bluuebunny/crossref_metadata_2025 huggingface dataset:
Disasters and Development: Part 3: Assessing Trade-offs in Investing in Vulnerability Reduction
Authors: Stephenson Rob S. , DuFrane Charles
Published: August 2016

This lesson describes how a government decides whether and how much it should spend on vulnerability reduction. There are techniques and methods by which decision-makers compare development alternatives. The differences between the risk that a potentially catastrophic event will occur and uncertainty are described, with uncertainty providing greater difficulty in economic analyses. There is a range of methods for identifying the complex mix of competing costs and benefits associated with any restructuring of investment priorities to accomplish disaster mitigation. The possibilities are described in terms of the opportunity costs and present value. Impact and consequent losses include: (1) direct monetary effects; (2) indirect monetary effects; (3) direct, non-monetary effects; (4) indirect, non-monetary effects; and (5) loss of non-renewable natural resources. The difficulties in assigning values to these effects are described, as well as the means of judging the costeffectiveness of such interventions. An advantage of screening projects using a framework of analytical methods is that it can assist in focusing on a variety of possible outcomes and make the factors influencing these outcomes quite explicit.
Risk and Risk Assessment in Health Emergency Management
Authors: Arnold Jeffrey L.
Published: August 2016

This article considers the critical roles of risk and risk assessment in the management of health emergencies and disasters. The Task Force on Quality Control of Disaster Management (TFQCDM) has defined risk as the “objective (mathematical) or subjective (inductive) probability that something negative will occur (happen)”. Risks with the greatest relevance to health emergency management include: (1) the probability that a health hazard exists or will occur; (2) the probability that the hazard will become an event; (3) the probability that the event will lead to health damage; and (4) the probability that the health damage will lead to a health disaster. The overall risk of a health disaster is the product of these four probabilities.

Risk assessments are the tools that help systems at risk—healthcare organizations, communities, regions, states, and countries—transform their visceral reactions to threats into rational strategies for risk reduction. Type I errors in risk assessment occur when situations are predicted that do not occur (risk is overestimated). Type II errors in risk assessment occur when situations are not predicted that do occur (risk is underestimated). Both types of error may have serious, even lethal, consequences.

Errors in risk assessment may be reduced through strategies that optimize risk assessment, including the:(1) adoption of the TFQCDM definition of risk and other terms; (2) specification of the system at risk and situations of interest (hazard, event, damage, and health disaster); (3) adoption of a best practice approach to risk assessment methodology; (4) assembly of the requisite range of expert participants and information; (5) adoption of an evidence-based approach to using information; (6) exclusion of biased, irrelevant, and obsolete information; and (7) complete characterizations of any underlying fault and event trees.
Injuries and Illnesses Treated at the World Trade Center, 14 September–20 November 2001
Authors: Perritt Kara R. , Boal Winifred L. ,   The Helix Group Inc
Published: August 2016

Introduction:

In response to the 11 September 2001 terrorist attacks on the World Trade Center (WTC), the United States Public Health Service (USPHS) deployed Disaster Medical Assistance Teams (DMATs) and the Commissioned Corps to provide on-site, primary medical care to anyone who presented. Patients included rescue and recovery workers, other responders, and some members of the general public.

Objective:

A descriptive analysis of WTC-USPHS patient records was conducted in order to better understandthe short-term impact of the WTC site on the safety and health of individuals who were at or near the site from 14 September–20 November 2001.

Methods:

The Patient Treatment Record forms that were completed for each patient visit to these USPHS stations over the 10-week deployment period were reviewed.

Results:

Patient visits numbered 9,349, with visits peaking during Week 2 (21–27 September). More than one-quarter of the visits were due to traumatic injuries not including eye injuries (n = 2,716; 29%). Respiratory problems comprised more than one-fifth of the complaints (n = 2,011; 22%). Eye problems were the third most frequent complaint (n = 1,120; 12%). With respect to the triage class, the majority of visits fell into the lowest category of severity (n = 6,237; 67%).

Conclusion:

USPHS visits probably were skewed to milder complaints when compared to analyses of employer medical department reports or hospital cases; however, given the close proximity of the USPHS stations to the damage, analysis of the USPHS forms provides a more complete picture of the safety and health impact on those who were at or near the WTC site.
The Advanced Life Support in Obstetrics (ALSO®) Program: Fourteen Years of Progress
Authors: Beasley John W. , Dresang Lee T. , Winslow Diana B. , Damos James R.
Published: August 2016

Background:

The Advanced Life Support in Obstetrics (ALSO®) program is a highly structured, evidence-based, two-day course designed to provide healthcare professionals with the knowledge and skills to manage the emergency conditions that can occur during childbirth.

Objectives:

To document the number of ALSO®-trained clinicians and instructors in the United States and internationally and to promote ALSO® training among prehospital and disaster medicine professionals.

Methods:

Records maintained by the American Academy of Family Physicians (AAFP) for each country where ALSO® is taught were reviewed for: (1) the years and locations of the ALSO® courses; (2) the number of ALSO®-trained caregivers; and (3) the number of ALSO® instructors.

Results:

Between 1991 and 2005, 54,071 ALSO®-trained caregivers and 2,251 instructors have completed provider and instructor ALSO® courses in 25 countries. Of these, 17,755 caregivers and 1,220 instructors are from outside the United States.

Conclusion:

The ALSO® program is a popular, multi-disciplinary course for preparing maternity caregivers to manage obstetric emergencies. Limited evidence suggests it can be effective and efficient in enhancing the knowledge and skills of prehospital and disaster medicine clinicians. Hong Kong provides a model in which emergency physicians have taken the lead in promoting the ALSO® course. As the ALSO® program expands, additional research is needed to assess its impact on educational and health outcomes.
The Sumatra-Andaman Earthquake and Tsunami of 2004: The Hazards, Events, and Damage
Authors: Kohl Patrice A. , O'Rourke Ann P. , Schmidman Dana L. , Dopkin Wendy A. , Birnbaum Marvin L.
Published: August 2016

The Sumatra-Andaman Earthquake and subsequent Asian Tsunami of 26 December 2004 affected multiple countries in the Indian Ocean and beyond, creating disasters of a scale unprecedented in recorded history. Using the Conceptual Framework and terminology described in the Disaster Health Management: Guidelines for Evaluation and Research in the Utstein Style, the hazard, events, and damage associated with the Earthquake and Tsunami are described. Many gaps in the available information regarding this event are present. Standardized indicators and reporting criteria are necessary for research on future disasters and the development of best practice standards internationally.
Health Aspects of the Tsunami Disaster in Asia
Authors: Kapila Mukesh , McGarry Nichole , Emerson Elizabeth , Fink Sheri , Doran Rodger , Rejto Khadija , Profili Maria Cristina
Published: August 2016

This is a summary of the proceedings of the Conference on the Health Aspects of the Tsunami Disaster in Asia that was convened by the sunami World Health Organization in Phuket, Thailand from 04–06 May 2005. It contains reviews of the experiences of the health sector and early recovery fol following the Earthquake and Tsunami with emphasis onwhat was done well and what could have been done better and the lessons learned that can be incorporated into actions that will mitigate the damage created by future events. It outlines the national and international responses and recovery and the actions taken and not taken by the international community in support of the countries affected. Specific issuesaddressed include: (1) needs assessments; (2) coordi- coordination; (3) filling gaps in essential services, and (4) capacity building at the country level. Each of these aspects is analyzed as to its: (1) appropriateness; (2) adequacy; (3) effectiveness; (4) efficiency; and (5) connectedness.

Much of what occurred provided benefits to the stricen population, but there is substantial room for improvement through implementation of the lessons learned. These lessons must be converted into actions in order to mitigate the damagesustained and to enhance our responses to the damage from future
Session 1.2: National Health Perspectives of the Tsunami Crisis
Authors: Singh Poonam Khetrapal , Ofrin Roderico , Ravindran P. , Paturussi Idrus , Yasir Ibrahim , Aung Than , Kahandailyanage H.A.P. , Kunaratanapruk Suprachai
Published: August 2016

This is a summary of the presentations and discussion of Session 1.2 of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related national health perspectives as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) discussion; (3) what was done well?; (4) what could have been done better?; and (5) what can be done to prepare for the future?.
Session 1.3: Health Protection and Disease Prevention: A Critical Review of Experience
Authors: Merlin-Scholtes Joanna , Narain Jai , Chunsuttiwat Supamit , Hyde-Price Caroline , Dubois Philippe Francois , Sorensen Eigil
Published: August 2016

This is a summary of the presentations and discussion of Health Protection and Disease Prevention of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related health protection and disease prevention as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections:(1) key questions; (2) national perspectives; (3) an international perspective; (4) laboratory aspects in disease surveillance; and (5) partnership.
Panel 2.2: Surveillance, Early Warning Alert, and Response: Communicable and Vector-Borne Diseases
Authors: Roure Collette , Khalakdina Asheena , Ungchusak Kumnuan , Yulizar Media , Ravindran P. , Watson John , Pinto Augusto
Published: August 2016

This is a summary of the presentations and discussion of Surveillance, Early Warning Alert and Response at the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO)in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the surveillance, early warning alert, and response to communicable and vector-borne diseases as pertaining to the responses to the damage created bythe Tsunami. It is presented in the following major sections: (1) key questions; (2) needs assessment; (3) coordination(4) gap filling; and (5) capacity building. The key questions section is presented in six sub-sections: (1) communicable diseases; (2) early warning; (3) laboratory capacity and referral networking; (4) coordination of disease surveillance, early warning, and response; (5) health infrastructure rebuilding; and (6) using existing national surveillance plans toenhance disease surveillance and early warning systems.
Panel 2.10: Reproductive, Mental, and Child Health
Authors: Sahu Supriya , Musani Altaf , Schaller Jane , Pairojkul Srivieng , Senanayake Manouri P. , Brenny Patrick , Rosati Michael J. , Dakkak Henia
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.10, Reproductive, Mental, and Child Health of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to reproductive, mental, and child health as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) background; (2) key issues; (3) discussion; and (4) recommendations. Key issues discussed included: (1) coordination/collaboration; (2) provision of services; and (3) raising awareness and advocacy.
Panel 2.14: Contribution of Non-Governmental Actors
Authors: Luna Jorge Mario , Malpani Rohit , Zawde Dawit , Canagarathnam Nallathamby , Arnold Saulina , Budstedt Grete , Muriuki David , Clarke John
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.14, Contribution of Non-Governmental Actors, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the role of media and communication as pertaining to the responses to the damage created by the Tsunami. It is presented in six sections: (1) Background; (2) Key questions; (3) Discussion; (4) What have we learned?; (5) Conclusions; and (6) Recommendations. The what have we learned section is presented in the categories of: (1) needs assessments; (2) coordination; (3) filling gaps; and (4) capacity building.
Integrated Decision-Making in Response to Weapons of Mass Destruction Incidents: Development and Initial Evaluation of a Course for Healthcare Professionals
Authors: Pryor Erica , Heck Emily , Norman Linda , Weiner Betsy , Mathews Rick , Black James , Terndrup Thomas
Published: August 2016

Introduction:

Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (weapons of mass destruction) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center.

Objective:

This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to weapons of mass destruction events.

Methods:

Course participants were healthcare professionals, including physicians, nurses, emergency medical services administrators, hospital administrators, and public health officials. Each course included three modified tabletop and/or real-time functional exercises. A total of 441 participants attended one of the eight course offerings between March and August 2003. An intervention group only, pre-post design was used to evaluate change in perceived capabilities related to administrative decision-making for weapons of mass destruction incidents. Paired evaluation data were available on 339 participants (81.9%). Self-ratings for each of 21 capability statements were compared before and after the course. A 19-item total scale score for each participant was calculated from the pre-course and post-course evaluations. Pairedt-tests on pre- and postcourse total scores were conducted separately for each course.

Results:

There was consistent improvement in self-rated capabilities after course completion for all 21 capability statements. Pairedt-tests of pre- and postcourse total scale scores indicated a significant increase in mean ratings for each course (allp<0.001).

Conclusion:

The tabletop/real-time-exercise format was effective in increasing healthcare administrators' self-rated capabilities related to weapons of mass destruction disaster management and response. Integrating the competencies into training interventions designed for a specific target audience and deploying them into an interactive learning environment allowed the competency-based training objectives to be accomplished.
On-Site Physicians at a Major Sporting Event in Nigeria
Authors: Olapade-Olaopa E. Oluwabunmi , Alonge Temitope O. , Amanor-Boadu Simbo D. , Sanusi Arinola A. , Alese Olatunji B. , Omisanjo Olufunmilade O. , Adeyinka Abiodun O. , Sanya Arinola O. , Ogunbunmi Paul A. , Adewole Isaac F.
Published: August 2016

Introduction:

Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate.

Hypothesis:

The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country.

Methods:

A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted.

Results:

The Games hosted 6,000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1,000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively.

Conclusion:

The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.
Burns Assessment Team as Part of Burn Disaster Response
Authors: Greenwood John E. , Pearce Andrew P.
Published: August 2016

With a huge, climactically hostile catchment area, limited retrieval options and finite resources at the only adult burns unit in South Australia, this paper discusses the case for the establishment and maintenance of a Burns Assessment Team in South Australia. The composition and role of the team and its relationship with other retrieval services, the primary care unit, and the proposed National Burn Coordinator also are discussed.
Realities of Rural Emergency Medical Services Disaster Preparedness
Authors: Furbee Paul M. , Coben Jeffery H. , Smyth Sharon K. , Manley William G. , Summers Daniel E. , Sanddal Nels D. , Sanddal Teri L. , Helmkamp James C. , Kimble Rodney L. , Althouse Ronald C. , Kocsis Aaron T.
Published: August 2016

Introduction:

Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored.

Problem:

This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness?

Methods:

Data were gathered through a multi-region survey of 1,801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities.

Results:

A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention.

Conclusion:

Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.
Sensitivity and Specificity of the Medical Priority Dispatch System in Detecting Cardiac Arrest Emergency Calls in Melbourne
Authors: Flynn Julie , Archer Frank , Morgans Amee
Published: August 2016

Introduction:

In Australia, cardiac arrest kills 142 out of every 100,000 people each year; with only 3–4% of out-of-hospital patients with cardiac arrest in Melbourne surviving to hospital discharge. Prompt initiation of cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac care greatly improves the chances of survival from cardiac arrest. A critical step in survival is identifying by the emergency ambulance dispatcher potential of the probability that the person is in cardiac arrest. The Melbourne Metropolitan Ambulance Service (MAS) uses the computerized call-taking system, Medical Priority Dispatch System (MPDS), to triage incoming, emergency, requests for ambulance responses. The MPDS is used in many emergency medical systems around the world, however, there is little published evidence of the system's efficacy.

Objective:

This study attempts to undertake a sensitivity/specificity analysis to determine the ability of MPDS to detect cardiac arrest.

Methods:

Emergency ambulance dispatch records of all cases identified as suspected cardiac arrest by MPDS were matched with ambulance, patient-care records and records from the Victorian Ambulance Cardiac Arrest Registry to determine the number of correctly identified cardiac arrests. Additionally, cases that had cardiac arrests, but were not identified correctly at the point of call-taking, were examined. All data were collected retrospectively for a three-month period (01 January through 31 March 2003).

Results:

The sensitivity of MPDS in detecting cardiac arrest was 76.7% (95% confidence interval (CI): 73.6%–79.8%) and specificity was 99.2% (95% CI: 99.1–99.3%). These results indicate that cardiac arrests are correctly identified in 76.7% of cases.

Conclusion:

Although the system correctly identified 76.7% of cardiac arrest cases, the number of false negatives suggests that there is room for improvement in recognition by MPDS to maximize chances for survival in out-of-hospital cardiac arrest. This study provides an objective and comprehensive measurement of the accuracy of MPDS cardiac-arrest detection in Melbourne, as well as providing a baseline for comparison with subsequent changes to the MPDS.
Accuracy of a Priority Medical Dispatch System in Dispatching Cardiac Emergencies in a Suburban Community
Authors: Reilly Michael J.
Published: August 2016

Introduction:

Over-triage of patients by emergency medical services (EMS) dispatch is thought to be an acceptable alternative to under-triage, which may delay how quickly life-saving care reaches a patient. Previous studies have looked at advanced life support (ALS) misutilization in urban- and county-based EMS systems and have attempted to analyze how dispatch methods either contribute to or alleviate this problem.1–5

Objective:

The purpose of this study is to assess the relationship between dispatches of a cardiac nature in a Medical Priority Dispatch (MPD) system, and the actual clinical diagnosis as determined by an emergency department physician.

Methods:

Calls for emergency medical assistance in a suburban community outside of a major metropolitan area were surveyed over a three-month period. Medical Priority Dispatch protocols determined that 104 of these calls were cardiac-related. Of these emergency calls, 56 (53.8%) patients were transported to the local community hospital and treated by the emergency physician. A retrospective review of the medical records was conducted to determine whether the patient had a cardiac-related discharge diagnosis from the emergency department.

Results:

Sixteen (28.6%) of the patients in this cohort were diagnosed with a cardiac-related condition upon discharge from the emergency department. Forty (71.4%) were diagnosed with a non-cardiac-related condition. The positive, predictive value of the dispatch protocol for the detection of an actual cardiac emergency in this EMS system was 28.6%.

Conclusion:

In this suburban community, the MPD system may over-triage emergency medical responses to cardiac emergencies. This can result in the only ALS (paramedic) unit in the community being unavailable in certain situations. Future studies should be conducted to determine what level (in any) of over-triage is appropriate in EMS systems using a MPD system.
The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation
Authors: Peralta Luis Mauricio Pinet
Published: August 2016

Introduction:

Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.

Objective:

The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.

Methods:

This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.

Results:

The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.

Conclusions:

Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.
KAMEDO Report No. 82 Explosion at the Fireworks Warehouse in the Netherlands in 2000
Authors: Björnhagen Viveka , Messner Torbjörn , Brändström Helge
Published: August 2016

A fire and subsequent explosions occurred in a fireworks warehouse on 13 May 2000. A total of 947 persons were injured and 21 persons died, including four firefighters and one reporter. Communication networks became overloaded and impaired notification chains. The hospital disaster plan was followed, but was proved inadequate. Public information was a high priority. A counselling center was established early and was planned to continue operation for five years. The command function did not perform to expectations. Hospital triage was impaired as many responsible left the triage area. Short-term psychosocial support evolved to long-term programs. Liability issues were examined.
KAMEDO Report No. 84 Terrorist Attacks Against the World Trade Center, 11 September 2001
Authors: Waage Agne , Hamberger Bertil , Lundin Tom , Suserud Björn-Ove , Riddez Louis
Published: August 2016

On 11 September 2001, two hijacked airplanes collided with the World Trade Center in New York. Both towers collapsed, spreading smoke and debris for miles. Rescue personnel arrived rapidly, but the collapse of the towers made the scene too dangerous for these teams to rescue all those trapped inside. Although this collapse was impossible to predict, fires occurring in skyscrapers can cause the structures to collapse. When a fire erupts in the upper levels of the building, it is even more difficult for those trapped inside to escape. Communications systems were shut down. In future incidents with large numbers of injured victims, the injured should be transported to hospitals by non-traditional medical transport vehicles (taxis, cars, etc.). If future disasters occur in the vicinity of a hospital, the most severely injured victims should go to the hospital instead of congregating at assembly points. These victims often are already at hospitals before substantial aid arrives at the assembly points. On-scene care must be documented, and easy-to-read triage tags should be used. Reserve power supplies in major cities should be maintained in preparation for emergencies. Both victims and rescue personnel are susceptible to post-traumatic, psychosocial reactions.
Military-Civic Action: Lessons Learned from a Brigade-Level Aid Project in the 2003 War with Iraq
Authors: Malish Richard , Scott John S. , Rasheed Burhan Omer
Published: August 2016

The primary mission of the military physician assigned to a combat-arms unit is to sustain the unit's fighting strength through prevention, primary medical care, and trauma resuscitation. Technical and organizational details of civic action assistance are not emphasized routinely during training. Real-world deployment, however, presents challenges approachable only with flexibility and improvisation. Historically, combatant commanders have recognized the health of civilians in their operational area as a target through which local acceptance of United States (US) intervention may be achieved. The medium-unit (battalion and brigade) physician may be charged with providing care to the host-nation populace. Because the mission's emphasis is one of public relations and not sustainable development, lasting medical benefits are not attained. This article addresses the challenge of on-the-spot military civic assistance. The experience of the 173d Airborne Brigade (Bde) Medical Section is used to color concepts with real events. The unit attempted to reach beyond the immediate directive in order to create a program of lasting results.
International Medical Response to a Natural Disaster: Lessons Learned from the Bam Earthquake Experience
Authors: Abolghasemi Hassan , Radfar Mohammad Hadi , Khatami Masoud , Nia Masoud Saghafi , Amid Ali , Briggs Susan M.
Published: August 2016

An earthquake measuring 6.5 on the Richter scale devastated Bam, Iran on the morning of 26 December 2003. Due to the great health demands and collapse of health facilities, international aid could have been a great resource in the area. Despite sufficient amounts and types of resources provided by international teams, the efficacy of international assistance was not supported in Bam, as has been experienced in similar events in other countries. Based on the observations in the region and collecting and analyzing documents about the disaster, this manuscript provides an overview of the medical needs during the disaster and describes the international medical response. The lessons learned include: (1) necessity of developing a national search and rescue strategy; (2) designing an alarm system; (3) establishing an international incident command system; (4) increasing the efficacy of the arrival and implementation of a foreign field hospital; and (5) developing a flowchart for deploying international assistance.
Role of Exercises and Drills in the Evaluation of Public Health in Emergency Response
Authors: Gebbie Kristine M. , Valas Joan , Merrill Jacqueline , Morse Stephen
Published: August 2016

Introduction:

Public health agencies have been participating in emergency preparedness exercises for many years. A poorly designed or executed exercise, or an unevaluated or inadequately evaluated plan, may do more harm than good if it leads to a false sense of security, and results in poor performance during an actual emergency. At the time this project began, there were no specific standards for the public health aspects of exercises and drills, and no defined criteria for the evaluation of agency performance in public health.

Objective:

The objective of this study was to develop defined criteria for the evaluation of agency performance.

Method:

A Delphi panel of 26 experts in the field participated in developing criteria to assist in the evaluation of emergency exercise performance, and facilitate measuring improvement over time. Candidate criteria were based on the usual parts of an emergency plan and three other frameworks used elsewhere in public health or emergency response.

Results:

The response rate from the expert panel for Delphi Round I was 74%, and for Delphi Round II was 55%. This final menu included 46 public health-agency level criteria grouped into nine categories for use in evaluating an emergency drill or exercise at the local public health level.

Conclusion:

Use of the public health-specific criteria developed through this process will allow for specific assessment and planning for measurable improvement in a health agency over time.
Disaster Management following the Chi-Chi Earthquake in Taiwan
Authors: Chan Yu-Feng , Alagappan Kumar , Gandhi Arpita , Donovan Colleen , Tewari Malti , Zaets Sergey B.
Published: August 2016

The earthquake that occurred in Taiwan on 21 September 1999 killed >2,000 people and severely injured many survivors. Despite the large scale and sizeable impact of the event, a complete overview of its consequences and the causes of the inadequate rescue and treatment efforts is limited in the literature. This review examines the way different groups coped with the tragedy and points out the major mistakes made during the process. The effectiveness of Taiwan's emergency preparedness and disaster response system after the earthquake was analyzed.

Problems encountered included: (1) an ineffective command center; (2) poor communication; (3) lack of cooperation between the civil government and the military; (4) delayed prehospital care; (5) overloading of hospitals beyond capacity; (6) inadequate staffing; and (7) mismanaged public health measures.

The Taiwan Chi-Chi Earthquake experience demonstrates that precise disaster planning, the establishment of one designated central command, improved cooperation between central and local authorities, modern rescue equipment used by trained disaster specialists, rapid prehospital care, and medical personnel availability, as well earthquake-resistant buildings and infrastructure, are all necessary in order to improve disaster responses.
What a Disaster?! Assessing Utility of Simulated Disaster Exercise and Educational Process for Improving Hospital Preparedness
Authors: Bartley Bruce H. , Stella Julian B. , Walsh Liam D.
Published: August 2016

Introduction:

Recent events have brought disaster medicine into the public focus. Both the government and communities expect hospitals to be prepared to cope with all types of emergencies. Disaster simulations are the traditional method of testing hospital disaster plans, but a recent, comprehensive, literature review failed to find any substantial scientific data proving the benefit of these resource and time-consuming exercises.

Objectives:

The objective of this study was to test the hypothesis that an audiovisual presentation of the hospital disaster plans followed by a simulated disaster exercise and debriefing improved staff knowledge, confidence, and hospital preparedness for disasters.

Methods:

A survey of 50 members of the medical, nursing, and administrative staff were chosen from a pool of approximately 170 people likely to be in a position of responsibility in the event of a disaster.The pre-intervention survey tested factual knowledge as well as perceptions about individual and departmental preparedness. Post-intervention, the same 50 staff members were asked to repeat the survey, which included additional questions establishing their involvement in the exercise.

Results:

There were 50 pre-intervention tests and 42 post-intervention tests. The intervention resulted in a significant improvement in test pass rate: preintervention pass rate 9/50 (18%, 95% confidence interval ((CI) = 16.1–19.9%) versus post-intervention pass rate 21/42 (50%, 95% CI = 42.4–57.6%; X2 test, p = 0.002). Emergency department (ED) staff had a stronger baseline knowledge than non-ED staff: ED pre-test mean value for scores = 12.1 versus nonED scores of 6.2 (difference 5.9, 95% CI = 3.3–8.4); t-test, p <0.001. Those that attended >1 component had a greater increase in mean scores: increase in mean attendees was 5.6, versus the scores of non-attendees of 2.7 (difference 2.9, 95% CI = 1.0–4.9); t-test, p = 0.004. There was no significant increase in the general perception of preparedness. However, the majority of those surveyed described the exercise of benefit to themselves (53.7%,95% CI = 45.5–61.8%) and their department (63.2%, 95% CI = 53.5–72.8%).

Conclusions:

The disaster exercise and educational process had the greatest benefit for individuals and departments involved directly. The intervention also prompted enterprise-wide review, and an upgrade of disaster plans at departmental levels. Pre-intervention knowledge scores were poor. Post-intervention knowledge base remained suboptimal, despite a statistically significant improvement. This study supports the widely held belief that disaster simulation is a worthwhile exercise, but more must be done. More time and resources must be dedicated to the increasingly important field of hospital disaster preparedness.
Weapons of Mass Destruction Preparedness and Response for the XIV Pan-American Games, Santo Domingo, 2003
Authors: Báez Amado Alejandro , Sztajnkrycer Matthew D. , Giráldez Ediza M. , Comprés Hugo Pérez
Published: August 2016

The Pan-American Games are considered to be the fourth most important international athletic event in the world. Hosted by the city of Santo Domingo, Dominican Republic, the XIV Pan-American Games lasted from 11–17 August 2003. In preparation for the Games, the Security Directorate developed and deployed a Weapons of Mass Destruction (WMD) Unit. For operational support, two strike teams (Alpha and Bravo) were active at any given time. Each team consisted of five members including a team leader, field physician, explosive ordinance disposal (EOD) officer, and two tactical offi-cers. Three hospitals—two military and one civilian—were designated as pri-mary medical centers for the event. With the assistance of the WMD Unit, emergency department staff were trained in the medical management of a WMD event, response protocols for WMD were created, and special decon-tamination areas were designated. Syndromic surveillance was performed by means of direct communications between the hospitals and units, as well as use of an electronic, Web-based surveillance tool.
Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-Event Disasters
Authors: Bracha H.Stefan , Burkle Frederick M.
Published: August 2016

Threats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fearbased signs and symptoms may be extremely debilitating and lead to chronic problems with a risk of permanent damage to the brain's locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are managed best by timely and effective information, rapid evaluation, and possibly medications that uniquely address the locus-coeruleus-driven noradrenalin over-activation. It is recommended that a Fear and Resilience (FR) Checklist be included as an essential triage tool to identify those most at risk. The use of this checklist facilitates an enhanced capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required. In addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, the fear and resilience Checklist simultaneously identifies individuals who are hyper-resilient and can be asked to volunteer, and thus, rapidly expand the surge capacity.
Latex Allergy in the Prehospital Setting
Authors: Bridgewater Franklin H.G. , Zeitz Kathryn , Katelaris Constance , Field John
Published: August 2016

Introduction:

Latex allergy first was recognized early in the 20th Century, but was not a matter of concern until the last decade of that Century. The reported incidence of latex allergy in different occupations varies considerably. It has been documented in dental workers, operating theater staff, anesthetists, and laboratory technicians. However, little data specifically related to those involved in patient care in the emergency prehospital setting are available.

Methods:

A questionnaire was distributed to a sample of both volunteer and salaried first responders from St. John Ambulance Australia in South Australia and Western Australia, and the South Australian AmbulanceService. The first responders were surveyed to: (1) determine the incidence of latex allergy; (2) consider possible factors associated with its development; (3) compare characteristics of the surveyed groups; and (4) reinforce the development of an educational program.

The study tool had predetermined statistical qualities. Data were collated and processed using standard statistical procedures. Surveys were collected anonymously.

Results:

Of the 2,716 forms distributed, 1,099 were returned, resulting in an overall response rate of 40.5%. Atopy was identified in 14.9% of participants, hand dermatitis in 9.4%, and latex allergy in 6.4%. In the group of full-time ambulance officers, there was a significantly higher incidence of hand dermatitis and latex allergy. There also was a significant relationship between latex allergies and both dermatitis and glove usage (as measured by frequency and duration).

Conclusion:

In a group of first responders assessed by an anonymous, voluntary questionnaire, the subset of full-time, salaried ambulance officers was identified as having a higher incidence of hand dermatitis and latex allergy than their volunteer co-workers. These results require further assessment to substantiate the frequency of latex allergy and determine the predisposing factors. All personnel must learn about hand care. Non-powdered, natural rubber latex gloves should be supported for general use in this setting.
Paramedic Evaluation of Adult Intraosseous Infusion System
Authors: Findlay Judy , Johnson David L. , Macnab Andrew J. , MacDonald David , Shellborn Ryan , Susak Lark
Published: August 2016

Introduction:

The First Access for Shock and Trauma (FAST 1) Sternal Intraosseous (IO) System is a vascular access device designed as an alternative to peripheral or central intravenous (IV) cannulation for the treatment of critically ill and injured adults. During the development of the device, key objectives included safety, speed of insertion, and ease of use with minimal training. This study evaluated these characteristics.

Methods:

Ten experienced paramedics participated in a 90-minute training program for the use of the FAST 1 System at the Paramedic Academy of the Justice Institute of British Columbia. Then, the paramedics used thesystem in three simulated prehospital scenarios and evaluated the ease of use and compatibility of the training method with current practice using a 10-centimeter (cm) (3.94 inches (in)), visual analog scale.

Results:

The duration of the procedure from opening the package to initiation of fluid flow ranged 52–127 seconds (mean = 92 ±32 seconds). Placement accuracy was excellent, with a mean displacement of 2 mm (0.08 in) and 1 mm (0.04 in) in the vertical and horizontal planes, respectively. The paramedics rated the system highly in all areas. They considered the training “straight forward” and “comprehensive”. The possibility for interference between the IO system and cervical collars was reported, and several suggestions to remedy this and achieve other improvements were made.

Conclusions:

Placement of the FAST 1 is fast, accurate, and easy to use. Paramedics had useful input concerning the design of the product.
Pediatric Trauma at Tertiary-Level Hospitals in the Aftermath of the Bam, Iran Earthquake
Authors: Sabzehchian Marzieh , Abolghasemi Hassan , Radfar Mohammad Hadi , Jonaidi-Jafari Nematollah , Ghasemzadeh Houman , Burkle Frederick M.
Published: August 2016

The Bam Earthquake caused one of the most destructive disasters from naturally occurring hazards in recent years. Children are one of the most vulnerable age groups during disasters, in terms of both physical and psychological injuries. The assessment of pedatric injuries in the aftermath of the Bam Earthquake is discussed is this article. Within one week of the Earthquake, 119 patients <16 years of age were admitted to three tertiary-level referral hospitals in Tehran, Iran. Extremity, chest, and abdomen, and head and spinal column injuries were present in 83, 17, and 36 patients, respectively. Lower extremity injuries were morecommon than upper extremity injuries. A total of 65 operations were performed: 52 (80%) orthopedic, eight (12.3%) general, and five (7.7%) neurosurgical.