bluuebunny/crossref_metadata_2025 huggingface dataset:
(A257) Enhancing Human Resources for Health in Crisis: Experience from the War-Affected Districts of Sri Lanka
Authors: Wickramage K. , Ranasinghe T. , Zwi A.
Published: May 2011

Aims

This paper examines the coordination framework and interventions undertaken by the Sri Lankan health sector in providing essential health services to the displaced communities in the aftermath of the violent conflict in 2009. The narrative describes, in a chronological format, the strategies and actions undertaken by the health sector in response to a rapidly changing humanitarian crisis. The paper examines some of the key challenges faced by the health sector in the post-conflict recovery phases, the most pertinent being the human resources for health needs.

Methods

A review of Ministry of Health departmental meeting minutes/circulars, inter-agency health coordination meeting reports, weekly surveillance reports, inter-agency/agency assessments, media files, and donor and health cluster member reports were compiled and then analyzed in order to construct a narrative on how the Health Sector responded to the humanitarian crisis (from acute emergency phase to the post-conflict recovery and resettlement phase). The authors also were integrally involved in the planning, development, implementation, and monitoring of a spectrum of health sector interventions during the humanitarian crisis from within Government and the United Nations system.

Recommendations

A health systems strengthening approach, which places emphasis on human resources for health, can be effective in delivering high impact, sustained, high quality health care even in difficult and complex humanitarian emergencies such as civil war. The Sri Lankan experience has shown that harnessing effective human resource management stratergies in crisis also is vital for the post-conflict health system recovery phase that follows.The excuse that “the system may be too overwhelmed”; or health departments “too overstretched” to lead a coordinated effort can be mitigated with positive leadership and planning. The dividends of working in such an approach also ushers reconcilliation via a unified health workforce and promoting the idea of health as a bridge for peace.
(A260) Triage Decision-Making in Intoxication
Authors: Mirhaghi A. , Mohammadi G.R. , Asghari M.
Published: May 2011

Background and Aims

Decision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.

Methods

Critical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.

Results

General physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.

Discussion

Resources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
(A261) Evolution of Triage Services in the Emergency Department Aga Khan University Hospital- Karachi
Authors: Khursheed M. , Ejaz K. , Hanif F.
Published: May 2011

The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.
(A266) Huma Disaster Relief Medical Mission for Flood-Affected Victims in the Islamic Republic of Pakistan
Authors: Ninomiya N. , Lin H. , Ogura K. , Suzuki K. , Maekawa S. , Kuno M. , Sugamura Y. , Ukai T.
Published: May 2011

A Flood disaster struck the Islamic Republic of Pakistan in July 2010. It affected 3 million people and caused 1,400 deaths. Humanitarian Medical Assistance (HuMA) is a non-profit organization in Japan. The organization dispatched three personnel to Islamabad on 20 August in order to conduct an initial needs assessment. They discovered that medical assistance and supplies could not reach all of the victims, especially in the North. Their visits to the surrounding regions highlighted the Nowshera district of KPK province, which had not received enough assistance from the government or aid organizations despite the fact that there were thousands of Internally Displaced Persons (IDPs) with health issues such as diarrhea, eye and skin disease, and upper respiratory tract infection (URTI). On 03 September, the HuMA Disaster Relief Mission began with the purpose of providing medical treatment and promoting public health for the flood victims in the Nowshera District. Eleven medical providers and coordinators from HuMA operated field mobile clinics in the district in collaboration with a local counterpart non-governmental organization, Nippa Welfare Association (NWA). This project was supported financially by the grant funding from Japan Platform. Humanitarian Medical Assistance served seven sites in Nowshera Districts as mobile field clinics, and consulted 2,216 patients. Total distribution of disease was: (1) URTI = 18.1%; (2) skin disease = 17.9%; (3) musculoskeletal = 15.2%; and (4) others = 19.7%. The team considered continuous medical consultation in the Nowshera District after 2010. The HuMa medical activities ended at the end of September, and the organization donated multi-vitamin tablets, syrups, FE tablets, and anti-biotic cream in order to assist NWA's continuing assistance for the affected communities. The medical providers also left lists of medicines for local doctors and medical staff. Humanitarian Medical Assistance also provided basic supplies needed to prevent victims from experiencing further sanitation problems.
(A270) Medical Reserve Corps, American Red Cross, and a University: Lessons Learned from their Partnership during the Ice Storm
Authors: Persell D.J.
Published: May 2011

The winter of 2009 brought the worst disaster caused by a natural hazard in the history of the state of Arkansas. An ice storm spanned the entire northern half of the state, leaving thousands without electricity, heat, transportation, health care, and in some cases, shelter, food, and water. In one county alone, > 13,000 power poles were destroyed. The infrastructure was severely damaged. In the University's arena, a shelter was opened by the Red Cross in partnership with the Medical Reserve Corps (MRC) to accept special needs victims and provide urgent primary care for shelter residents. The majority of patients presenting to the MRC had more than two illnesses. Examples included diabetes, renal disease requiring dialysis, hypertensive crisis, injuries from the storm, MRSA, respiratory syncytial virus, and mental illness ranging from depression to schizophrenia. Because the Red Cross did not consider ice storms as a reasonable cause for medication/medication supplies, these items were not replaced; this had health consequences of under-managed illness. Oxygen converters were preferred over oxygen tanks; however, the arena was on a generator and not all plug-ins had electricity. An ambulance company loaned the MRC a glucometer so blood glucose levels could be monitored. Those with mental illness required significant time from MRC providers. Largely, the MRC was nurse-managed with physicians or nurse practitioners available for sick call twice a day. Relationships became strained when the state placed a hold on the arena to secure it for a regional shelter. This put the university's financial stability in peril due to breech of contract with vendors scheduled to use the arena. The partnership between these three organizations does remain intact with formal memorandums of agreement now existing. They continue to work together in the community and jointly respond to regional disasters.
(A271) Building Resilient Healthcare Systems during Natural Disasters — Impacts of the 2007 Tulsa, Oklahoma Ice Storm
Authors: Gulden J. , Pond B. , Stewart M.K. , Stewart C.E.
Published: May 2011

On the evening of 07 December 2007, an ice storm occurred in the south central United States, causing severe power outages in Tulsa, Oklahoma, and leaving > 900,000 people without power for up to three weeks. Eighteen states contributed power workers to restore functioning power over a three-week period. Cleanup of debris from fallen trees took an additional five months. Hospitals and other healthcare facilities are considered to be critical infrastructure facilities in the community. During this storm, five of the six tertiary care hospitals lost power. In these hospitals, the internal telephone systems failed, internal suctioning systems failed, and the internal oxygen system failed. Water treatment plants were without power for 48 hours. Nursing home patients were discharged to homes or transferred to hospitals, as nursing homes tried to function without power for heating, patient monitoring devices, or cooking. Communication for these outlying care facilities was disrupted by the storm damage. Hospital emergency departments that had power became havens as they had heat, communication, water, and even warm food. Multiple patients with injuries due to cleaning up tree debris, falls, and carbon monoxide poisoning from ill-advised efforts to heat dwellings were seen in these emergency departments. Ambulance services had fuel shortages early in the course of the ice storm due to the inability to pump fuel (electrically operated pumps initially were non-functional). Three standards of care were altered for prehospital responders. This paper explains the efforts taken to mitigate future calamities, based on the lessons learned from this event.
(A272) Socioeconomic Impact of “Hurricane Karl” on Health Facilities in Veracruz, Mexico with a Population of 7 Million 600 Thousand in September 2010
Authors: Cruz Flores P.
Published: May 2011

Socioeconomic impact of “Hurricane Karl” on health facilities in Veracruz, Mexico with a population of 7 million 600 thousand in September 2010 Summary Hurricane Karl, thirteenth tropical cyclone of the season in the Atlantic hurricane of 2010, originated in the Caribbean Sea and slammed into the Yucatan Peninsula as a strong tropical storm, to emerge into the Gulf of Mexico where it gradually reorganized to achieve Category 3 (major hurricane) on the Saffir-Simpson scale and hit the east coast of Mexico on September 17th of 2010. Preparations On September 16th, the Federal Government, Federal Electricity Commission, Laguna Verde Nuclear Power Plants, The Ministry of National Defense, The Ministry of Marine Affairs and human elements and materials deployed for relief to the population. The health sector also was prepared to take appropriate measures under the concept of Safe Hospital PAHO / WHO. Impact In the state of Veracruz (more than 7 million 600 thousand habitants), Hurricane Karl arrived around 11:30 am on September 17th to 15 km north of the port of Veracruz reaching a capacity of 195 km per hour. Torrential rains flooded the streets of the phenomenon and avenues of the historic center of the port, the water reached 40 centimeters to 1 meter in height, to the south of the state and surrounding areas reached 2 meters in height. Caused serious damage since its inception in health infrastructure, such as suspension of public services, damage to the distribution system of drinking water, broken windows and flooding of a hospital as well as several units of Family Medicine.
(A284) Improving Hospital Mass Casualty Preparedness through Ongoing Readiness Evaluation
Authors: Adini B. , Laor D. , Hornik-Luria T. , Goldberg A. , Schwartz D. , Aharonson-Daniel L.
Published: May 2011

Background

Israeli Hospitals are required to maintain a high level of emergency preparedness.

Objectives

To investigate the effect of on-going use of an evaluation tool on acute-care hospitals' emergency preparedness for mass casualty events (MCE).

Methods

Evaluation of emergency preparedness for MCE was carried out in all acute-care hospitals, based on an evaluation tool consisting of 306 objective and measurable parameters. Two cycles of evaluations were conducted in 2005 to 2009 and the scores were calculated to detect differences.

Results

A significant increase was found in the mean total scores of emergency preparedness between the two cycles of evaluations (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training and equipment, but the change was significant only in the training category. The relative increase was highest in hospitals that did not experience real MCE.

Discussion

This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated measurable benchmarks. An ongoing assessment of the level of emergency preparedness motivates hospitals' management and staff to improve their capabilities and thus results in a more effective response mechanism for emergency scenarios.

Conclusions

Utilization of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the evaluated areas. The expectation is that these benchmarks will allow for a better response to actual MCEs. The study further demonstrated that even hospitals without “real-life” experience can gear up using preset benchmarks and reach a high standard of mass casualty event preparedness.
(A286) Safe Hospital Program and Safe Medical Unit in Mexico
Authors: Cruz Vega F. , Cruz Flores P.
Published: May 2011

Safe Hospital Program and Safe Medical Unit in Mexico. The program was established in 2006 within the General Coordination of Civil Protection of the Department of Government and includes a National Evaluation, Diagnosis and Certification integrated of all the institutions of the Public Health Sector, Private and Social. They have about 700 accredited assessors more than 2,700 who have taken the training. There have been more than 1,700 self-assessments and have been assessed in 205 hospitals. The legal framework has been integrated the Safe Hospital Program in the Civil Protection General Law, is included in the Official Mexican Standard that relates to health facilities, has gained access to the Disaster Prevention Fund that manages the Interior Secretary and has established that prior to the Certification of Quality Health Council General (including international standards of the Joint Commission) is evaluated as Safe Hospital. Of the hospitals classified as unsafe have been evacuated two (which will be demolished) with alternative of building new high level of security. In a large number of hospitals have improved fire detection systems, evacuation routes and emergency stairs, as others.
(A288) World Health Organization Regional Office for Europe All-Hazard Hospital Emergency Preparedness Checklist
Authors: Sorensen B. , Bayer C.P. , Zane R. , Wante B. , Rockenschaub G.
Published: May 2011

Objectives

Hospitals play a critical role in communities to provide essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the health care system at large. The World Health Organization (WHO) Regional Office for Europe All-Hazard Hospital Emergency Preparedness Checklist aims to assist hospital administrators and disaster managers in preparing health facilities to respond effectively to the most likely disaster scenarios.

Methods

A checklist tool was developed that comprises current hospital-based emergency management principles and techniques, and integrates applications specific to hospital preparedness needs in the WHO European Region.

Results

A list of recommended actions within critical service categories is provided in a step-wise, all-hazard form for rapid implementation by hospital administrators and disaster managers in response to the most likely types of disaster.

Conclusions

The principles and recommendations provided in this tool may be used by hospitals at any level of emergency preparedness. The checklist is not intended to replace standards and protocols already defined in hospital emergency management plans. Rather, it provides recommendations to enhance existing plans in concert with national guidelines.
(A290) Coordinated Hospital Disaster Response: A Detailed Assessment of Leadership
Authors: Downey E. , Andress K.
Published: May 2011

Introduction

The Hospital Preparedness Program, prompted by the 9/11 terrorist attacks, emphasizes the value of developing coordinated response capabilities by community leaders. Immediately following Hurricanes Katrina and Rita, this study examined the hospital emergency preparedness coordinators' leadership style and applied leadership theory to Louisiana planners as an integral part of a complex National Response Framework. This regionally coordinated system remains in place today and has been tested a minimum of 15 times in hurricane activations and state-wide exercises and drills.

Methods

Three hospital groups participated: (1) regional coordinators representing nine geographic areas; (2) coordinators at acute care facilities; and (3) coordinators at non-acute care facilities. A total of 744 study participants represented over 150 hospitals. The Multifactor Leadership Questionnaire (Bass, 1995) assessed three dimensions of leadership style and the Emergency Preparedness Indicator assessed planning priorities, performance ratings, demographic variables of gender, education, and Healthcare Performance Partners (HPP) planning experience and disaster declarations.

Results

Transformational leadership was highest among all three groups and included characteristic of: idealized influence, idealized behaviors, inspirational motivation, intellectual stimulation, and individual consideration. Transactional leadership was highest (but still lower than transformational) among the non-acute care group and included characteristics of: contingent reward and management by exception (both active and passive). Gender and education were not significant predictors of leadership style but positive associations of time spent on emergency preparedness activities were found.

Conclusions

Previous studies reported the relationship of transformational leadership style to cohesion scores of 2.1. This study expands those results by further detailing leadership styles to the hospital emergency preparedness coordinator. It builds on a standardized approach to assess coordinator leadership style and effectiveness measures.
(A292) Disaster Assessment and Gathering Medical Intelligence Following a Major Public Health or Complex Humanitarian Emergency
Authors: Reilly M.
Published: May 2011

Introduction

Immediately following a major public health emergency or complex humanitarian emergency such as the South East Asian Tsunami in 2004, the Haitian Earthquake in 2010 or Hurricane Katrina in 2005, there is a critical need to rapidly and as accurately as possible gather information not limited to morbidity and mortality, but necessary to assess the stability and existence of a public health or medical infrastructure, logistic supply chain, condition of food, water and shelter for victims and rescue workers, and particularly the security and stability of the region following the incident. With this information, only then can an effective humanitarian response be planned and executed that meets the actual versus perceived needs of an affected population.

Methods

Specific disaster risk assessment and medical intelligence techniques will be presented that are currently used by a variety of relief organizations. Specific topics of discussion include: Disaster epidemiology; Indicators of health in populations; Systems of surveillance; Impact of weather and climate; Displaced populations and refugee health; Tactical and combat medical intelligence; Zoonotic diseases; Agricultural trends and food security; Public health and health system infrastructure assessment; and Personal and physical security concerns.

Conclusions

Utilizing case reports, best-practices and lessons learned from numerous international humanitarian responses, this session will guide participants though the performance of a rapid disaster assessment and the gathering of critical medical intelligence to determine the kinds and types of resources needed in an affected area. And the process of utilizing limited information to plan humanitarian relief efforts.
(A293) Critical Incident Stress Management and Mental Health Strategies after the 2009 American Samoan Tsunami
Authors: Bouslough D.B. , Biukoto P. , Stracensky S.
Published: May 2011

Background

Tsunamis are infrequent but devastating natural disasters. Loss of life, livelihood, and property contribute psychological stresses to an affected population, resulting in new psychiatric illness.

Objective

To describe post-disaster hospital, Department of Human Services (DHS), and Department of Education (DOE) methods of mental health resource dissemination, and their effectiveness.

Methods

A retrospective review of after-action reports, psychiatric clinic charts, and key-informant interviews over a 4 month period was employed. Descriptive statistics were used to evaluate data.

Results

The September 29, 2009 tsunami claimed 33 American Samoan lives. Hospital Family Assistance Center counselors aided families in the identification of 12 corpses, 9 missing persons, and providing psychiatric referral. Fifty-four hospital staff suffered loss. (Loss of: transportation, n = 13; utilities, n = 15; homes/shelter, n = 2). Coupled with the stresses of providing post-event medical care, the hospital staff was at high risk for psychiatric sequelae. Debriefing sessions for hospital staff were poorly attended due to conflicting work responsibilities, and an unfamiliar discussion format. DHS assembled four teams, each composed of one psychiatrist/psychologist leader and 6 crisis counselors. DOE school counselors utilized DHS mental health teams to screen all school aged children. The hospital psychiatry clinic remained the definitive referral destination. Federal mitigation grants provided funding for two psychiatrists, and two psychologists (including pediatric specialists) to augment hospital mental health capacity. Screening statistics and prevalence of psychiatric disease are further reported. Six month post-event rates of persistent psychiatric disease reflect that reported in recent literature (1-2%).

Conclusion

Hospital critical incident stress management requires culturally acceptable counseling methods and administrative support. Family assistance counselors are key players in identifying the needs of families of the deceased. Student counseling services and collaborative mental health teams provide a novel approach to the dissemination of mental health services within a community.
(A294) Women Widowed in the Disaster – A Psychosocial Perspective
Authors: Henry G.C. , Sekar K.
Published: May 2011

Disasters refer to collective stress situations that happen or at least manifest themselves suddenly in a particular geographic area, involve some degree of loss, interfere with the ongoing social life of the community, and are subject to human management (Gist and Lubin, 1989). The World Disaster Report (2001) has reported that about 211 million people are affected by natural disasters every year and the poorest are becoming more exposed to disaster risks and disasters set back the development process by decades. The Tsunami imposed a huge burden on the community not only physically but also in terms of psychological trauma inflicted on them. Asia remained the most affected continent. Nine of the top 10 countries with the highest number of disaster-related deaths were in Asia. Women play an integral part in the functioning of societies, with established roles and rules. Enerson (1998) in her review of twenty years of disaster studies reports study findings that show that women are progressively vulnerable. The vulnerability of women stems due to the pre existing social epi- centres. Vulnerable woman-headed households generally consist of women with severely handicapped husbands and young children, handicapped women, widows, and young single women. The widows have to bear and go through the grief of the loss of their spouse. They have the burden of increased responsibility towards their surviving children, aged parents/ in laws and other family members. The current study focus on understanding the impact of widowhood in the after math of the disaster.
(A300) Psycho-Physiological Training of Disaster Medicine Staff
Authors: Kipor G.V. , Pichugina N.K. , Bobi B.V.
Published: May 2011

Training special medical teams to be prepared for delivering emergency relief to the injured requires a special psychological conformity of individuals and mutual inter-understanding based on professional qualifications. The psycho-physiological approach comprises a set of methods of computerized tools for medical staff education, training, and preparedness, keeping in mind the aim of the necessity of mutual activities in triage process, medical care, and decision-making for evacuating injured victims from the emergency site. The goal of this presentation is to expose the battery of new original methods and technologies of staff preparedness in order to realize the maximum conformity of personal composed together in one unique mobile team sent into the situations of emergency accompanied by psychological tension, insufficient volume of info sharing, field conditions, etc. Methods are based on the measurements of the functional asymmetry of brain hemispheres tested by computer-loaded, original software. Several levels of evaluation of functional asymmetry status have been proposed for discussion and for choosing of criteria for the conformity matrix study. These include: (1) a primary table of digital variables characterizing the first level of comparison of psycho-physiological individual regulation obtained for everyone of the emergency medical team permitting to propose the primary team composition; (2) co-efficients of psycho-physiological regulation for the determination of conformity between the individualities of medical staff team and the dynamics of psychological resistance in emergency environment; and (3) integrative profiles of functional asymmetry, giving the objective fundamentals for team composition and its training, to the ideal sophisticated model of psycho-physiological conformity. Quantitative, objective data give the arguments to prepare the criteria for the composition of field medical team. The individual programs issued from examination are proposed for the improvement of permanent psycho physiological staff conformity.
(A304) Catastrophe Biologique Dans La Ville De Rio
Authors: Silveira L.T. , Plotkowski L.M. , De Souza I.A.G. , Borghi D.P. , Julien H.
Published: May 2011

Catastrophe Biologique dans la Ville de Rio. Silveira L, Plotkowski LM, Arouche I, Borghi D, Julien H. Sécretariat d'Etat de ls Santé et Defense Civile.. Au début de l'été de 2007 la ville Rio a subi une catastrophe responsable de 232 morts (42% d'enfants ) et 150.00 malades. En quelques semaines, l'épidémie de dengue a bloqué toute la structure de soins de Rio. Les hôpitau pourtant dotés de plans blancs, n'ont pu faire face a l'afflux massif de patients. La gravité était due au choc hypovolémique par perte de plasma, plus qu'aux hémorragies. La diffusion alarmiste de la presse a augmenté les réactions de panique populaire. En février 2008, chaque heure des centaines de nouveaux cas ont été enregistrés. Les autorités réunies (Secrétariat d” État de la Santé et Sécurité Civile, Le Service de santé du Sapeur Pompier, de l Ármée de Terre, de la Marine et de l' Armée de L'Air) ont décidé d'installer 12 PMA (Hôpitaux de Campagne) pour trier les malades et les hydrater sur place. Chaque “ Tente d'Hydratation” a été équipée d'un laboratoire d'analyse (hémogramme et plaquettes ) de 30 lits pour l'hydratation en perfusion, deux lits de réanimation et une ambulance, pour le transfert vers l'hôpital de référence. Près de 1000 professionnels de santé y ont travaillé. Dans le premier mois, 49 700 consultation on été assurées dans les PMA. Les patients étaient tous triés et 10 % ont eu besoin d'une hydratation par perfusion pendant 12 heures en moyenne. Seulement 2% des malades ont été hospitalisés. Le diagnostique précoce et l'hydratation rapide a permis aux PMA de renvoyer les malades chez eux, de réduire efficacement l'afflux hospitalier et la mortalité par dengue. Les PMAs ont été démontés progressivement à mesure du contrôle de l'épidémie, jusqu'a 2 mois plus tard.
(A306) Community Resilience and the Christchurch Earthquake: Best Laid Plans or Practise Made Perfect?
Authors: Humphrey A.R.G. , Mitchell J. , Mcbride S.K.
Published: May 2011

On February 22, 2011 at 12:51 pm an earthquake measuring 6.3 on the Richter scale struck the city of Christchurch, population 376,700 in the South Island of New Zealand. This followed a 7.3 magnitude earthquake in September 2010, but the shallowness (5km) and proximity of the February earthquake to the central city, resulted in far more devastation, with Modified Mercalli scores reaching ten in some areas and upward ground acceleration exceeding 2.4G. The application of the Coordinated Incident Management System (CIMS) routinely used by New Zealand Civil Defence agencies was swift, innovative and efficient, facilitating rapid deployment of local and international emergency teams and response resources. The effectiveness of this response was partially attributed to lessons learnt from the September earthquake which, with hindsight, was a practise for the more serious February event. The community response was equally remarkable, with standard approaches to measuring preparedness and resilience suggesting that community resilience in Canterbury was high. A number of initiatives by the New Zealand Ministry of Civil Defence and Emergency Management may have fostered some of this resilience,particularly community- based resilience-building projects initiated by the Regional Emergency Management Office on 2009 and 2010, supported by the Ministry of Civil Defence and Emergency Management. In addition, website education resources and media promotion (“Get Ready Get Thru”) and a travelling exhibition called “The Pandemic Roadshow” had been particularly well received and remembered by Canterbury residents. However, two key events provided an impetus for the Canterbury community to burnish its resilience. First, the Swine flu (AH1N1) pandemic in 2009 resulted in a greater awareness of public health in emergencies along with a doubling of neighbourhood support groups. Secondly, the September 2010 earthquake resulted in the establishment of the student army of volunteers and improvement of public information management. This presentation will describe the markers of community resilience following the Christchurch earthquake and discuss how such resilience can be fostered in communities where emergency preparedness is not recognised as a priority.
(A308) Come Hell and Cold, High Water…
Authors: Mclean A.J.
Published: May 2011

It is extremely rare in disaster mental health annals to have consistent psychosocial interventions pre-disaster. For the third year in a row, the Red River Valley of the United States and Canada has experienced catastrophic flooding, on the heels of almost two decades of yearly major flooding. This paper describes the community and individual psychosocial responses to the current Red River flood, based on resiliency paradigms and the backdrop of successful mitigation of serial disasters. In addition, the author will present examples of real-time networking with colleagues around the world who are responding to natural disasters.
(A314) Challenges Faced in Establishing the Emergency Prehospital Ambulance Service in North Central Sri Lanka: Developing Something from Nothing
Authors: Dassanayake L.
Published: May 2011

The existence of a prehospital emergency care system signifies how secure an area is in aftermath of a health-related emergency. The systems save lives during most out-of-hospital health emergencies. Until 2010, there was no regular prehospital care system in Anuradhapura, or even in the entire north central region of Sri Lanka. Trauma patients were brought to the hospital generally with little or no prehospital care. They were transported to hospital by relatives or other people at the scene with using whatever vehicle was available at the time, which in many occasions was a trishaw. The concept of developing a prehospital emergency ambulance service to cover the municipality of Anuradhapura as a pilot project was formulated in 2009. The objectives were to: (1) provide emergency prehospital care in the municipality; (2) identify the difficulties; and (3) assess the feasibility of implementing it in the entire district. Some of the challenges faced in the process from the initial draft of the concept up to now include: 1. Studying an established emergency medical services (EMS) system; 2. Developing a pressure group in hospital; 3. Convincing the need to administration; 4. Funding in the initial period; 5. Selecting the proper team and supportive peers; 6. Providing standard training to selected staff; 7. Formulating duty norms and standard operating procedures; 8. Infrastructure development, acquiring instruments, and vehicles with limited fund capacities; 9. Cooperating with the trade unions and external/internal negative forces; 10. Rallying the collaborators with same interest; 11. Handling donors; 12. Getting the support of other key institutions (police/municipal council); 13. Utilizing local media to help promote the project; 14. Social mobilization to ensure sustainability; and 15. Ensuring worker satisfaction, encouragement, and liaison with other units of hospital.
(A317) Evaluation Outcomes - Capacity Building for Emergency Medical Services along National Highway No. 5 in Hai Duong Province, Vietnam – October 2009
Authors: Bollinger P. , Baird S.
Published: May 2011

Background

This project was designed to reduce secondary injury of road traffic accidents (RTA) victims in Hai Duong (HDRC) province in Vietnam in collaboration with the Red Cross with funding from Medical Teams International (MTI). The approximate number of beneficiaries was 601,820, including the 1,820 direct beneficiaries who received first responder training and emergency treatment. The 600,000 indirect beneficiaries is the population along a 45km corridor of National Highway #5 crossing Hai Duong province.

Methods

In late October 2009 an evaluation team from MTI reviewed the training of Vietnam Red Cross volunteers in Hai Duong province. The pre-evaluation activities (review of patient contact log books and patient interviews) were conducted by the MTI-Vietnam staff. 58 trained lead volunteers and 20 community members participated in this evaluation. Additionally 92 patients who had been treated by the volunteers were also interviewed.

Results

Findings included: a) the volunteers who received training stated an increase in their confidence to respond to emergencies, b) a 65% increase of Red Cross volunteers, c) a increased awareness of EMS within the province, d) greater community engagement at emergency scenes, and e) broad respect from the community towards the HDRC volunteers.

Discussion

Considerations for the future include: a) development of a continuing education program, b) increase of supplies to volunteers, c) more training involving multi casualty incidents, d) development of a communications protocol between volunteers and other healthcare providers and e) limit CPR training to drowning related events.

Conclusion

The outcomes exceeded the planned goals: knowledge and retention of course materials and skills is good, confidence levels of volunteers increased and those that are involved in emergency events in Hai Duong province are safer. The profile of EMS and first responders as a critical component of community health has been measurably raised among key stakeholders and the community.
(A285) Planning and Organization of Emergency Medical Services in Mumbai
Authors: Prakash A. , Nagose R.
Published: May 2011

In the past two decades, Mumbai has witnessed several mass-casualty incidents. Somehow, it seems that the city has missed some important lessons from these events. Mumbai has no formal structure for emergency medical services (EMS). Although EMS may seem to be a much-desired necessity, scholars have raised questions on the practicality and feasibility of having such a system in Mumbai. Factors such as population congestion, traffic volume, and lack of coordination among existing hospitals, the success of such a system in a city like Mumbai is jeopardized. In spite of having similar challenges in some other regions of the country, EMS systems (e.g., in Gujarat) have achieved substantial success. This paper deals with the planning and organization of EMS in Mumbai. It evaluates the performances of the existing EMS systems in other Indian cities. The paper also discusses the advantages of having such a system, particularly during the events such as disasters, accidents, acts of terrorism, etc. The paper also discusses the possible consequences of the absence of EMS, such as delayed ambulance dispatch, improper distribution of patients, overcrowding at certain hospitals thereby leading to poor triage, and several similar problems that can worsen a crisis. It studies the potential challenges for the establishment of such a system in Mumbai, and suggests a model for an effective EMS system for the city.
(A287) Animal Health in Disasters: Why does it Matter?
Authors: Hollier P.
Published: May 2011

Animal production is an important component to economic stability and food security in developing country. Economic development programs have targeted agriculture in developing country as a means of decreasing poverty and empowering vulnerable populations throughout much of the developing world. Disasters due to natural and man-made hazards that impact animal agriculture have a disproportionate impact on the rural poor and vulnerable populations affecting the economic well being and health of the greater population. Protection of livelihoods dependent on animal agriculture is important to consider in community resilience and humanitarian assistance activities that range from capacity building through response and recovery. In order to meet the challenges of the next generation of global health threats, policy, research, and practice must adopt a new cross-cutting approach that targets the human-animal-ecologic interface taking into account political, socioeconomic, and cultural factors.
(A322) Animals in Disasters and Emergencies: A Version of Wild Kingdom
Authors: Madigan J.
Published: May 2011

Dr. Madigan will discuss the evolution of awareness of the need for emergency preparedness and response for the animal component in disasters and emergencies in the United States and internationally. Emergencies and disasters affect animals and those who own them, including companion animals, animals who's use is for sustainment or groups of animals which serve as a key component of individuals economic existence. Numerous studies have shown the public will delay or refuse evacuation from impending risks if they have to leave their animals behind. A significant component of the public will refuse use of non pet associated shelters which then affects public safety and wellbeing. Emergency responders can be put at risk because of rescues required of non-evacuated individuals staying with their animals. Emergency responders may be called to be involved in animal rescues or animal evacuation. Animals impacted by disasters may incur injury, entrapment, and lack of food and water. Veterinary triage, emergency rescue, treatment and humane euthanasia are driven by animal welfare concerns as well as legislation mandating care of animals in declared disasters in some countries. Dr. Madigan's presentation will provide discussion and video examples of organized response to small and large scale animal emergency and disasters associated with 15 years as Chief of the UC Davis Veterinary Emergency Response Team. Additionally the training components needed for effective and safe preparedness and response will be discussed.
(A323) Wildfire Associated Burn Injury of 1400 Sheep in Northern California: A Coordinated Mass Casualty Veterinary Response
Authors: Madigan J. , Rowe J. , Angelos J. , Herthel W.F. , Matz D. , Dinucci M. , Fletcher V.
Published: May 2011

Introduction

Wildfires can injure animals both from burns and inhalation of smoke and particulates. In 2006 a rapidly moving grass wildfire burned 12 square miles in Yolo County. Approximately 1400 sheep on the range suffered variable degrees of burns. A coordinated effort of triage and individual treatment or humane euthanasia was performed by the UC Davis Veterinary Emergency Response Team.

Methods

Animals: Two sheep ranches with 1100 (ranch A) and 300 (ranch b) adult sheep of different breeds, ranging in age from 1-6 years of age. Initial owner evaluation: Both ranchers considered humane destruction of all sheep showing evidence of burned discoloration, estimated to be over 95% of 1400 sheep. Ranch B attempted shooting comprised sheep but stopped and requested aid from UC Davis as did ranch A. Veterinary initial evaluation and communications: Several burned sheep were visible from the roadway. Many sheep were standing with limited movement and some were recumbent. Triage was performed by bringing food and water sources to the sheep and those not eating and drinking were evaluated first. Gunshot euthanasia following AVMA guidelines based on veterinary determination of hopeless prognosis was used. Veterinary team members (N = 25) coordinated treatments, communications with public health, animal control, and press media, carcass disposal, volunteer management, and acquisition of office of emergency services resources.

Treatment

Topical treatment of eyes and skin burns with silver sulfadiazine ointment, administration of systemic antibiotics (LA 200), pain relief (flunixine meglumine), wound debridement, and cesarean section of late term terminal sheep were performed.

Results

Over 500 sheep were euthanized by gunshot and the remainder (approximately 900) recovered lasting from 1-42 days. Progression of burn injury to skin, udder, face, and hoofs persisted for 42 days.

Conclusion

A coordinated veterinary response provided humane care and triage of this mass casualty animal emergency.
(A326) The Military Veterinarian's Role in Stabilization and Reconstruction Operations
Authors: Smith J.C.
Published: May 2011

Stabilization and reconstruction operations in failed or failing states require a bottom-up approach, focusing on the population as the strategic center of gravity. This bottom-up approach must address the population's basic needs as defined by Dr. Abraham Maslow's “Hierarchy of Needs” and provide a long-term means of self-sufficiency, rather than creating an “aid dependent economy”. Focusing stabilization and reconstruction operations on agricultural and agricultural related projects provides relief from donor dependency, stimulates economic growth, and thwarts the power of spoilers. Military veterinary personnel are uniquely qualified to design and implement agricultural stabilization and reconstruction programs in conjunction with the host-state ministries and agencies across the full range of military operations. Early, sustained engagement by military veterinarians stimulates agricultural productivity, improves animal and human health, directly supports the population's hierarchy of needs on all levels, and accelerates stabilization operations by reducing the population's susceptibility to spoilers.
(A294) The Veterinary Stability Operations Practitioner Course: A Model for Bridging the Gap in Veterinary Medical Education for the Global Veterinary Medicine Practitioner
Authors: Hollier P.
Published: May 2011

Veterinary education provides a solid clinical and public health background that is applicable to several international development and humanitarian assistance sectors; however key skills and experiences that are required to be an effective Global Veterinary Medicine practitioner are not covered. In response to the US Department of Defense adopting Stability Operations as a core mission, the US Army Veterinary Corps has developed a Veterinary Stability Operations Practitioner Course intended to prepare Veterinary Corps officers to function effectively if tasked to conduct or support Stability Operations. The Veterinary Stability Operations Practitioner Course is a two part workshop series that provides a global veterinary perspective including knowledge, skills and experience necessary for Veterinarian to function in an international developing setting. Skills in assessment methodologies, program planning and evaluation are core to each workshop. Knowledge is based on production, market, and disease surveillance systems in the developing world. The intent is for the attendee after completing the course series to view their operational environment differently by understanding the social and cultural context that influences local population decisions and behaviors.