only a two-day intensive course, this increased familiarity with workflows, tested the coordination of workflows between different disciplines and allowed the identification of gaps.
Development of a Tool Measuring Nurses’ Competence for Disaster Response
Authors: Marin Sandra Mara , Witt Regina Rigatto
Published: May 2019

Introduction:

Disasters are situations of complexity and unpredictability that require the performance of teams from various instances with preparation and qualification to assist the victims, recover the environment, and restore living conditions. Health services are essential in the response to a disaster, and nurses all over the world play a significant role in these disasters.

Aim:

To develop a valid and reliable scale to identify nursing competencies in disasters.

Methods:

Competencies were selected from those related to the framework developed by the International Council of Nurses. A methodological study was developed in two stages: I) validity of content and appearance verification and II) verification of applicability and reliability with test-retest. The participants of stage I were eight specialists in emergencies and disasters in Brazil. In stage II, 326 nurses from the Emergency Mobile Assistance Service in Southern Brazil participated. Data analysis utilized the Content Validity Index and Interest Reliability Index. Psychometric properties of the instrument were measured with Cronbach’s alpha coefficient; applicability and test-retest reliability with the use of the t-test and intraclass correlation coefficient and factorial validity.

Results:

Forty-one competencies of 51 were organized in three domains according to Factor Analysis. Cronbach’s alpha values showed good internal consistency. There was no significant difference between the test and retest scores. The intraclass correlation coefficient values were adequate. The instrument showed reproducibility and adequate applicability.

Discussion:

This tool will assess nurses’ competencies for disaster response and provide evidence for the development of educational policies in disasters, creating a reliable and prepared workforce to respond more effectively during a disaster.
Development of an Active Learning Program for a Community Utilizing a Scenario Participating as Simulated Rescuers and Sufferers in an Earthquake Prone Area of Japan
Authors: Takeda Taichi
Published: May 2019

Introduction:

Major earthquakes with a magnitude of 8-9 are anticipated to occur in the next 30 years at a 60 percent chance on the southern coast of Japan. Since the most part of our Prefecture is likely to be damaged by tsunami and landslides, residents are expected to take a self-reliant approach on the initial several days after the earthquakes and tsunami.

Aim:

To improve the resilience of the local communities we have developed and applied an educational program of disaster response.

Methods:

An active learning program was designed on roles of rescuers and sufferers, and conducted two-hour sessions for high school students using a scenario in which they encountered an earthquake during a field trip. Half of the participants were assigned to play students on a field trip and asked to discuss options as a small group to survive and secure their safety in an isolated situation after an earthquake. They exchanged ideas to stay alive, cooperate with local residents and request disaster assistance using very short radio messages to the appropriate counterpart. The other half of the participants were assigned to be school administrations and asked to estimate the situation of sufferers. Their task as a small group was to organize assistance based on the best assumption from the limited information of the isolated students and local villagers.

Results:

After the sessions, the participants expressed their discovery in the discrepancy of situational recognition between the two groups and they learned about assumption-based planning as well as good information sharing.

Discussion:

Through this program, the participants experienced simulated situations and learned perspectives from both sides; providing relief as rescuers and receiving aid as sufferers. The participants were motivated to share and utilize their knowledge and skills to make their community resilient to disasters.
The Diagnostic Value of Ultrasonic Measurement of Inferior Vena Cava Diameter Respiratory Variability on Volume Response Evaluation of Geriatric Hip Fracture
Authors: Li Yang , Cen Yuan
Published: May 2019

Aim:

To evaluate the value of ultrasonic measurement of the respiratory variability of inferior vena cava (IVC) in the preoperative volume-response evaluation of elderly hip fracture patients.

Methods:

Volume-loading tests were carried out in elderly patients with hip fractures requiring surgical treatment from August 2017 to February 2018. The maximum diameter (IVCe) and minimum diameter (IVCi) of the IVC were measured by ultrasound, and the variation of IVC (IVC-CI) was calculated before surgery. SV was monitored by a FloTrac/Vigileo system, and positive volume responsiveness was defined as ΔSV increasing by more than 15%. The sensitivity and specificity of IVC-CI to volume responsiveness evaluation was analyzed by ROC, and the correlation between IVC-CI and ΔSV was analyzed by Spearman correlation analysis.

Results:

Ultrasound measurements and volume-loading tests were successfully performed in 39 of the 44 patients. Among them 21 cases were volume responsiveness positive (group R) and 18 cases were volume responsiveness negative (group N). Before the volume-loading test, IVCi in group R was significantly smaller than group N and IVC-CI was significantly larger than group N (P<0.05), while the difference between IVCe and group N was not statistically significant (P>0.05). After the volume-loading test, the differences between IVCe, IVCi, IVC-CI, and group N were not statistically significant (P>0.05). Area under curve (AUC) of IVC-CI to assess volume responsiveness in geriatric hip fracture patients was 0.80±0.08 (0.65-0.95, P=0.001), with a 20.69% cut off value, 77.78% sensitivity, and 76.19% specificity. Through the Pearson correlation analysis, IVC-CI and Δ SV were positively correlated with the coefficient r = 0.367 (P<0.05).

Discussion:

As a rapid and noninvasive monitoring method, ultrasonic measurement of the respiratory variability of inferior vena cava in assessing the volume responsiveness of geriatric hip fracture patients can provide guidance for perioperative fluid management.
Disaster and Mass Casualty Incident Responses by Doctor Car
Authors: Kuno Masamune , Suzuki Kensuke , Unemoto Kyoko , Tagami Takashi , Nakayama Fumihiko , Kaneko Junya , Saito Ken , Sato Shin , Tanaka Chie , Fukuda Reo , Kudo Saori , Kitahashi Akiko
Published: May 2019

Introduction:

Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.

Aim:

To review the past disaster responses of our hospital.

Methods:

The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.

Results:

Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.

Discussion:

For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.
Disaster Preparedness and Management in Pakistan: A Systematic Review
Authors: Shahbaz Sana
Published: May 2019

Introduction:

Since its inception about 66 years ago, Pakistan has experienced a variety of both natural and man-made disasters like earthquakes in 2005 and 2015 and widespread flooding in 2010. Pakistan has also experienced a range of politically motivated violence, bombings in urban areas, as well as mass shootings. Such events generate a large number of casualties. To minimize the loss of life, well-coordinated prehospital and in-hospital response to disasters is required.

Aim:

To identify all the existing peer-reviewed medical literature on prehospital and in-hospital disaster preparedness and management in Pakistan.

Methods:

The search was conducted using PubMed and Hollis plus search engines in accordance with the PRISMA guidelines. The articles selected included articles on both natural and man-made disasters, and their subsequent prehospital and in hospital management. The following search terms and keywords were used while searching PubMed: mass casualty incident preparedness and management Karachi, mass casualty incident preparedness, disaster preparedness Karachi, and disaster management Karachi. To search Hollis plus, we used the terms: mass casualty incident preparedness and management Pakistan, mass casualty incident Pakistan, mass casualty incident preparedness and management Karachi, and disaster preparedness Karachi. We selected only peer-reviewed articles for a literature search and review.

Results:

The reviewed articles show a lack of data regarding disaster management in Pakistan. Almost all the articles unanimously state the scarcity of planned prehospital and in-hospital management related to both man-made as well as natural disasters. There is a need for planned and coordinated efforts for disaster management in Pakistan.
Emergency Ambulance Dispatch and Drive Times: An Analysis of Prehospital Vehicular Response in the Kingdom of Bhutan
Authors: Kincaid Jenevieve , Mize Charles , Dorji Mila
Published: May 2019

Introduction:

The Kingdom of Bhutan is a small, mountainous country with limited financial resources. Its population is scattered in hard-to-reach villages with poor road access. Ambulance drivers piloting Toyota Landcruisers provide the majority of the country’s emergency response and are dispatched by the national emergency response center (Health Help Service/112) to calls in the nation’s twenty districts.

Aim:

By collecting and analyzing prehospital response data, we aimed to describe Bhutanese emergency medical response (EMS) ambulance activities and make system-wide recommendations to improve the speed of emergency vehicle dispatch, reduce the time between ambulance activation and ambulance arrival on scene, and adequately describe emergency vehicle drive time as it relates to distance driven.

Methods:

The following data was compiled in Excel: Dispatch center phone records, EMS ambulance activation times, drive times, vehicle geospatial data, and written records of ambulance drivers. No identifiable data was collected.

Inclusion Criteria: All prehospital calls from 2017 and 2018 where complete data was available.

Exclusion Criteria: Complete data unavailable, i.e. geographic data without a matching call or report.

Statistical Tools: SPSS Statistics Version 25, NVivo 12-12.2.0.3262.

Results:

Preliminary analysis of the data shows a significant difference between data collected and data previously reported, the speed of emergency vehicular response and dispatch, drive times, and distance traveled. Facility transfer rather than scene response was found to take more time.

Discussion:

Due to adverse road conditions, lengthy drive times, and an inadequate number of personnel and satellite ambulance locations, we recommend optimizing ambulance location using an optimization model that will minimize the number of ambulances needed and maximize response time. Future considerations may include adding a ground arm to the Bhutan Emergency Aeromedical Retrieval team, or a second aeromedical team in the eastern part of the country.
An Emergency and Disaster Course on Responding to Community and Family Healthcare Problems with Interprofessional Education for Undergraduate Medical, Nursing, and Dietitian Students
Authors: Ariani Madelina , Donna Bella , Sutono Sutono , Hartriyanti Yayuk , Fitriana Fitriana , Wilasto Nandyan , Rahayu Gandes
Published: May 2019

Introduction:

Emergencies and disasters need inter-discipline and inter-professional approaches because many problems in a disaster are due to poor coordination and collaboration. The disaster events during a decade in Indonesia highlighted the limitations of the healthcare system in responding to large-scale public health problems. Disaster health preparedness is the key to an effective response to any problems in community and family. Thus, education for health students has become a priority.

Aim:

Preparing fourth-year health students to be aware of disaster health problems in family and community with an inter-professional approach.

Methods:

Faculty of Medicine, Public Health, and Nursing UGM were prepared for the fourth year undergraduate health students through a semester “Emergency and Disaster Course” under Community Family and Healthcare with the Inter-professional Education Program, first given in 2016 for four hundred students. Mix method between class lecture, training skill, and simulation. The course goals are to (1) educate students on disaster health management, (2) understand the health preparedness and disaster family kit, and (3) define the principle of health worker’s role and collaboration in disaster.

Results:

The course was well received and at the 2017-2018 session was improved based on students and faculty feedback. Disaster knowledge of students changed. However, they still had a problem in communication between professions. And addition, they became aware of the function and each role of health profession competency during a disaster.

Discussion:

A course for fourth-year health students about emergency and disaster health management is extremely relevant because they will be health workers soon. They must have good awareness, knowledge, and attitude to cope with disaster health problems in the future.
An Emergency Medical Triage Tool for Swiftwater Rescue
Authors: Jaslow David , Zahustecher Nathaniel , Ellinger Fred , Zecher Derek , Overberger Ryan
Published: May 2019

Introduction:

Climate change and overdevelopment increase the intensity and frequency of flash flooding, which may generate more swiftwater rescue (SWR) incidents. Rescue personnel may fail to properly risk stratify (triage) these victims due to limited medical and/or variable SWR training, or due to an adverse rescuer-to-victim ratio. Some victims may attempt to refuse medical evaluation due to lack of awareness of incident-related morbidity and/or comprehension of risk.

Aim:

To develop an SWR emergency medical triage tool.

Methods:

A cross-sectional literature search identified SWR-related medical conditions. A flow diagram reliant upon incident history, chief complaint, and observational exam rather than interpretation of vital signs was created to guide medical decision-making.

Results:

Every SWR victim should receive a medical screening exam focused on six clinical categories—drowning, hypothermia, hazmat exposure, physical trauma, psychological trauma and exacerbation of pre-existing disease. Drowning potential is identified by dyspnea, new cough or a history of (even brief) submersion. Shivering SWR victims and those with altered mental status but no shivering are assumed to be hypothermic. Any victim with open skin lesions/wounds who was immersed in floodwater and anyone who has swallowed floodwater is contaminated; these victims require decontamination and possible antibiotic therapy. SWR victims injured upon entering the water or from contact with either water-borne stationary or floating objects require trauma evaluation. Distraught victims and those who exhibit exacerbation of pre-existing organ-system disease also require ED evaluation.

Discussion:

Most SWR course curricula are oriented towards technical rescue; they do not address comprehensive medical decision-making. We present a rapid medical screening exam designed to determine which SWR victims require an ED evaluation. Such a triage tool will assist rescuers to simultaneously honor patient autonomy and avoid risky and uninformed refusal of medical aid. Simplified medical decision-making should enable the application of this tool worldwide.
Emergency Patients with Mental Crisis Accessing Emergency Medical Services in Thailand
Authors: Wachiradilok Porntip
Published: May 2019

Introduction:

Emergency responders face an increasing number of calls involving people with behavioral and mental crisis issue. Integrated multi-agency schemes involving ambulance, police and mental health services are now being developed to provide urgent and emergency care pathways for these vulnerable patients.

Aim:

The objectives were to study the situation, characteristics, issues, and accessibility to emergency medical services (EMS) and appropriate treatment for emergency patients with a mental crisis in Thailand.

Methods:

The sample included 26,511 mental crisis patients accessing EMS. Data were obtained from the database of the Information Technology for Emergency Medical System between 2015-2017 and from stakeholders from four provinces distributed regionally using focus groups and in-depth interviews. The data were analyzed using descriptive statistics and content analysis.

Results:

The number of patients with mental crisis accessing EMS increased in the past three years. Most patients are male in the working age group from the Northeastern area during the raining and winter season, especially between September and October. During patient encounters with maniacal attacks, assistance will be requested from the police and the emergency medical units. The response depends on the experience and community capability. The emergency responder teams had insufficient knowledge and skills. Emergency rooms in most hospitals lack specific caring unit. Psychiatric hospitals have different criteria for admitting patients. Most had no fast track system and even refuse admittance.

Discussion:

Mental crisis patient calls with EMS were rising. However, accessibility to appropriate service centers was still an issue. Most hospitals lack prioritized access and staffs had insufficient knowledge and skills. Cooperation among the police, emergency medical operation team and the rapid psychiatric emergency team is need to be reinforced.
Emergency Response Training Program for Theme Parks: Experiences of Taiwan
Authors: Hsiau Yawen , Liu Yu-Han , Lin Chi-Chun
Published: May 2019

Introduction:

“Tailor-made” training programs have been started in two theme parks in North and East Taiwan after the dust explosion of Ba-xien theme park in 2015. The training programs emphasized several areas. They work to strengthen the incident command system (ICS) and the skills of first responders, especially evacuation, placement, triage, and first aid, as well as to assist the park’s cooperation with local disaster response units, such as the fire department and Health Bureau.

Methods:

The first step was to find out the practical problems of the two theme parks, and then make a one-year, tailor-made training program according to the needs of parks and different levels of staff: senior supervisors, middle-level district supervisors, and frontline colleagues. After the phased training, the training results are inspected in the non-scripted exercise mode.

Results:

It was found that the staff are relatively familiar with the evacuation process and placement of tourists. The initial emergency responses such as triage, first aid skills, and patient transport gradually improve after several drills. The ICS operation and communication also became more effective and efficient. The regional emergency response units could understand these theme parks capability and how to cooperate with them.

Discussion:

The experience of emergency response training and exercise in these two theme parks has shown that such a model is feasible and should be valued.
Enhancing the Effectiveness of Disaster Simulations through Contemporary Simulation Design and Technology
Authors: McNamee Sarah , Wullschleger Martin , Donohue Andrew , Campbell Don , Watkins Nathan , Brazil Victoria
Published: May 2019

Introduction:

Simulation is often employed to test mass casualty and disaster response planning within hospitals, but it is resource intensive and needs to achieve high-quality recreation of scenarios to be effective. The delivery of large-scale interdisciplinary team and system simulation requires consideration of physical safety, system integrity for real patients, simulation team communication, and effective dissemination of outcomes.

Aim:

To describe challenges and potential solutions for effective delivery of disaster simulations, drawn from simulation service experience at Gold Coast Hospital and Health Service (GCHHS).

Methods:

This case study reviews strategies used to deliver a large-scale multi-team in-hospital disaster and trauma simulation, involving more than 75 participants drawn from paramedic/ambulance, emergency, trauma service, anesthetics, perioperative, surgical, and hospital administrative teams.

Results:

Issues reviewed include simulation delivery team composition and briefing, safety strategies, matching simulation methodology to exercise objectives, the use of real-time communications technologies and apps for real-time communication and performance tracking, and leveraging the simulation experience for observers by narrated Facetime stream. Following the simulation, a debriefing was conducted with participants to address performance, communication and interfaces, strengths and weaknesses, and overall opportunity for improvement. Facility-wide dissemination of messages through standardized reporting, infographics, and video vignettes were also reviewed.

Discussion:

Simulation is an engaging way to assess protocols and practices for disaster response within a tertiary hospital, and effectiveness can be enhanced through the strategic use of contemporary techniques and technologies.
Environmental Factors at Mass-Gathering Events: Considerations for Health Research and Evaluation
Authors: Hutton Alison , Ranse Jamie , Lund Adam , Turris Sheila , Munn Brendan , Gray Katy
Published: May 2019

Introduction:

This poster will document the environmental domain variables of a mass gathering. They include factors such as the nature of the event, availability of drugs or alcohol, venue characteristics and meteorological factors.

Method: A systematic literature was used to develop a set of variables and evaluation regarding environmental factors that contribute to patient presentation rates.

Results:

Findings were grouped pragmatically into factors of crowd attendance, crowd density, venue, type of event, mobility, and meteorological factors.

Discussion:

This poster will outline a set of environmental variables for collecting data at mass gathering events. The authors have suggested that in addition to commonly used variables, air quality, wind speed, dew point, and precipitation could be considered as a data points to be added to the minimum standards for data collection.
Evaluation of Published Expedition Medical Resources Compared with Treatment Protocol Recommended Medical Resources for Injuries and Illnesses Encountered on Expeditions
Authors: Fiebig Kaspar , Heslop David
Published: May 2019

Introduction:

People are increasingly embarking on expeditions into remote wilderness environments and subjecting themselves to increased medical risk. Medical provisions for the management of anticipated injuries and illnesses must be selected carefully due to financial and size and weight constraints on expeditions. Literature suggests decisions surrounding medical resource provisioning are rarely made using evidence-based methods.

Aim:

The aim of this study was to evaluate the medical provisions taken on expeditions against the medical provisions recommended as best practice in published treatment protocols for the management of conditions encountered on expeditions.

Methods:

Firstly, a mixed methods study approach was used to develop a conceptual model linking injuries and illnesses with the medical resources (equipment and medications) recommended for their management. In the second part of the study, injuries and illnesses reported in four studies from the published literature were analyzed using the conceptual model.

Results:

Expected medical resources for the injury and illness burden were compared to the medical resources included in published equipment and medication lists. It was found that medical resources taken on expeditions were both significantly underequipped (p<0.01) compared with the list of provisions recommended by the treatment protocols, but also included a range of resources that were not indicated as part of best practice.

Discussion:

These findings suggest that unnecessary over-provisioning and under-provisioning risks are being assumed on expeditions. Further research supporting the development of a medical provision recommender system may provide a more evidence-informed method of matching medical resource requirements to anticipated injury and illness profiles on expeditions.
From Yokohama, Hyogo, and Sendai to the World: The Global Legacy of Kobe
Authors: Archer Frank , Spencer Caroline , McArdle Dudley
Published: May 2019

Introduction:

The Hyogo and Sendai Frameworks for Disaster Reduction are well known and have been influential globally. However, less is known of their broader contexts.

Aim:

A recent opportunity to visit Kobe, Japan, provided an opportunity to experience the rich, and largely unknown tapestry behind the scenes of the Hyogo and Sendai Frameworks. This paper aims to illuminate the journey of the Kobe Legacy and its global influence.

Methods:

An experiential visit to Kobe and exploring its rich resources relating to disaster risk reduction.

Results:

The First World Conference on Natural Disasters, was held in Yokohama, Japan, in 1994. Almost immediately, Kobe experienced the Great Hanshin Earthquake, January 17, 1995, resulting in 6,434 dead, 43,792 injured, and 249,180 homes damaged. The United Nations International Strategy for Disaster Reduction (2000 – 2005) culminated in the Second World Conference on Disaster Reduction, Kobe, 2005 and the Hyogo Framework for Action 2005 – 2015. The Great East Japan Earthquake occurred on March 11, 2011, with 18,453 dead or missing, 6157 injured, 1.1M homes damaged, with a tsunami and nuclear accidents. The Third World Conference on Disaster Risk Reduction followed in Sendai in 2015 with the Sendai Framework for Disaster Risk Reduction 2015 – 2030 agreed on. Subsequently, the Sendai Framework has further evolved. However, behind the scenes, Kobe has developed a rich tapestry of insightful and valuable resources which will be outlined in this presentation.

Discussion:

In the words of the Mayor of Kobe, Mr. Tatsuo Yada in 2010, “I would like to reaffirm my determination to never allow our experiences of the disaster to fade away. It is our responsibility to make the utmost effort for disaster prevention and mitigation and keep passing on our experiences and the lessons learned to future generations”. This is the real legacy of Kobe.
Gender-Based Violence After A Natural Disaster
Authors: Reddy Himabindu , Goodman Annekathryn
Published: May 2019

Introduction:

Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.

Aim:

To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.

Methods:

The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel

Results:

Disaster response programs should ensure:

Collection of data to identify vulnerable populations

Establishment of procedures for monitoring and reporting

Inclusion of female staff at all levels of planning and response

Implementation of holistic services including physical and psychosocial care and legal response

Safety in designing accommodations and distribution centers

Pre-Deployment training should include:

Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence

Familiarity with behaviors and conditions associated with gender-based violence

Non-judgmental, supportive, and validating approach to inquiry and response

Familiarity with risk assessment tools

Mobilization of social supports

Knowledge of resources, including medical and legal services

Discussion:

Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.
Happy New Year! Do New Year’s Eve Festivities Influence the Workload of the Emergency Department of an Urban Hospital?
Authors: Scholliers Annelies , Gogaert Stefan , De Fré Dimitri , D’haese Inge , Vandycke Carine
Published: May 2019

Introduction:

Bruges is the largest city in the province of West-Flanders in Belgium. Because of its ample canals, it is sometimes referred to as “Venice of the North.” As such, it is a major tourist destination, and during New Year’s Eve, there are many festivities. The AZ Sint-Jan is the largest hospital providing medical care to the area.

Aim:

To examine the impact of the New Year’s Eve festivities on the workload of the emergency department of AZ Sint-Jan.

Methods:

Data was analyzed for every patient presenting to the emergency department from the 31st of December starting from 06:00 PM until the 1st of January 08:00 AM from 2009 until 2018. The time of entry, type of injury, gender, age, and whether the patient was intoxicated were evaluated. Ten other dates in this time period were obtained for comparison via a random date generator. Data were analyzed using Jasp©.

Results:

There were 826 patients included for analysis. On average, 41 patients presented themselves to the emergency department on New Year’s Eve between 06:00 PM and 08:00 AM. On a random day, there were only 31 patients. Most of the patients on New Year’s Eve arrived between 00:00 AM and 08:00 AM. 57% of all patients were male. 22% of all patients were intoxicated with alcohol. From 00:00 AM until 08:00 AM, one in three patients were intoxicated. The average age on admission was 36 years.

Discussion:

During New Year’s Eve there is a consistently higher workload in the emergency department. There is an influx of young males who are intoxicated. These patients tend to stay a long time to “sleep it off” and put considerable stress on the available resources. More attention should be given to risk mitigation strategies tailored to this group to prevent excessive drinking.
The HOPE Model for Disaster Nursing
Authors: Hugelius Karin , Adolfsson Annsofie
Published: May 2019

Introduction:

Despite a large number of nurses involved in disaster situations in different ways, there are few theories or models that define and describe the goal and content of disaster nursing.

Aim:

This study aimed to present a model for disaster nursing, based on a literature review of the concept and content of disaster nursing.

Methods:

A systematic literature review of 15 original qualitative or quantitative articles was conducted. A thematic synthesis was used to analyze the data.

Results:

The main theme of Disaster Nursing: Crossing Borders, included three dimensions (personal borders, professional borders and environmental borders) and four themes describing the process of disaster nursing (being hit by reality; adapting to the conditions; providing aid, relief, and caring; recovering, remembering, and growing). Based on these results the HOPE model was developed. ‘HOPE’ stands for ‘Holistic health assessment and promotion; Organization and management of immediate response; Professional adaptation; Endurance and recovery.

Discussion:

The HOPE model for disaster nursing describes the core element and essence of nursing in the disaster response phase and can serve as guidance both for nurses deployed in disasters and in disaster nursing training.
Hospital C.O.D.E (Clinical, Operational, Disaster, and Emergency) Terminology
Authors: Buckley Christine , Molloy Michael S. , Hart Alexander , Voskanyan Amalia , Sarin Ritu , Ciottone Gregory
Published: May 2019

Introduction:

Healthcare facilities frequently use disaster codes as a way to communicate with employees that an emergency or incident is occurring. As increasing numbers of providers work at multiple facilities, and healthcare systems continue to build disaster response teams and protocols covering multiple facilities, standardization of disaster code terminology is critical. A lack of consistency in terminology can potentially have a devastating impact on the understanding and response of visiting or relief staff.

Aim:

To evaluate the level of standardization in terminology of disaster codes in healthcare facilities.

Methods:

A convenience sample was taken from a private Facebook™ group consisting of emergency department nurses from a wide range of facilities. The Facebook™ group was asked to share their hospital disaster codes. Of the 40,179 total members, 78 commented, including 55 photos of quick reference badges, and the rest were descriptions/lists of codes. One badge was excluded due to a blurry photograph. Results were collated and analyzed for trends and standardization.

Results:

The most common codes were, “Code Red” for fire (72.7%), “Code Blue” for cardiac arrest (44.9%), “Code Silver” for active shooter/weapons event (37.7%) and “Code Orange” for hazardous materials (33.8%). There were 168 instances of a code term being associated with a particular event by five or fewer facilities. Two facilities used numeric systems, with 11 using plain language descriptions.

Discussion:

Disaster code language is inconsistent. Few of the codes were consistently assigned to the same meaning, and none were universal. Color coding was the most common method, but there was little consistency even within color code systems. Additionally, some facilities used a combination of colors, numbers, terms, and plain language. Healthcare facilities should embrace standard terminology and create a consistent language for disaster codes to enhance response capabilities and medical security.
Implementing Guidelines for Ambulance Services
Authors: Hodza-Beganovic Ruhije , Carlsson Henrik C. , Lidberg Henrik , Berggren Peter
Published: May 2019

Introduction:

If there is consensus about how to handle a patient with a specific condition, from the ambulance service point of view, it matters less for the patient which ambulance arrives to take care of the patient. Guidelines are a way of standardizing treatment or management of the patient for a given patient condition. Clear and implemented guidelines that promote the handling of the patients is done from best practice and are evidence-based according to the best ability of the organization.

Aim:

The aim of the current study was to implement guidelines into an organization that was not currently using guidelines. The study was conducted as a collaborative effort between a Swedish pre-hospital training organization and the local ambulance service organization in Kosovo.

Methods:

An iterative process of implementing the guidelines was applied:

1.

Identify guidelines appropriate for the local organization. For each iteration, five guidelines are chosen.

2.

Have the five guidelines translated into Albanian.

3.

The guidelines are adapted to local conditions and context.

4.

The five guidelines are approved by an expert group.

5.

The five guidelines are implemented in the organization.

Results:

The initial iteration included was carried out in the form of a workshop where 22 persons (doctors and nurses) from the local ambulance service in Kosovo participated. During the workshop, the first three implementation steps were taken, while remaining steps were carried out by the local organization.

Discussion:

With the local management and ambulance personnel involved throughout the process, the implementation of guidelines were delivered in a more feasible way as well as more easily accepted and adhered to. Supporting a standardized treatment or management of the patient will benefit future patients. These standards should be based in evidence-based practice adopted to local conditions.
Innovating Disaster Health and Medical Emergency Responses for an Emerging Global Threat
Authors: Finnigan Gerard A.
Published: May 2019

Introduction:

The global health threat posed by the ongoing deterioration in natural ecosystems and damage to our physical environment is growing at a rapid pace. Less recognized is the threat from natural hazard disasters, which concentrate contaminants from the damaged environment and expose large vulnerable populations to life-threatening medical conditions and disease. Currently neither international nor any national health and medical emergency response protocols or programs have prepared health responses to protect the health of communities in such events.

Aim:

This study performed a retrospective health risk assessment on two recent events where such impacts unfolded, namely the 2015 southeast Equatorial Asia smoke haze disaster and the 2016 Melbourne thunderstorm asthma epidemic. The primary objective was to test if the characterization of health risk could have been identified earlier and catastrophic levels of mortality and morbidity reduced.

Methods:

The study employed a two-staged retrospective health risk characterization assessment. The first step applied the UNISDR (2017) framework for health risk disaster assessment combing a thematic and targeted word literature review to identify the level of health and medical risk knowledge prior to each event. The second stage applied a risk characterization matrix developed using ISO and Australian Health Department semi-quantitative health assessment standards.

Results:

The 2015 southeast Equatorial Asia smoke haze disaster risk assessment was characterized as an extreme health risk and the 2016 Melbourne thunderstorm asthma epidemic characterized as a high health risk.

Discussion:

Innovative medical response approaches are urgently needed to mitigate the growing health risk to whole populations from natural hazard disasters compounded by deteriorating natural ecosystems and the physical environment. This requires emergency medical and health teams to recognize the two-tailed human health risk from natural disaster hazards, along with investment in advanced planning, environmental risk surveillance, specialist training, technical guidance, and multi-sector coordination.