bluuebunny/crossref_metadata_2025 huggingface dataset:
(A18) The Influence of Status and the Patterns of Driving License Ownership Toward the Gradation of Open Fractures According to Sardjito Scoring System Suffered by Motorcycles Accident Patients in Emergency Department of Saiful Anwar General Hospital from April to June 2010
Authors: Maharani T. , Haedar A.
Published: May 2011

Introduction

3880 fracture patients are admitted in the Emergency Department of Saiful Anwar General Hospital from January to August 2009. It signifies to the second place of the cause of patients' admission. Most cases are motorcyclist victims from road traffic accident. Driving license is encouraged by the government to reduce the number of road traffic accident victims.

Methods

This study utilizes observational with cross sectional study and purposive sampling to correlate the relationship between status of motorcycle driving license ownership and the obedience of traffic law, the relationship between the patterns of motorcycle driving license ownership and the obedience of traffic law, and the relationship between the obedience towards traffic law and the gradation of open fractures among motorcyclist victims in accordance with Sardjito Scoring system.

Results

Most patients have no driving license. And those who has driving license, mostly have never undergone driving license test. Patients with open fractures of cruris come with severe Sardjito scoring system, open fractures of antebrachii with moderate Sardjito scoring system, and open fractures of femur with moderate Sardjito scoring system.

Discussion

It is strongly related between the ownership of driving license and road traffic accidents. The most road traffic accidents cases of are open fractures of cruris, open fractures of antebrachii, and open fractures of femur respectively. High obedience and strict use of personal protective equipment (safety helmet, glove, and jacket) would be effective in mitigating road traffic accident injuries.
(A22) Promoting Emergency Preparedness of Local Municipalities for Disasters – Lessons Learned
Authors: Ringel R. , Laor D. , Ohana A. , Adini B.
Published: May 2011

Background

Involvement of local municipalities in promoting emergency preparedness has been recognized as a key factor to build a resilient community. As part of the efforts to build and maintain knowledge and capabilities, the Israeli Ministry of Health initiated a series of conferences aimed at capacity building of city councils to provide services to the population following disasters.

Methods

6 conferences have been planned for the years 2010-2011 in which 250 senior administrative employees from all municipalities, responsible for the health status in their communities are expected to participate. Each conference covers a variety of emergency scenarios, including biological events, regional hostilities and management of massive Acute Stress Reactions among the civilian population. Pre-post tests based on Multiple Choice Questions are conducted before and following each conference to identify impact of the training program.

Results

Findings from the pre-post tests conducted up to date showed a significant increase in all elements included in the training program. The average knowledge scores of the pre-post tests were 33% and 79% respectively. The highest increases in level of knowledge were found in regard to deployment of community centers for light casualties in chemical warfare scenarios (48% and 100% respectively) and concerning population that requires evacuation during emergencies (68% to 100% respectively). Overall levels of knowledge regarding community treatment centers in biological events were relatively low both before and after the training (16% and 44% respectively).

Discussion

Training local municipalities' personnel is crucial in order to promote emergency preparedness. Raising knowledge regarding response to newly emerging threats (such as deployment of exposure centers in biological events) was found to be more complex in comparison to well-recognized hazards (such as deployment of community treatment centers in chemical warfare). There is a need to conduct follow-up studies to determine the retention of knowledge over time.
(A27) Traumatic Wound Management by Bystanders – Myths
Authors: Raju V.
Published: May 2011

Objective

To receive trauma victims from site of incidence to the emergency department without mauling with adjuvant by first aid managers.

Material

Poor dressing techniques practiced for first aid in industrial, domestic, traffic, calamity, etc. inflicted wounds. Dressing with copious amounts of cotton on traumatized parts that are open or exposed. Wrong wrapping, storage, transport of amputated parts for attempt of salvage / reimplantation.

Methods

Assessment of increased rate in sepsis and rise in rate of risk of complications or loss of traumatized body part or even life in cases of trauma in which primary / incident manager with poor awareness / skills, shortage of first aid material.

Discussion

Need of training of general public on skills of first aid. Maintaining First Aid Kits for Emergencies as per stipulation and need based.

Observation

Improved results in management of trauma that were properly attended to from time of incidence to casualty.

Results

Improved ratio of post traumatic sequel like sepsis, delayed amputations, revisions, graft rejections, co morbidities, expenditure, etc.
(A28) A Matter of Degree: Teaching “Disaster” and “Emergencies” to Public Safety Executives
Authors: Carroll J.J.
Published: May 2011

What is the difference between a “disaster” and an “emergency”? One can safely say that for the victim of an event, it is always a disaster. But what about the first responders who are tasked with returning conditions to normal as quickly as possible? What about the executives who must direct the first responders, as well as coordinate resources? The difference is a “matter of degree” because it depends on the amount of resources that are required to respond to the incident. For example, an overturned gasoline tanker truck may only be an emergency for a major metropolitan area, but a disaster in a more rural region. American public safety is a mirror image of the government system of federalism that developed during the founding of the United States. Public safety entities are attached to the various local, state, and federal government agencies. There are almost 18,000 local law enforcement agencies across the US. Only 47 agencies have more than 1,000 sworn officers, while almost 90 percent have less than 50. There are more than 30,000 fire departments, yet only about one-quarter of all firefighters are full-time professionals. The rest are volunteers. The author, a 30-year law enforcement veteran, has developed a college-level course for public safety executives to help them understand the “matter of degree.” The intent of the course is to challenge executives to conduct a careful self-examination of their own public safety agencies to determine what they are capable of doing in an event. An executive only gets one chance to do it right, so being able to distinguish between a disaster and an emergency response will be critical to success. When the event occurs, a public safety executive will be better prepared to make key decisions.
(A30) Risking It All on Risk Assessment – Why Risk Assessment is broken in Disaster Medicine and How We Can Fix it
Authors: Arnold J.
Published: May 2011

Why did we predict Y2K, but not 911? Why did we predict dirty bombs for much of the past decade, but failed to predict the Asian Tsunami, Hurricane Katrina, and the Haiti Earthquake? Rational disaster preparedness depends on rational risk assessment – but does this really occur? This presentation will explore why risk assessment in disaster medicine is broken, including (1) type I and type II errors in risk assessment; (2) limitations of human neurophysiology; (3) cognitive biases in risk assessment; (4) impact of the media; (5) lack of harmonization of the language of risk; (6) deference to so-called risk experts; (7) risk innumeracy; (8) flaws in risk assessment matrices; (9) black swan events; and (10) managing risk based on extreme events. Concomitantly, this presentation will explore how we can fix risk assessment in disaster medicine, proffering practical solutions to each of these common yet surmountable barriers.
(A31) Integrating Health Volunteers into Community-Based Disaster Risk Reduction
Authors: Keim M.
Published: May 2011

Background

Disaster risk reduction (DRR) has emerged as a core element of sustainable development. (UN/ISDR 2002). Reducing risk requires long-term engagement (O'Brien 2006), and the actual work of DRR is largely a task for local communities. (Schipper 2006). DRR shares some tenets with preventive medicine (Sidel 1992). As in preventive medicine, risk reduction calls for a basic attitude shift in the minds of many who traditionally get sick first and seek treatment later. The challenge for DRR, as applied to health, is to broaden the focus of disaster management from that of tertiary prevention, (response and recovery) to also emphasize primary and secondary prevention, (prevention, preparedness and mitigation).

Discussion

The role of the health sector spans across the spectrum of DRR to include prevention, mitigation and preparedness activities. DRR, as applied to health, is intended to prevent and/or reduce the negative health consequences of disaster hazards. This is accomplished by two means: hazard avoidance and vulnerability reduction. Health and medical volunteers at the community level can play an important role in reducing human vulnerability to disasters by: (1) reducing susceptibility – “healthy people” (2) reducing exposure to disaster hazards – “healthy homes; (Srinivasan et al. 2003); and (3) increasing resilience – “healthy communities”. Volunteers help to reduce exposures to disaster hazards through participation in population protection measures such as shelter-in-place, evacuation and mass care. They work to reduce susceptibility by participating in health care, health promotion, and immunization programs. Finally, volunteers may build resilience by way of their participation in community-level preparedness, response and recovery efforts. (Keim 2008)
(A35) Building National and Community Resilience
Authors: Mcaslan A.
Published: May 2011

Each year a report is prepared for the World Economic Forum on global risks. It outlines the issues most likely to impact on society, and makes recommendations on actions required. The 2010 report concludes that global risks are becoming more volatile, uncertain, complex and ambiguous; and it comments on the increased number of high-impact, hard to predict ‘black swan’ events over the past decade. Indeed, recent disasters such as the Haiti earthquake which killed over 250,000 people, the eruption of Mount Eyjafjallajökull in Iceland, the rapid onset of the 2008/09 global financial crisis, and terrorist attacks around the world have all contributed to a heightened awareness of personal risk and vulnerability. In less than a decade the term resilience has evolved from the disciplines of materials science and environmental studies to become a concept used enthusiastically by policy makers, practitioners and academics. The concept is attractive as it suggests an ability of something or someone to cope in the face of adversity – to recover and return to normality after confronting an abnormal, alarming and often unexpected threat. It is used alongside security to understand how governments, local authorities, the emergency services and health agencies can best address the threats from natural disasters, health pandemics, malicious attacks on a country's critical infrastructure, and other major disruptive events. The paper discusses the meaning and utility of the concept of resilience. It traces the origins of the term through to its current use in addressing contemporary threats facing individuals, communities, organisations and nations. It identifies and describes a number of characteristics which are common to the concept of resilience in its many contexts and manifestations. In conclusion, the paper supports a review of the language and thinking of emergency and disaster management, and promotes the emerging concept of disaster resilience.
(A49) Disaster Content Varies in Australian Postgraduate Tertiary Emergency Nursing Courses: Implications for Educational Preparedness
Authors: Ranse J. , Arbon P. , Shaban R. , Considine J. , Mitchell B. , Lenson S.
Published: May 2011

Emergency nurses have key roles in responding to healthcare disasters. Emergency nurses often complete postgraduate qualifications in their area of specialty to equip them with a breadth and depth of knowledge to respond to the challenges and complexities of emergency nursing care. However, little is known about the disaster preparedness of emergency nurses in Australia. More specifically, the educational preparedness and training for disaster nursing roles is not well understood. This purpose of this study is to describe the disaster content of Australian postgraduate tertiary emergency nursing courses as a means of better understanding emergency nurses' educational preparedness for disaster. An exploratory, descriptive approach was used to survey postgraduate tertiary emergency nursing course convenors. Data were collected from course convenors by structured telephone interview. Questions included: (1) nursing background; (2) demographics and disaster experience of course convenors; (3) course type, duration and mode of delivery; and (4) the type and amount of disaster content. Currently, 12 universities in Australia offer postgraduate courses specific to Emergency Nursing, ranging from Graduate Certificates to Masters Degree level. Of these universities, 10 participated in this research project. This presentation will report on the demographics of course convenors, including their disaster education and experience. However, the focus of the presentation will be on the review of the course content. Seven courses had some disaster content, while three had none. The disaster content in these courses varied in both content and duration. Three had learning objectives, and one had an assessment item related to disasters. Five had recent modifications relating to disaster content; this was in response to real-world events, such as terrorism and communicable diseases. This research highlights that the disaster content in Australian postgraduate emergency nursing courses varies. This finding supports the need for national consistency and supporting framework for disaster content in post-graduate courses. The 2009 Ben Morley Scholarship, a financial award sponsored by the College of Emergency Nursing Australasia, supported this research.
(A65) Stress & Trauma Studies Program (STSP): Theoretical & Practical Emergency Mental Health Interventions Studies for BA Social Work Students
Authors: Farchi M.U.
Published: May 2011

The Tel Hai college Department of Social Work established this program as part of its community commitment to ensure that persons with skills in emergency mental health / trauma intervention will be available to the community as first responders when needed. The main goal of the STSP: Training Social work students As First Responders with Very High Professional Standards of Emergency as well as Long Term Mental Health Interventions Qualifications. This program enables the students to integrate between theory and hands-on basic and advanced skills in stress & trauma interventions – from the help to a single traumatized person to mass disasters involving more complex interventions. In addition, program underlines and empowers the students self efficacy and resilience. The studies are carried out in 4 main channels: A. Academic studies and advanced professional workshops. B. Outdoor drills with other help and rescue units: MDA (EMS), IDF, Police, Israel fire and rescue services, local and national rescue units) C. Volunteering in community trauma / first responder units D. Emergency mental health interventions during real time events (Last one: Emergency interventions among the evacuated families during the mount Carmel bushfire) Student's Skills Acquired During the STSP • Theoretical & practical knowledge of the stress & trauma development process. • Differentional diagnosis of the trauma stages (From ASR to C-PTSD). • Identifying all sources of resilience and coping strategies. • Basic & advanced crisis and disaster intervention methods. • Crisis & disaster management & command • Professional self confidence, Independency & Creativity, leadership and leading capabilities. The program, its benefits and latest drills and real time intervention will be discussed as well as demonstrated with videos.
(A66) Integration of Psycho-Social Social Support and Mental Health Services in to National Disaster Management Guidelines
Authors: Christy J.K.
Published: May 2011

Integration of Psycho-social Social Support and Mental Health Services in to National Disaster Management Guidelines India is vulnerable, in varying degrees, to a large number of natural as well as man-made disasters and also a high risk country for disasters due to expanding population, urbanization and industrialisation, development within high-risk zones, environmental degradation and climate changes. The creation of National Disaster Management Authority (NDMA) in 2005, as the apex body for disaster management, has brought out a paradigm shift in the area of disaster management. One of the important mandate of NDMA is to issue National Disaster Management Guidelines (NDMG) to the ministries/ departments to assist them to formulate their respective Disaster Management (DM) plans. In this direction NDMA has issued number of NDMG on different themes to provide basis of preparation of DM plans at different levels. There are policies & guidelines on Psycho-social Support and Mental Health Services (PSSMHS) in disasters at the international level in the form of Inter Agency Standing Committee guidelines (IASC) which advocates PSSMHS in disasters. In India there was no such policy which streamlines the Psycho-social Support and Mental Health Services in Disasters. During preparation of various National Disaster Management Guidelines, one remarkable factor noticed was the need for psycho-social care, subsequently preparation of NDMG on Medical Preparedness and Mass Causality Management brought out an overwhelming consensus to formulate a separate NDMG for PSSMHS. In order to translate the critical need for psycho-social care and support into guidelines, NDMA adopted a mission-mode approach for integrating PSSMHS in disaster response by involving participatory and multi step methodology to formulate NDMG on Psycho-social Support and Mental Health Services in Disasters.
(A69) Epidemiological Study of Trauma in Pregnancy: An Emergency Department-Based Study of a Level-1 Trauma Center
Authors: Sharma G. , Bhoi S. , Gautam P. , Adhikari G. , Sinha D.T. , Manral P. , Rodha M.
Published: May 2011

Background

Trauma during pregnancy poses a challenge in assessment and management due to its unique anatomical and physiological changes. Trauma is the leading non-obstetrical cause of death. There is paucity of epidemiological data in this subgroup in India. An emergency department (ED)-based epidemiological study was conducted.

Methods

Female trauma victims of reproductive age with both positive and negative urinary pregnancy tests (UPTs) were selected retrospectively. Documentation was done by the nursing staff from the ED case records. Mode, mechanism, severity, site of injury, and ED disposal time were noted, compiled, and analyzed.

Results

Of 64 patients, 32 patients were UPT-positive and 32 were UPT-negative. The mean age was 26 (range 18–36) years. A total of 75% of UPT-positive and 59.3% of UPT-negative cases had assault due to domestic violence. As per START triage protocol, 84.3% of UPT-positive and 59.3% patients in UPT negative were triaged as yellow. Blunt trauma to the abdomen was the most common mechanism and site of injury in all patients. FAST and ultrasonic evaluation of the fetus was performed for all UPT-positive patients. The average ED disposal time was 2 hours 62 minutes in UPT-positive and 1.9 hours in UPT-negative.

Conclusions

Limited data suggest domestic violence as leading cause of trauma in pregnancy. A large, epidemiological study is required to validate this.
(A72) Efficacy of Parental Opioid Analgesics versus Non-Opioid Analgesic in Acute Pain Management of Trauma Victims in the Emergency Department
Authors: Adhikari G. , Bhoi S. , Gautam P. , Sinha T.P. , Rodha M. , Kurrey L. , Bhasin A.
Published: May 2011

Background

The pyramid of pain management involves sequential drug escalation but its role is limited in an emergency department (ED). The efficacy of parental opioid analgesics versus non-opioid analgesic in acute pain management of trauma victims in the ED was evaluated to formulate protocol.

Methods

All alert patients with a baseline visual analogue scale score (≥ 7) was randomly assigned either parental non-opioid (Group A) or opioid analgesics (Group B). The emergency care providers noted the VAS in either group at 15 minutes, 30 minutes, and 60 minutes, and at the time of discharge from the ED. If the patient's VAS score did not reduce by 50% at 30 minutes, repeat parental analgesics was given. The oral analgesics prescribed at the time of discharge were documented. Ethical clearance was taken. Data was compiled and analyzed.

Results

Of 106 patients, 99 were analyzed. The mean age in Group A was 33.2 ± 13.2 years and 32.5 ± 18 years in Group B. The male:female ratio in Group A was 1.5:1 and 7:1 in Group B. The average baseline VAS score in Group A was 7.5, and that of Group B was 8.96. The average VAS at 15, 30, and 60 minutes and at discharge in Group A was 5.4, 5.34, 4.3, and 3.5 and it was 6.1, 6, 5.1, and 4.4. Repeat parental dose of analgesics were required in 95/99 (95%) patients in Group A and 5% that of Group B. The most common prescription at discharge from ED was non-opioid analgesics.

Conclusions

Acute pain relief was comparable in both groups. Non-opioid analgesics may be preferred over opioid in VAS score ± 7 in a busy emergency department for early disposition.
(A74) Reducing the Potential for Tourniquet Associated Reperfusion Injury
Authors: Van Der Velde J. , Iohom G. , Serfontein L.
Published: May 2011

Background

Tourniquets have reappeared in the management of massive hemorrhage and as a tool to ameliorate the effects of reperfusion injury from limb entrapment or suspension trauma, while the patient is rescued to a safer environment. Strategies to minimize subsequent reperfusion injury were investigated in this prospective, randomized study.

Methods

In the safety of an operating theater, sixteen fit and healthy patients scheduled for repair of bimalleolar ankle fractures were randomized into two groups. In the standard release group (R, n1 = 6), the tourniquet was fully deflated at the end of surgery. In the staggered release group (SR, n2 = 10), the tourniquet was fully deflated for 30 seconds and subsequently re-inflated to 300mmHg. The procedure was repeated twice at three-minute intervals prior to full removal. Hemodynamic and blood biochemistry measurements were obtained from an indwelling arterial catheter immediately prior to initial tourniquet deflation and thereafter at 1, 4, 7 and 15 minutes.

Results

Serum Ca2 + concentrations were less in group R at 4 (1.027 ± 0.5 vs. 1.084 ± 0.07mmol/l, p = 0.046) and 7 minutes (1.045 ± 0.04 vs. 1.110 + /- 0.06mmol/l, p = 0.013). Serum lactate concentration was greater in group R compared to group SR at 1 (1.75 ± 0.19 vs. 1.33 ± 0.31mmol/l, p = 0.005) and 4 minutes (1.98 ± 0.23 vs. 1.48 ± 0.39mmol/l, p = 0.007), respectively. End-tidal CO2 was less in group SR compared to group R at 1 (4.82 ± 0.45 vs. 5.68 ± 0.26kPa, p = 0.0004) and 4 minutes (5.01 ± 0.59 vs. 5.68 ± 0.35kPa, p = 0.01), respectively. At 15 minutes, less hypotension and bradycardia was noted in group SR.

Conclusions

A staggered tourniquet release was associated with greater hemodynamic stability and reduced the rate of acute systemic metabolic changes associated with limb reperfusion. Re-application of a tourniquet seemed to halt further reperfusion, providing a window period for patient evaluation and management.
(A77) Should Response Times continue to be used for Performance Measurement and Targets?
Authors: Turner J.
Published: May 2011

Purpose

Response time performance for emergency calls has been used as an indicator of ambulance service quality in England since 1974. It was revised in 1996 with targets set of eight minutes for life-threatening (category A) and 19 minutes for urgent (category B) calls. Internationally, response time has been used as the benchmark for emergency medical services (EMS) performance. The evidence to support use of response times as a quality measure has been examined.

Methods

A rapid review was used to assess the evidence base for the eight minute response time target. Also, a descriptive observational study of the clinical characteristics of category B calls was performed using two months patient report form data from one English ambulance service.

Results

Five papers were identified that have examined the relationship between response time and mortality for 911/999 emergency call populations. Four papers were from the USA, and in all cases no survival benefit was found for response times > 5 minutes even after adjustment for variables including age, sex and illness severity. This finding was replicated in one UK study. The descriptive study examined call characteristics for 26,882 category B calls. Half of the patients received no intervention other than basic vital signs measurement and 75% had assessment only. Twenty-five percent required some clinical intervention with the majority only requiring oxygen. Less than 5% received significant intervention such as drugs, intravenous cannula, or airway management.

Conclusions

With the exception of cardiac arrest there is consistent evidence that response time has no impact on mortality for EMS calls. Alternative indicators of quality of care should be developed that allow less focus on time targets and more effort on innovation and development of services which could better meet the needs of the majority of patients who do not have a life-threatening problem.
(A81) Curing Overcrowding and Boosting Patient Flow in a High Volume, Low Capacity Emergency Department
Authors: Arnold J. , Ferguson I.G. , Montefusco A. , Nguyen C.
Published: May 2011

Background

Overcrowding afflicts emergency departments (ED) worldwide. The CDC has reported that EDs in the metropolitan US provide 1 bed per 1800 patient visits per year on average.

Objective

We sought to improve patient flow in our 24-bed ED at Santa Clara Valley Medical Center, a large tertiary public hospital in San Jose, California.

Methods

We applied a bundle of interventions based on Lean principles aimed at improving overcrowding in our department step-wise from October 2006 to December 2010, ranging from rapid medical evaluation to physician on arrival. We measured patient volume, left without being seen (LWBS) rates, time to provider (minutes), and time to discharge (minutes) as monthly averages. We secondarily measured CMS core measure performance for pneumonia and STEMI care and patient satisfaction scores.

Results

Our emergency patient volume doubled from an average of 192 to 412 per day (peak). Our LWBS rate decreased from 16.0 to 1.4%. Our time to provider decreased from 86 to 32 minutes. Our time to discharge decreased from 210 to 145 minutes. Core measure performance improved to 100% for all five ED-related metrics. The percentage of patients who ranked their care as excellent increased from 30% to 45%.

Conclusion

The bundle of interventions based on Lean principles applied in our ED appears to have enabled us to significantly improve multiple operational outcomes, despite a doubling of our patient volume in our low capacity ED. Posting a physician on arrival, as the first healthcare worker that a patient meets when they enter the ED, may have had the greatest impact on operational performance.
(A85) Analysis of Health Risk Perception and Behavior Changes during Elevated Temperatures for an Urban Chinese Population
Authors: Chan E.Y.Y. , Kim J.H. , Lee P.P.Y. , Lin C.L.Y.
Published: May 2011

Background

Limited research has been conducted to understand the relationship between heat wave warnings with public awareness and behavioral changes in the Asian population. The Hong Kong Observatory introduced the “very hot weather warning” in 2000 to alert the public of heatstroke and sunburn in Hong Kong. However, the population's behavioral responses to these weather alerts is unclear. Moreover, the relationship between perceived health risks and behavioral changes has not been examined. The goal of this study is to examine the health risk perceptions and behavioral changes following public heat wave warnings in Hong Kong.

Methods

A cross-sectional, population-based, telephone survey, using the last-birthday method was conducted within two weeks following a heat wave warning in 2009. A heat warning and a health study instrument, based on Intergovernmental Panel on Climate Change (IPCC) guidelines and related literature was developed and validated. Descriptive and multivariate logistic regression analyses were conducted.

Results

The questionnaire was completed by 1,123 individuals whose socio-demographic characteristics were comparable to 2009 Hong Kong population census data. Of respondents, 83.6% were aware of the heat wave weather warning. Multivariate logistic regression of socio-demographic factors indicated that being female, those in middle age groups, and those with higher educational attainment was significantly associated with heat wave warning awareness. Among those aware of the public warning, the majority were unconcerned about potential adverse health effects, < 40% were aware of the community heat-related preparedness plans, and < 50% changed their behavior to mitigate the potential adverse health impacts of hot weather.

Conclusion

This is the first study to examine climate change and health behavioral responses in an urban Chinese population. Future research direction should further investigate correlations between awareness and health protective actions, as well as the drivers for health behavioral changes that mitigate the impact of climate change.
(A86) Emergency Department Patient Presentations during the 2009 Heatwave in Adelaide
Authors: Mayner L. , Arbon P.
Published: May 2011

Background

Recordings of heatwaves date back to the early 1900s and usually are associated with high mortality. In Australia, heatwaves have been the major cause of natural hazard-related deaths. Heatwaves usually do not carry the global media coverage associated with other disasters, and frequently, are referred to as silent disasters. The main impact of heatwaves is on health and human life.

Objectives

Preliminary results are presented for the 2009 heatwave, investigating the emergency department patient presentations from three public hospitals in Adelaide, a city in the central southern area of Australia.

Methods

Demographic and syndromic data were obtained from emergency department records. Ethics permission was obtained prior to data collection. Heatwave conditions occurred from 26 January–07 February 2009. Two non-heatwave periods were day-matched approximately two weeks before and after the heatwave. Data were analyzed by age groups, gender, and ICD codes for chronic conditions.

Results

The two largest groups of people presenting were between 15 and 64 years of age and > 75 years of age during the heatwave and non-heatwave periods. During the heatwave period, both groups had significant increases in patient presentation related to renal problems (ICD 10: N000-N3999) and dehydration and hyperthermia (ICD10: E86, T67). The latter syndrome was far more accentuated during the heatwave, with emergency department patient presentations rising from 2 (non heatwave) to 62 presentations for the 15 and 64 years cohort and from 4 (non heatwave) to 91 for the > 75 years cohort. Cardiovascular- and respiratory-related presentations showed slight increases during the heatwave, while mental health had high presentations for the 15–64 year cohort throughout heatwave and non heatwave periods.

Conclusions

Both young and older people were affected by heatwave, and precautionary warning should be used throughout the community to alert people of the dangers underlying extreme heat conditions.
(A89) The Greenhouse Effect in Nigeria
Authors: Sanya D.I.
Published: May 2011

The atmosphere contains gases that act like the glass in a greenhouse. They are transparent to visible light from the sun, and allow it to pass through to the earth below; but they absorb and trap infrared light radiated outward from the earth and convert it into heat. The principal “greenhouse gases” are chloroflourocarbons (CFCs), methane, and most importantly, carbon dioxide. The concentration of greenhouse gases is rising due to two factors: (1) the manufacturing of CFCs; and (2) the burning of fossil fuel at a tremendous, and still increasing rate. If this trend is not reversed, research predicts that there will be a steady rise in the temperature of the earth. This global warming could cause drastic climatic changes with devastating results, including: (1) shifting of seasonal winds, with the creation and spreading of deserts in the northern areas; (2) alteration in crop patterns with social upheaval; (3) starvation; and (4) the inundation of large areas of land. When this chaos begins, developing countries such as Nigeria, Kenya, etc. also will be affected, along with developed countries. The solution to the problem of CFCs in principle, though not in practice is simple: STOP MAKING THEM!! But one cannot burn carbon without producing carbon dioxide. Which is why new ways to produce energy must be used?
(A94) Information for Action? Analysis of Needs Assessment Reports Available on the Internet Following the 2010 Haiti Earthquake
Authors: Wefer A. , Von Schreeb J.
Published: May 2011

On 12 January 2010, a powerful earthquake struck Port-au-Prince, Haiti. To help ensure outside assistance, information that describes and quantifies the severity of the disaster is needed urgently. Several studies have suggested that needs assessments are seldom performed, and that initial media images direct relief interventions rather than needs. This study sought to assess the extent of information on the situation that was available rapidly after the earthquake. The aim was to document and analyze information on severity and needs available on the Internet during the first week after the Haiti earthquake, and to compare the results with official severity data. Reliefweb is the most used information-sharing Internet portal following humanitarian disasters. All documents related to the Haiti earthquake published on Reliefweb during the first seven days after the earthquake were selected. Indicators that described the severity of the earthquake were searched for, including the number of affected and dead and the assumed needs of the population. Results were compiled and cross tabulated for frequency and compared with official outcome data. A total of 822 reports were posted. An estimate on the number of dead was available in 10% of the reports, ranging from 40,000 to 100,000. The most commonly reported number of affected was three million. The estimated numbers of dead and affected were similar to the official data. Not one posting described the method used for the estimates they provided. These results indicate that the severity of the earthquake was relatively well documented after four days. However, a striking finding was the lack of description of how the data had been collected. It remains difficult to determine the reliability of needs estimates, as they were done and posted by the relief organizations themselves. No independent attempt to estimate the needs was found.
(A80) Second Thoughts about the Health System and Dilemmas in Wide Disasters, Using Haiti as a Case Study
Authors: Peleg K.
Published: May 2011

In the Indonesian earthquake a total 21 USAR teams comprising upward of 688 rescue personnel and 67 dogs. The cost of which was estimated at tens of millions of dollars did not succeed in extricating any trappers. In Haiti, there were around 350000 casualties and 250000 dead. In this disaster 43 international USAR missions comprising over 1700 rescuers were deployed. These teams succeeded in rescuing approximately 134 trapped people, an average of about 3 trapped people per mission. During this period one field hospital treated a total of 1,111 people, 737 of these patients were hospitalized, 243 surgical procedures were carried out, of which at least 200 were life-saving procedures. In addition many other life-saving procedures that were not directly related to the injuries inflicted as a result of the earthquake were also carried out. Without the resources of the field hospital it is very possible that most of the trappers would not have survived. It mean; One field hospital (personal: 120 people) was able to save more people than 43 USAR teams, all of the highly dedicated and professional, who worked day and night to extricate people trapped.ngs. It seems that there is no need to carry out a complex economic analysis in order to determine the cost benefits and understand the significance of providing field hospitals and clinics as soon as possible after the occurrence of a disaster stemming from an earthquake. A consensus/brainstorming conference is needed.

The aim

To formulate a logical and balanced approach to configuring and dispatching rescue and medical missions. The major goal of the conference would be to establish the guidelines for rescue missions that will result in the rescue of the maximum number of people, and to provide guidelines for the provision humanitarian aid in parallel to the rescue missions.
(A99) Remote Access and Extrication, the Haiti Experience
Authors: Paladino L. , Lucchesi M.
Published: May 2011

Introduction

The January 12 2010 7.0 magnitude earthquake's epicenter hit just 10 miles west of Port-au-Prince and its 2 million inhabitants at 4:53 pm. Estimates of dead 222,517 at the time of writing, with thousands missing and hundreds of thousands living in tent cities. Haiti is the poorest country in the Western Hemisphere with approximately 80% of the population living under the poverty line. There is a lack of seismic risk perception and planning at the national level. As a result in many areas there are no, or poorly followed, road, highway or bridge building codes.

Need

Although assistance arrived to major ports and cities from all corners of the globe, access from rural and remote areas to centralized hospitals remained difficult. Our group, a mobile medical team able to negotiate difficult terrain by foot with vehicle support in close proximity, deployed to these remote areas. EMS systems were poor in rural areas prior to the earthquake and now are nonexistent, in areas where no access to phones or even addresses (tent cities) to respond to. We found many injured without access to transportation even a month after the earthquake. No family or friends had access to vehicles to transport them. Many knew help was available, but did not know where or how to access. They waited in situ for help not knowing if it was coming. Limb threatening injuries were left to get necrotic and infected, no doubt adding to the morbidity and mortality. Our groups identified patients requiring transport and arranged for drivers, many times using paid locals from cities.

Call for future action

Implementation of a disaster plan for International NGOs to provide organized EMS transport for remote victims without access. Coordination with local community leaders and OCHA to identify areas in need of this service.
(A102) Training Agricultural Emergency Responders
Authors: Cowen P.L.
Published: May 2011

Training Agricultural Emergency Responders by Paula L. Cowen, D.V.M., Director, Professional Development Staff, Veterinary Services, Animal Plant Health Inspection Service, United States Department of Agriculture

Background Emergency Response is a critical component of our Animal Agriculture infrastructure. The ability to deploy trained personnel to handle any kind of emergency is key to quickly containing any disaster and mitigating the effects. This training is provided by a number of federal agencies, universities as well as at the state and local level. Body Several training strategies are employed by a number of different entities. Training is available on-line, in the classroom, with wet labs using live animals, through exercises and case studies. An overview of training and education of Agricultural Emergency Response personnel across the United States will be covered with a more in depth look at the training provided by the Animal Plant Health Inspection Service.

Conclusion

The Professional Development Staff provides technical training in disease identification and control, emergency response, import/export, and other topics as needed. Protecting and promoting American Animal Agriculture is our core mission. Veterinary Services provides leadership at the intersection of Animal and Public Health concerns.
(A103) Understanding Terror Medicine
Authors: Cole L.
Published: May 2011

The term terror medicine emerged early in the 21st century to describe medical issues associated with terrorist events. While related to emergency and disaster medicine, the field also includes several features that are specific to terrorist attacks. The Israeli healthcare experience as related to terrorist attacks during the intifada (2000–2006), provides a base for comparison to responses elsewhere including to events in Oklahoma City (1995), Madrid (2004), and London (2005). Terror medicine covers four broad areas. First is preparedness, which encompasses hospital surge capacity, training and exercises, and the stockpiling of medical provisions for conventional and non-conventional attacks. Second is incident management, which includes protocols for on-site care, triage, distribution of victims to hospitals, and hospital-receiving procedures. Third is mechanism of injuries and responses, which ranges from determining treatment priorities in someone with multiple injuries (burn, crush, ruptured organs, etc.) to dealing with biological, chemical, or radiological exposures. Fourth, psychological consequences, involves care for acute and long-term emotional effects of a terrorist attack. Growing interest in terror medicine has been manifested in recent publications and conferences. (Egs., SC Shapira and LA Cole, Terror Medicine: Birth of a Discipline, J Homeland Security and Emerg Management, Vol. 3, No. 2 [2006] http://www.terrormedicine.com/publications_files/Terrormedicine.pdfAC; SC Shapira, JS Hammond, LA Cole, eds., Essentials of Terror Medicine, NY: Springer [2009]; Symposiums on Terror Medicine and Security, University of Medicine and Dentistry of New Jersey [Newark, NJ, July 2009; Montclair, NJ, Sept. 2010]). Efforts to prevent terrorist attacks should be among a society's highest priorities. No less important are the requirements to prepare for, respond to, and recover from these events. The more that individuals and institutions become familiar with the essentials of terror medicine, the greater the protection they can provide to others.
(A105) A Core Curriculum for Nurses in Disaster Preparedness and Response
Authors: Chang L. , Briggs S.M.
Published: May 2011

Background

Nurses play an essential role in disaster response. All health care responders, including nurses, must have knowledge of the key principles of disaster medicine. The International Trauma and Disaster Institute (ITDI) at Massachusetts General Hospital has developed a core curriculum for Mass Casualty Incident (MCI) management. The curriculum provides all members of the multidisciplinary disaster team with the fundamentals of the MCI response. The proposed concurrent session will report on understanding of the fundamental knowledge in disaster medicine and preparedness for nurses in local and international disaster responses.

Discussion and Observations

Disasters follow no rules. Traditionally, medical providers have held the erroneous belief that all disasters are different, especially those involving terrorism. In reality, all disasters, regardless of etiology, have similar medical and public health consequences. A consistent medical approach to disasters, based on an understanding of their common features and the response they require, is becoming the accepted practice throughout the world. This strategy, called the MCI response, has the primary objective of reducing the mortality/morbidity caused by the disaster. The Advanced Disaster Medical Response (ADMR) Course, available in eight languages, including Chinese, is designed to train nurses in the ABC's of basic medical and public health disaster care. The delivery of optimal care in a disaster relies on a common understanding of each health professional's role and common mastery of defined essentials of disaster response such as the Incident Command System, field triage, decontamination, care of specific injuries, environmental considerations, psychological response to disasters, and care of the dead and their families. Understanding key principles and training in medical disaster response will guide nurses in disaster preparedness and response to future disasters.
(A106) Nursing Simulation in Disaster Management
Authors: Moore D. , Atchison K. , Boone J.
Published: May 2011

In the United States in 2010, there were 81 federal disasters, for this reason and at the request of our clinical partners, when West Coast University (WCU) started its Baccalaureate of Science in Nursing (BSN) program in 2008, it recognized the need to have a course in disaster management. The Disaster Management course was developed in concert with other parts of the curriculum such as Leadership, Physical Assessment, Critical Care courses to help students focus their assessment and intervention skills to prepare them to be future responders. As a component of the skill development, simulation exercises were developed in the simulation center within the college of nursing. To prepare students to respond to disasters, a variety of scenarios were developed to meet national patient safety goals and various types of disaster and emergency situations. In the scenarios students learn how to work as a team, follow the chain of command, assess and rapidly intervene to such medical crisis such as hemorrhaging, trauma, burns, cardiac arrest and respiratory arrest. They also learn how to delegate to the appropriate personnel as well as leadership skills. Students find this educational and reassuring to be able to practice these very high level sentinel events in a secure environment where they will get immediate feedback not only from instructors but from their peers. Preliminary research have identified students having significant improvement in their clinical skills from the first to the third exercise in regards to assessment, intervention, communication, and delegation. We have received feedback from our clinical partners that our students are better prepared than their current emergency staff in regards to disaster management and to that end we plan to work with our clinical partners to translate our class into an online course so their staff can be trained on disaster management.