bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster
Authors: Ryan Benjamin , Franklin Richard , Burkle Frederick , Smith Erin , Aitken Peter , Leggat Peter
Published: May 2019

Introduction:

Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.

Aim:

To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.

Methods:

A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.

Results:

There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.

Discussion:

The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
Disaster Risk Reduction and Health: The Potential of Health Registers for Public Health Monitoring
Authors: Dückers Michel , Arnberg Filip , Baliatsas Christos , Reifels Lennart , Stene Lise , Yzermans Joris
Published: May 2019

Introduction:

The Sendai Framework seeks to substantially reduce disaster risk and losses in lives, livelihoods, health, and other assets including persons, communities, and countries. The framework focuses on reducing mortality while increasing population wellbeing, early warning, and promotion of health systems resilience. The use of scientific evidence to inform policy and formulate effective initiatives and interventions is crucial to disaster risk reduction within health. Different instruments and methodologies are available to guide policy and operations. The potential value of routinely collected patient data from health registers is that they can provide pre-event health and comparison group data without burdening affected populations.

Aim:

The current contribution aims to illustrate how health registers can help monitor the health impact of natural and human-made disasters.

Methods:

Patient data from health registers of general practitioners and other health professionals, sometimes combined with other registers and data sources, have been utilized to monitor the health impact of disasters and environmental hazards in the Netherlands, Norway, and Sweden since 2000.

Results:

Health registers allowed monitoring of mental health problems, medically unexplained symptoms, chronic health problems, and social problems. These were compared to groups not directly exposed. The health impact and care utilization was tracked after the fireworks explosion in Enschede affecting inhabitants of the neighborhood (2000; data range 1999-2005), children and parents after the Volendam café fire (2001; data range 2000-2006), Swedish survivors of the Tsunami in Southeast Asia (2004; data range 2004-2010), and parents of children affected by the terrorist attack on Utøya (2011; data range 2008-2014).

Discussion:

Health systems with registers have an important advantage when it comes to the potential for monitoring population health, and perhaps offer early warnings of pandemics. However, data generation should be closely connected to policy-making before and during the planning and evaluation of public health intervention.
Is There Calm After the Storm? A General Practice Registry-based Study Following the Case of a Severe Hailstorm in the Netherlands
Authors: Baliatsas Christos , Yzermans Joris , Nielen Mark , Dückers Michel
Published: May 2019

Introduction:

On June 23 and 24, 2016, a heavy hailstorm in the south of the Netherlands destroyed farms, greenhouses, and crops, and caused severe damage to many residences and cars in multiple communities. The size of the massive hailstones ranged from 3 to 5 centimeters in diameter. The farm damages alone were estimated to be 100 million euros, while total insurance industry losses were expected to exceed half a billion euros. In addition to the storm, the affected region also had its first tropical day of the year, with temperatures reaching 32 degrees Celsius. To date, the psychosocial impact and possible adverse health effects caused by the storm have not been thoroughly investigated.

Aim:

To explore whether the occurrence of chronic and acute health problems in the affected region increased after the hailstorm compared to “control” areas.

Methods:

Health data for the time period before (2013-2015) and immediately after the hailstorm (2016-2018) will be collected based on electronic health records (morbidity, psychosocial problems, and prescribed medication) from general practices (GP) located in the affected municipalities. For the same period, health problems in the affected region will also be compared with GP-registered data from different Dutch municipalities with similar urbanization levels, which will be used as a control group. The combination with external datasets (e.g. socioeconomic status, environmental exposures) will also be considered.

Results:

Multilevel regression analyses will be carried out to test the health impact of this sudden, onset event. The current study is a work in progress. Final results are expected in February 2019 and are presented during the conference.

Discussion:

The present study illustrates how routinely collected patient health records, recorded by GPs, can be used for epidemiological research in the aftermath of a disaster within the context of climate and weather extremes in Europe.
Earthquake, Tsunami, and Liquefaction in Central Sulawesi, Indonesia: How Far is Our Disaster Health Management Progress?
Authors: Donna Bella , Ariani Madelina
Published: May 2019

Introduction:

Located in the Pacific Ring of Fire, Indonesia is prone to natural hazards, such as earthquakes, tsunamis, floods, and volcanic activity. Management in the health sector is a necessary foundation for dealing with a disaster. Management lessons and essential experiences identified from disasters are often forgotten. The faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada has been developing disaster health management since 2009 after Padang Earthquake, followed by Merapi Volcano Eruption (2009), Pidie Jaya Earthquake (2016), and Lombok Earthquake (2018). The latest series of earthquakes that struck Central Sulawesi has revealed management problems with respect to the communication process, the development of coordination, and information and data synchronization.

Aim:

To show the importance of effective management in a health cluster, including what went well, what went poorly, and what will happen from the acute phase until the transition phase.

Methods:

Disaster health management implementation was compared from Padang to the Central Sulawesi’ earthquake. Then health cluster management was compared in Lombok and Central Sulawesi. Indicators were coordination, communication, data information, and organization.

Discussion:

There has been good progress for disaster health management in Indonesia. The health cluster approach makes coordination, data collected, and communication much easier. However, it also needs to focus on disaster planning, training, or simulation for the district health office while enhancing district response capacity. Although the challenges have changed in the last few decades, additional research is planned to limit management difficulties in the health cluster.
A Comprehensive Coalition Based Regional Approach to Pediatric Disaster Planning
Authors: Frogel Michael , Cooper Arthur , Foltin George
Published: May 2019

Introduction:

Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events.

Aim:

To prepare NYC for a large-scale pediatric disaster, NYCPDC has worked with an increasing number of providers that initially included a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include public health, emergency management, and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.

Methods:

The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.

Results:

The Plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing Guidelines and Templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Ob/Newborn/Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists is provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This includes pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.

Discussion:

The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.

The NYCPDC has responded to real-time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.
The Illinois EMSC Pediatric Preparedness Checklist - An Innovative Approach to Improving Pediatric Disaster Planning and Preparedness in Chicago
Authors: Severin Paul , Lyons Evelyn , Weber Elisabeth
Published: May 2019

Introduction:

The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.

Aim:

The goal of this study was to identify strengths and areas for improvement in pediatric disaster preparedness in participating Chicago hospitals.

Methods:

The impact of the EMSC Pediatric Preparedness Checklist was assessed during the 2016 Pediatric Facility Recognition hospital site surveys. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. All survey items were extracted, collated, and reviewed.

Results:

Fourteen Chicago hospitals participated in the survey. Almost all hospitals (93%) surveyed indicated that they consult staff with pediatric expertise when updating their EOP, incorporate pediatric trained mental health professionals into their disaster call lists (93%), and integrate staff with pediatric focus into their incident command system/emergency operation center during a disaster (79%). Almost all of the hospitals (93%) had an infant/child abduction plan and all hospitals (100%) were testing the process at least once per year. Finally, almost all of the hospitals (93%) had incorporated a patient connection program into their tracking and reunification plan. However, not all hospitals included drills for pediatric surge, decontamination, and evacuation. Less than one-third of the hospitals had pediatric components in their alternate treatment site plans. Half of the hospitals did not have pediatric components incorporated into their decontamination plans.

Discussion:

Integrating the EMSC Pediatric Preparedness Checklist surveys into the recognition process is an innovative approach to improve pediatric disaster planning and preparedness in hospitals.
Validation of the Pediatric Physiological and Anatomical Triage Score in Pediatric Patients with Burn Injuries
Authors: Toida Chiaki , Muguruma Takashi , Takeuchi Ichiro , Morimura Naoto
Published: May 2019

Introduction:

Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.

Aim:

This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.

Methods:

A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).

Results:

Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).

Discussion:

The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.
Developing Sustainable Prehospital Care for NCD Emergencies in Rwanda: A Collaboration between EMS, Ministry of Health of Rwanda, and Virginia Commonwealth University
Authors: Uwitonze Jean Marie , Asay Basil , Kabagema Ignace , Louka Stephanie , Wolfe Luke , Rosenberg Ashley , Dushime Theophile , Jayaraman Sudha
Published: May 2019

Introduction:

Every year, 71% of all deaths globally are due to NCDs. Over 85% of these deaths occur in low- and middle-income countries (LMICs), with 36% of all reported deaths in Rwanda attributed to NCDs. Approximately 24 million lives are lost each year in LMICs due to emergency medical conditions. The collaboration between VCU and the EMS Rwanda designed and implemented a pre-hospital medical emergencies training course and train-the-trainers program to address the rise of NCDs.

Methods:

During the course, pre and post 50 assessment questions were administered. Two cohorts participated 25 prehospital staff identified by EMS to form an instructor core and 19 emergency staff from public hospitals who are likely to respond to local emergencies in the community. A two-day EMCC was developed using established best practices. The Instructor core completed EMCC 1 and a one-day educator course and then taught the second cohort (EMCC2). Student’s t-test and matched paired t-tests were used to evaluate the assessments.

Results:

Mean score on EMCC 1 was 43% (SD: 20) compared to 85% (SD: 5) on post-course assessment. Pre-assessment failure rate was 88%. Mean scores for EMCC 2 were 45% (SD: 14) and 81% (SD: 10) on post-assessment. Pre-assessment score was low (50%). A paired t-test comparing pre-course to post-course assessment means demonstrated an increase by 42% (SD 30) for EMCC 1 (p<0.001) and 37% (SD: 14) for EMCC 2 (p<0.001) with 95% confidence. No items had to be removed from analysis based on the discrimination index (di).

Discussion:

NCDs often present as emergencies such as myocardial infarction and stroke. Effective management of these in the prehospital setting is essential to optimal outcomes. This study effectively implemented a training program in Kigali, Rwanda and created an instructor core to allow scale-up of effective pre-hospital services across the country.
Technology Development for Disaster Planning and Response: The Development of an Interactive Website to Communicate and Coordinate Primary Health Providers for Planning and Response Purposes
Authors: Callahan Deborah , McColl Graeme , Robertson Kelly
Published: May 2019

Introduction:

The Canterbury Primary Response Group (CPRG) was formed to provide a community-wide approach to manage, coordinate, plan for, and respond to health emergencies in the prehospital setting. Original communications within the CPRG group and to the primary sector were via email and the use of other organizations’ websites. These means were not easy to access and update content, and the group was depending on third parties.

Aim:

To outline the development of a primary health interactive website, provide up-to-date planning and event information, and provide information and support in relation to emergency planning for major emergency and non-emergency health events.

Methods:

The advancements of technology and planning practices have given CPRG the ability to develop information, planning, and operational reporting systems.

Results:

CPRG has developed a web-based portal that is available to primary health care (including community pharmacy) to provide planning assistance and templates as well as information on current events, such as the influenza season. It includes access to the CPRG suite of emergency plans and is a document repository for the Emergency Operations Centre (EOC). A further development has been a response management system for use in the CPRG EOC to assess any health situation and status of providers to enable a continually up-to-date dashboard and situational awareness reports to be visible to those coordinating the response.

Discussion:

Communication is a major factor, often the most criticized, when managing any response. The development of the CPRG website and system as described can alleviate this and provide accurate and consistent event and planning advice to those in the primary health sector.
Tailoring Disaster Risk Reduction for Adolescents: Perspectives from China and Nepal
Authors: Newnham Elizabeth , Gao Xue , Tearne Jessica , Guragain Bhushan , Jiao Feng , Ghimire Lajina , Balsari Satchit , Chan Emily , Leaning Jennifer
Published: May 2019

Introduction:

More than half of the world’s youth live in the Asia Pacific region, yet efforts to reduce disaster risk for adolescents are hindered by an absence of age-specific data on protection, health, and engagement.

Aim:

China and Nepal have faced a recent escalation in the number of climatic and geological hazards affecting urban and rural communities. We aimed to examine disaster-related threats experienced by adolescents and their caregivers in China and Nepal, determine the scope for adolescent participation, and elicit recommendations for improving disaster risk reduction.

Methods:

Sixty-nine adolescents (51% female, ages 13-19) and 72 adults (47% female, ages 22-66) participated in key informant interviews and focus group discussions in disaster-affected areas of southern China and Nepal. Using inductive content analysis, several themes were identified as key to adolescents’ needs.

Results:

Security and protection emerged as a central issue, interlinked with preparedness, timely and equitable disaster response, psychosocial support, and adolescent participation. The mental health risks emerging from trauma exposure were substantial. Adolescents made extensive contributions to disaster response including involvement in rescue efforts and delivering first aid, rebuilding homes and caring for family members. Participants forwarded a number of recommendations, including investing in psychological support, skills training, and stronger systems of protection for those at risk of family separation, trafficking, or removal from school.

Discussion:

The findings informed a multilevel, interconnected model for disaster risk reduction tailored to adolescents’ needs. Supporting adolescents’ recovery and long-term resilience after humanitarian crises will require coordinated efforts in preparedness, security, and mental health care.
Consideration and Practice on Hospital Incident Command System During Mass Casualty Incidents in Chinese Hospitals
Authors: Fan Haojun , Hou Shike , Zhao Yanmei
Published: May 2019

Introduction:

More and more hospitals are using the Hospital Incident Command System (HICS) for organizational management under emergency conditions. HICS is an incident management system based on principles of the Incident Command System (ICS), which assists hospitals and healthcare organizations in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. This study aims to explore how Chinese hospitals manage their organizations with HICS in Mass Casualty Incidents (MCI).

Aim:

To explore the feasibility of HICS in Chinese hospitals under MCI.

Methods:

A combination of literature analysis and empirical research was used in this study. Through case studies and experience summarization, the necessity and feasibility of the incident command system (ICS) and the emergency medical response system (EMRS) was demonstrated in the early stage of MCI. Based on this, a new "1 SECTION-5 GROUPS-10 TEAMS " model was proposed, and its value of practical application was discussed in MCI.

Results:

Multiple resources must be mobilized In MCI, and it is necessary to establish an ICS and an EMRS as soon as possible in the early stages of MCI. The earlier ICS is set up, the more initiative can be taken. The "1 SECTION-5 GROUPS-10 TEAMS" model proposed in this study has a good effect on the practice of drills and rescues, indicating that this model has a certain promotion effect in the hospital's response to MCI.

Discussion:

The "1 SECTION-5 GROUPS-10 TEAMS" model has high feasibility and can be further verified in the subsequent rescue practice.
A Backup System for Clinical Information after the Great East Japan Earthquake and Tsunami
Authors: Nakayama Masaharu
Published: May 2019

Introduction:

On March 11, 2011, the Great East Japan Earthquake and Tsunami hit the northeastern part of Japan, causing 15,895 deaths and 2,539 missing persons as of March 1, 2018. Moreover, many medical facilities were destroyed, resulting in the loss of medical information stored in paper records or on servers in hospitals and clinics.

Aim:

To highlight the need for a backup system for saving all clinical information during disaster preparation.

Results:

In 2012, a prefectural medical network system - the Miyagi Medical and Welfare Information Network (MMWIN) - introduced a cloud backup data storage service for disasters. This system facilitates the sharing of clinical data among hospitals, clinics, pharmacies, and other care facilities. The backup system is based on the Standardized Structured Medical Information Exchange (SS-MIX), which enables data from medical record systems, developed by different vendors, to be stored in a common format. By the end of September 2018, the total backed up clinical data, including patients’ basic information, disease names, blood tests, and prescription list, reached 370 million items from 11.2 million persons. We renewed the system last year and initiated an image data sharing service this year. The number of facilities within the MMWIN was 948, while the number of opt-in patients exceeded 80,000.

Discussion:

Although the project was financed by the government, a usage fee was collected from the participating facilities. To sustain this project, it is crucial to improve the balance between cost and income by increasing the number of participating facilities and decreasing maintenance cost. Thus, our clinical information backup system for disasters facilitates information sharing among medical facilities.
Feasibility and Accuracy of a Wearable Biosensor Device for Vital Sign Monitoring in Septic Emergency Department Patients in Rwanda
Authors: Garbern Stephanie , Mbanjumucyo Gabin , Umuhoza Christian , Sharma Vinay , Mackey James , Martin Kyle , Twagirumukiza Francois , Rosman Samantha , McCall Natalie , Wegerich Stephan , Levine Adam
Published: May 2019

Introduction:

Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.

Aim:

This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.

Methods:

This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.

Results:

42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).

Discussion:

Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.
Prehospital Advanced Resuscitation with Video Direct Medical Control Using Mobile Smart Device
Authors: Wang Soon-Joo
Published: May 2019

Introduction:

The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.

Aim:

The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.

Methods:

Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.

Results:

A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).

Discussion:

As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.
Watching to Save Lives
Authors: Herbst Raphael , Jaffe Eli
Published: May 2019

Introduction:

As Israel's National Emergency Medical Services (EMS) provider, Magen David Adom (MDA) is constantly looking for ways to improve the response to mass casualty incidents (MCIs). Previous research has shown that in an MCI situation, the demand for resources is disproportionate to the available resources, thus creating a dilemma of how to triage and treat the patients, as well as how to best prioritize and treat the critical patients.

Aim:

Smartwatches have become an integral part of society. MDA constantly looks for ways to integrate new technologies into their emergency response protocols. Smartwatches were used in this experiment to determine if in an MCI, relaying live information to the dispatch center would improve the time it takes for emergency crews to effectively treat and transport critical patients.

Methods:

A drill and scenario were designed to simulate an MCI in which there were 3 severe, 2 moderate, and 5 lightly wounded patients. There were then different colored smartwatches placed on each victim. The watches transmitted real-time blood pressure, pulse, and oxygen saturation readings to the dispatch center. The live information was transferred directly to responding teams. A second drill was conducted using the same scenario, same number of patients, but without watches to examine the differences in response times.

Results:

MDA found that the use of smartwatches directly improved the times (by 3.27 minutes) in which emergency teams were able to reach the most severely wounded patients and evacuate them to the hospital in a timely manner.

Discussion:

Using smartwatches to transmit live information to the dispatch center allowed for effective treatment and transport of patients in an MCI. Use of such information allows the dispatch center to direct teams to provide accurate treatment to the patients according to their needs.
Risk of Retrogression in Social Rights and Reduction of Brazilian Public Policies
Authors: Bellini Maria Isabel Barros , de Bellini e Soares Rodollfo
Published: May 2019

Introduction:

Brazil has 200 million descendants of African, Portuguese, Indigenous, German, Italian, and other peoples who have built their identities. The Federal Constitution was rewritten in 1988 to include a Social Protection System. Between 2000 and 2016, the federal government was governed by the Workers’ Party. This party invested in the creation of inclusive public policies and affirmative actions built through collective processes of citizenship that guaranteed better living conditions for the population. In one decade, it went from being underdeveloped to developing. In 2016, the elected president of the Workers’ Party was withdrawn from power through impeachment. In the next election, right-wing conservatives excluded speech, attacked minorities (e.g. LGBT population), and defended the traditional family.

Aim:

To understand the retreat of Brazilian public policies in a country that set public social policies, compensatory policies, and affirmative actions guaranteeing citizenship of men and women.

Methods:

Qualitative research with analysis and reflection on the regression of universalist public policies and affirmative policies with the creation of quotas.

Results:

The creation of affirmative actions was guaranteed. Vacancies in public tenders for the black population led to the establishment of 50% quotas for blacks in universities, and the creation of a universal health system, or universal expanded health indicators. The federal government created a group of SUS analysis by reducing actions.

Discussion:

Social inequality in Brazil is one of the worst in the world. 16 million people live below the poverty line (OXFAM, 2017). In recent decades, the population that was expanding and strengthening access to services, health, education, and social assistance network has seen a reduction of public policies. The importance of research that points to this reduction of rights is fundamental for documenting what has already been achieved.
Absence of Cultural Awareness Training in International Non-Governmental Organizations
Authors: Hart Alexander , Issa Fadi
Published: May 2019

Introduction:

Cultural awareness is the understanding of differences in cultures, and openness to these differences. It is a vital step in the development of cultural sensitivity and becoming operationally effective when working within different cultures. The benefits of Cultural Awareness have become apparent in recent decades, including within governments, militaries, and corporations. Many organizations have developed Cultural Awareness training for their staff to improve cross-cultural cooperation. However, there has not been a large movement toward cultural sensitivity training among Non-Governmental Organizations (NGOs) who provide aid across a number of countries and cultures. Cultural Awareness can be a useful tool which enables an NGO to better serve the populations with which they engage.

Aim:

To evaluate the presence within International NGOs of Cultural Awareness Training to employees and volunteers.

Methods:

Ten of the largest international NGOs were identified. Their websites were evaluated for any mention of training in Cultural Awareness available to their employees and volunteers. All 10 were then contacted via their public email addresses to find out if they provide any form of Cultural Awareness training.

Results:

Of the ten NGOs identified, none have any publicly available Cultural Awareness training on their websites. One NGO deals with cultural awareness by only hiring local staff, who are already a part of the prevalent culture of the area. None of the others who responded have any cultural awareness training which they provide.

Discussion:

Cultural awareness is a vital tool when acting internationally. Large NGOs, which operate in a wide range of cultures, have an obligation to act in a culturally aware and accepting manner. Most large NGOs currently lack cultural awareness training for their employees and volunteers. It is time for these NGOs to develop, and begin to employ, cultural awareness training to better prepare their staff to serve international populations.
Abu Dhabi Police Ambulance EMTs Medical Errors January-October 2018
Authors: Chalgham Riadh
Published: May 2019

Introduction:

Medical errors are a reality for Emergency Medical Technicians (EMT’s) working in a prehospital, high-stress environment. A “medical error” can be defined as a mistake or system failure which results in improper care of a patient’s injury.

Aim:

To study the frequency, severity, types, and causes of medical errors committed by Abu Dhabi Police Ambulance (ADPA) crews, and how to prevent these errors. The study is retrospective. All the data was collected using the Electronic Patient Care Report (EPCR) of all the patient treated and transported by ADPA crew from January to October 2018. After the EPCR auditing and monitoring, the medical errors were identified and discussed by a medical committee.

Results:

The total number of studied EPCR (trauma and medical cases) was 36.000. The medical errors identified were 265 cases (0.74%). 134 cases (51%) were moderate (can cause side effects), 115 cases (43%) were minor, and 16 cases (6%) were critical (can lead to death). The most common type of medical errors were cognitive errors. The causes were skill-based errors 27 times (10%) with 16 intravenous failures, 10 intraosseous failures, and one dislodged endotracheal tube after orotracheal intubation. The rule-based errors were committed five times (2%) when the Paramedics did not follow ACLS Algorithm, three times shockable cardiac arrest and two times Pulseless Electrical Activity. The knowledge-based errors were drug indications errors five times (2%). The three EMT’s levels in ADPA (Basic, Intermediate, and advanced) committed medical errors. The question to ask is not who made the mistake, but why the mistake was made. Preventing ADPA crew errors requires a systematic approach to modify the conditions that contribute to errors. The strategies are developing more awareness of cognitive errors by education and incorporating simulation into training.
Analysis of Disaster Psychiatric Assistant Team Activity During the Past Four Disasters in Japan
Authors: Takahashi Sho , Tachikawa Hirokazu , Fukuo Yasuhisa , Takagi Yoshifumi , Tetsuaki Arai , Watari Michiko
Published: May 2019

Introduction:

The Disaster Psychiatric Assistant Team (DPAT) is Japan’s original mental health care dispatched team during disasters. Established in 2013, this team has been involved in the response to many disaster-related mental issues.

Aim:

We Aimed to evaluate the DPAT activity in response to the past 4 disasters (Ontake volcano, Hiroshima flood, Joso flood, and Kumamoto earthquake), using the disaster mental health information support system (DMHISS).

Methods:

DMHISS data from the four disasters was extracted. Descriptive statistics were performed from the obtained dataset and the characteristics of the disaster victims from each disaster were compared and examined.

Results:

About 2,400 cases were obtained and tabulated to from the database. Based on descriptive statistics, the DPAT support objectives, activities and activity periods Aim to establish (1) the characteristics of the affected areas (population composition, psychiatric medical condition), (2) the scale and content of the disaster (the injured, building damage, number of evacuees), and (3) the activity ability. The number of counseling cases peaked several days after the disaster onset, and the importance of the DPAT activity during the acute phase was confirmed. The time course of the consultation number, which is a measure of the termination, could be predicted from the disaster scale and content. These results suggest that DPAT activity may be a guideline for local disasters for one month and for wide-reaching disasters for two months or longer.

Discussion:

It is suggested that the timing of activity and the termination period could be estimated from factors including the type of disaster, the size of the disaster, and the number of evacuees using the disaster mental health medical activities from four disasters. It should be considered necessary to accumulate data and examine indicators related to the DPAT activity.
Are Australian Pharmacists Willing to Work in a Disaster?
Authors: McCourt Elizabeth , Watson Kaitlyn , Singleton Judith , Tippett Vivienne , Nissen Lisa
Published: May 2019

Introduction:

Current literature suggests that a large percentage of the health workforce may be unwilling to work during a disaster. The willingness of pharmacists to work during a disaster is under-researched internationally and non-existent in Australia.

Aim:

To determine if Australian pharmacists are willing to work in a disaster and the factors that affect the willingness to work.

Methods:

A 13-question survey was developed from the current literature and released nationally through professional organizations and social media.

Results:

Sixty Australian pharmacists completed the survey. Most participants believed their pharmacy was an essential service for their community. Pharmacists reported they would be likely to report to work during a pandemic or biological disaster (73%) or natural disaster (78%). The two major factors likely to prevent pharmacists from working in a disaster are family and safety concerns. Pharmacists perceived that their duty of care to their patients would make them likely to work during a disaster. Most pharmacists noted they would work even if they were expected to work outside their scope of practice, or if their place of work lacked electricity or was damaged.

Discussion:

Depending on the disaster, up to 27% of the pharmacy workforce may be unwilling to work in a disaster. Family and safety concerns were the primary barriers to pharmacists reporting to work in the aftermath of a disaster. Providing guidelines on how pharmacists can prepare their family for a disaster may assist in ensuring pharmacists are willing to work. The pharmacists surveyed demonstrated a strong commitment to their duty of care with the majority stating they would be likely to work in austere work environments. This research raises questions of the safety of pharmacists working outside their scope and in austere environments and whether it is safe for them, their patients, and the broader community.
Assessment of HEMS Teams Performance in Out-of-Hospital Cardiac Arrest (OHCA)
Authors: Gula Przemyslaw , Rzonca Patryk , Galazkowski Robert , Podgórski Marcin
Published: May 2019

Introduction:

The Out of Hospital Cardiac Arrest (OHCA) procedures constitute one of the most quantifiable indicators of the quality of Emergency Medical Services (EMS). In Poland, HEMS teams perform such procedures both during primary missions and when they support EMS teams.

Aim:

To carry out a retrospective analysis of OHCA related calls received from January 1, 2011, to December 31, 2016.

Methods:

During the relevant period there were 2,447 OHCA related calls. Of those, 308 cases were excluded from the analysis because no cardiac arrest was confirmed or the patients showed signs of death that prevented any emergency procedures.

Results:

The Return of Spontaneous Circulation (ROSC) was achieved in 1,119 cases. Resuscitation was clearly much more effective if CPR procedures were commenced prior to the arrival of the HEMS team. The groups in which higher survival rates were obtained included women, patients younger than 40 and patients who had signs of shockable rhythms. The use of HEMS team allowed for faster transport of patients to relevant specialist institutions, specifically if an invasive cardiological intervention was needed.

Discussion:

The use of HEMS teams in OHCA related calls indicates that such actions are highly effective both in primary missions and when HEMS teams support other EMS terms. An additional advantage is the possibility of quick transportation to a relevant specialist medical center.
Comparing Training Techniques in Chemical Disaster Preparedness
Authors: Salway Richard , Williams Trenika , Londono Camilo , Arquilla Bonnie
Published: May 2019

Introduction:

Currently, there are no universally accepted personal protective equipment (PPE) training guidelines for Emergency Medicine physicians, though many hospitals offer training through a brief didactic presentation. Physicians’ response to hazmat events requires PPE utilization to ensure the safety of victims, facilities, and providers; providing effective and accessible training is crucial. In the event of a real disaster, time constraints may not allow a brief in-person presentation and an accessible video training may be the only resource available.

Aim:

To assess the effectiveness of video versus in-person training of 20 Emergency Medicine Residents in Level C PPE donning and doffing (chemical-resistant coverall, butyl gloves, boots, and an air-purifying respirator).

Methods:

A prospective observational study was performed with 20 Emergency Medicine residents as part of Emergency Preparedness training. Residents were divided into two groups, with Group A viewing a demonstration video developed by the emergency preparedness team, and Group B receiving in-person training by a Hazmat Team Member. Evaluators assessed critical tasks of donning and doffing PPE utilizing a prepared evaluation tool. At the drill’s conclusion, all participants completed a self-evaluation to determine their confidence in their respective trainings.

Results:

Both video and in-person training modalities showed significant improvement in participants’ confidence in doffing and donning a PPE suit (p>0.05). However, no statistically significant difference was seen between training modalities in the performance of donning or doffing (p>0.05).

Discussion:

Video and in-person training are equally effective in preparing residents for donning and doffing Level C PPE, with similar error rates in both modalities. Future trainings should focus on decreasing the overall rate of breaches across all training modalities.