bluuebunny/crossref_metadata_2025 huggingface dataset:
(A23) Mass Casualty Incident and Terrorist Attack Preparedness of German Hospitals and Physicians Compared to Austria, Switzerland, the USA and a Worldwide Collective
Authors: Fischer P. , Nitsche C. , Kabir K. , Wafaisade A. , Müller S. , Rohner M. , Kees T.
Published: May 2011

Context

Because of worldwide increase of catastrophes and recent terrorist attacks, hospitals and physicians are devoting increased attention to disaster and mass casualty incident (MCI) preparedness not only outside but also inside hospitals. In case of a terrorist attack physicians have to cope with injuries caused by conventional, biological, chemical, or radioactive weapons.

Objective

The aim of this study was to evaluate the current state of preparedness of German hospitals and physicians in case of an MCI or terrorist attack and to compare those results to the preparedness of hospitals and physicians from Austria, Switzerland, the United States of America and a worldwide collective.

Materials and Methods

Using an online questionnaire, we interviewed 1343 physicians in Germany, Austria, Switzerland, the US and a worldwide collective. The replies were analyzed statistically with the Shapiro-Walk test and the Mann-Whitney-U test.

Results

in Germany physicians are less prepared than their colleagues worldwide for disasters inside and outside hospitals. 48,4% of German physicians (37% worldwide) did not know their area of responsibility as a physician in case of an “internal” emergency (fire, water pipe burst, power cut), even though 30,2% of German physicians (29,1% worldwide) have already had a real emergency in their hospital. Only 65,3% of physicians in Germany (75,5% worldwide) knew their area of responsibility in case of an MCI; MCI training was given less often in Germany (42,7%) than worldwide (64,3%). Most physicians in every country were unaware of injury patterns and treatment strategies in patients following bombings or nuclear, chemical and biological contamination.

Conclusions

Hospital Physicians are insufficiently prepared for internal emergencies and MCIs. There is a need for more drills in hospitals. In spite of the recent threat of terrorist attacks, the physicians' emergency training should be modified to accommodate the increased risk of catastrophes and terrorist attacks.
(A41) Perceptions of Military Medical Disaster Training
Authors: Higgins D.M.
Published: May 2011

Backgound

To be effective, disaster preparedness training should continually meet the needs of the trainees. Most military medical personnel undergo training focused on practicing in austere environments with little support. However, while located at their home station, disaster response is conducted in a different manner due to staffing and available resources. This survey attempts to identify areas of the military medical disaster response staff are most concerned with in order to better formulate future training for home station as well as contingency operations, ultimately increasing confidence and effectiveness.

Methods

An online survey service was utilized to anonymously poll 106 military medical personnel assigned to a joint Level 1 trauma center in Iraq using 38 forced Likert-scale questions. The training issue of most concern for both arenas is the patient surge. Military-civilian collaboration was a key point regarding the home station setting and supplies/equipment for the deployed setting.

Results

Eighty-nine percent of responders rated disaster training as moderate to very important. However, there was a low perception of disaster exercises conducted in the manner of a real-world event. This was attributed to unrealistic participation and training methods. Computer-based training (CBT) was identified as an ineffective method of training; hands-on instruction clearly identified as the preferred method. Participants rated considerable confidence in Level C personal protective equipment, and the majority surveyed would report for duty despite exposure risk.

Conclusion

Current training methods may not optimally produce disaster response effectiveness. Management of the patient surge was a repeating training concern for both home and deployed settings. Future training efforts should focus on military-civilian collaboration for the home station, and management of the patient surge for both arenas.
(A96) Process Improvement in Disaster Relief: Improvement of Disaster Resource Utilization through Systematic Organization
Authors: Bloem C. , Gore R. , Arquilla B. , Naik T. , Schechter J.
Published: May 2011

Introduction

Upon arrival of the SUNY Downstate Medical Center team for their disaster relief mission in Port au Prince, Haiti, it was observed that obstacles to patient care were directly related to difficulty in locating supplies and medications in a timely manner. In addition, staffing schedules had not been correlated to patient flow patterns.

Methods

A survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center. The following variables were obtained to assess existing resources: number and types of providers available, provider staffing schedules, medication/supply inventories and management systems. Basic ED operation and supply system flow maps were created.

Results

The assessment revealed a large volume of patients presenting in the early morning. Night shifts were inconsistently staffed with ED physicians. Although medications and supplies were reported to be available on-site, they were not tracked, inventoried, or centrally managed. As a result, this increased time to treatment and practitioner fatigue. Process improvements included: (1) Institution of swing and night shifts accommodated peak patient volumes, decreased waiting times, provided care for critical patients during off-peak hours, and decreased physician fatigue. (2) Identification and labeling of existing medications/supplies facilitated more accurate management of inventories and decreased time to treatment and disposition.

Conclusion

Process improvement through systematic analysis led to better disaster resource utilization in this tent hospital.
(A98) Animal Relief Coalition of Haiti (ARCH): A Collaborative Approach to Animal Relief and Recovery
Authors: Green D.
Published: May 2011

Background

Following the devastating earthquake in Haiti last January, the International Fund for Animal Welfare (IFAW) and the World Society for the Protection of Animals (WSPA) developed the Animal Relief Coalition of Haiti (ARCH). 19 animal welfare agencies from around the world joined IFAW and WSPA to provide a $1.04M managed fund to the Minstery of Agriculture, Natural Rescources, and Rural Development (MARNDR).

Discussion and Observations

The relief and recovery efforts were based around six objectives: 1. Mobile veterinary clinic 2. Public Outreach emphasizing disaster preparedness, disease prevention, and animal welfare 3. Educational outreach to include an animal welfare curriculum for school-aged children 4. Cold-chain: to provide solar-powered refer/freezer units in remote sections of Haiti to keep vaccines cold 5. Dog and cat survey in Port-au-Prince 6. Rebuilding of the National Laboratory The purpose of this presentation will be to discuss how ARCH was developed and Best Practices and Lessons Learned from a collaborative approach to animal relief and recovery.
(A113) Ethics in the Delivery of Humanitarian Health Response: Learning from the Narratives of Health Care Workers
Authors: Redwood-Campbell L. , Hunt M. , Schwartz L. , Sinding C. , Elit L. , De Laat S. , Ranford J.
Published: May 2011

Aims

1. To hear the types of ethical challenges foreign health care workers (HCWs) experience while providing health care in conditions of disaster and deprivation. 2. To hear how they responded 3. To understand the kinds of resources that may have been helpful to support HCWs in these ethical dilemmas.

Methods

Qualitative study, loosely grounded theory. Canadian trained HCWs (n = 20, mean age 39) who have worked in disaster response, conflict, post disaster.

Results

Ethical dilemmas emerged from 4 main sources: resource scarcity, historical/political/social structures, aid agency policies/agendas, HCWs norms roles/interactions. Participants described little preparation to deal with ethical dilemmas, and the value in pre-departure training. Clinicians are nurtured in western ethics- mostly formed on autonomy, beneficence, non-maleficence and justice. New realities for many were related to community oriented Public Health Ethics. Early discussion has emerged about the possibility of developing a simple, practical, hand held decision-making model (toolkit) to be used in the field to help guide reflection about ethical dilemmas for HCWs in disaster settings.
(A128) Awareness and Preparedness of Western Children's Hospitals for Disasters
Authors: Fette A.
Published: May 2011

Disasters involving children are becoming more and more frequent. Thus, optimal preparedness will be a challenge for every Western pediatric disaster specialist. However, for any appropriate decision to be made, there must be a practical tool for accurately evaluating the levels of specific disaster awareness and preparedness. This tool is based on the idea that child injury prevention campaigns [n = 6] are usable as a platform for the simulation of specific pediatric disaster scenarios, and that different simulations might be able to modulate overall awareness and overall preparedness levels, as well as affect the training provided. Data are gathered from a disaster phase-related (Haddon-Matrix) set of questionnaires answered by key disaster response personnel [n = 58]. Overall awareness for a pediatric disaster scored highest for the “in the world” scenarios, with less, but with similar scores for “in the country” and “in the region” scenarios. Overall preparedness scored low for “in the world”, with higher scores for “in the country” and “in the region”. Both, overall awareness and overall preparedness scored inconsistently for “in the hospital” in the first instance, but later in the matrix, “in the hospital” had the highest scores. In general, basic knowledge about disaster plans is moderate, and knowledge about existence and activation of preparedness measures is above average. Individual position-taking and feelings of personal competency in position-taking is low, especially among junior staff. Currently, only a group of seniors are able report participation in a specific training. This platform is an upgradable tool for the awareness of and preparedness for pediatric disaster assessments, regarding phases, locations, and training, with promising trends for their modulation, especially among junior staff.
(A151) Non-Traumatic Out-of-Hospital Arrests: Initial Cardiac Arrhythmia, Circadian Differences and Cause of Death
Authors: Alicia V. , Yih Chong Michael C. , Eillyne S.
Published: May 2011

Background

Out-of-hospital cardiopulmonary arrest (OHA) is an international health issue. There is an urgent need to better understand the key factors that affect OHA survival. Epidemiological surveillance is the first step towards scientific understanding of the problem. This study looks at the profiles of patients who suffered an OHA.

Methodology

In this retrospective study, the medical records of all patients who died upon arrival at Tan Tock Seng Hospital, Emergency Department (TTSH ED) between 1st January 2009 and 31st December 2009 were reviewed. The outcomes include patient demographics, pre-hospital management and the cause of death.

Results

Within the study period, there were a total of 275 OHA, 5 (1.8%) traumatic and 270 (98.2%) non-traumatic cases. Emergency Medical Service (EMS) conveyed 247 (91.5%) of OHA and 23 (8.5%) arrived by self-transport. The incidence of non-traumatic OHA was 14 per 10,000 ED attendees, predominantly male (72.2%). Male were significantly younger than female (63 vs 70 years, p = 0.002). The commonest initial cardiac arrhythmia recorded on scene by paramedics was asystole (54.1%), pulseless electrical activity (34.8%) and ventricular fibrillation (11.1%). One hundred sixty-one (59.6%) patients collapsed during the day (0600 – 1759 hours). Patients found in ventricular fibrillation on scene peaked in the morning (1020hours). All OHA were started on cardiopulmonary resuscitation, intubated with laryngeal airway mask, given intravenous adrenaline, and all ventricular fibrillation was electrically defibrillated en-route by the paramedics. Despite continued resuscitative efforts in the ED, all remained in asystole. The State Coroner reviewed 266 (96.7%) OHAs, of which, 96 (36%) were subjected to post mortem. Among patients with asystole at scene, acute coronary syndrome (55.2%), hypertensive heart disease (13%) and bronchopneumonia (5.2%) were the three commonest cause of death. The commonest cause of death for ventricular fibrillation at scene was acute coronary syndrome (76.7%), of which 10 (43.5%) had no pre-existing medical conditions.

Conclusion

In our study population, majority of patients had asystole as their presenting arrhythmia at scene. OHA with ventricular fibrillation demonstrated significant circadian differences and the underlying cause of death was acute coronary syndrome. This knowledge will allow EMS to devise future strategies that have the greatest potential to improve survival outcomes.
(A185) Did the Ministry of Health's Intervention Increase Compliance of Medical Teams to be Vaccinated against H1N1?
Authors: Adini B. , Laor D. , Hornik-Luria T. , Goldberg A. , Aharonson-Daniel L.
Published: May 2011

Background

Pandemic influenza poses a great challenge to healthcare systems. Vaccinating medical teams and the population against pandemic influenza is the global recommended strategy to contain spread of the disease. As part of the efforts made to overcome the H1N1 pandemic, the Israeli Ministry of Health (MOH) initiated a general vaccination program for medical teams and the total country population. Due to low compliance rates of the medical staff, the MOH conducted regional conferences aimed at providing knowledge and encouraging staff to be vaccinated.

Objectives

To evaluate the effect of the regional conferences on the compliance rates amongst medical providers to be vaccinated against H1N1.

Methods

Medical providers from the primary health care services were invited to conferences that were conducted in 3 regions. Attitudes of the teams regarding compliance to be vaccinated were assessed pre and post the conferences. Additionally, the actual rates of vaccinations were recorded over the period of vaccination program. Actual compliance rates before and after the conferences were compared to detect differences as well as the relationship between teams' attitudes and actual vaccinations.

Results

Vaccination rates of medical providers remained low during the full vaccination period. Among the non-vaccinated, 24% to 29% reported before the conference that they agree to be vaccinated versus 57% to 62% following the conference. Analysis of the actual vaccination data among the medical providers did not demonstrate a change in compliance following the conferences and an overall decrease was noted after the first two weeks of the vaccinated project.

Conclusions

A statistically significant relationship was not found between reported attitudes of medical providers regarding readiness to be vaccinated and their actual vaccination. The MOH intervention did not achieve the expected result and did not raise compliance to be vaccinated.
(A211) Nanosciences and CBRN Threats: Considerations about the Potential Risk of Illicit Use of Nanosystems
Authors: Rossodivita A. , Guidotti M. , Ranghieri M.
Published: May 2011

In the history of humankind, any new scientific discovery has shown the risk of a “dual use” for peaceful purposes or for warfare. In regard to non-conventional weapons, the recent exponential development of nanosciences and nanotechnology can provide efficient tools for counteracting these threats, by improving the detection, protection, and decontamination capabilities in the field of CBRN defence. Nevertheless, these disciplines also may offer novel, uncontrolled means of mass destruction, leading to the synthesis of new, intentionally toxic systems. Furthermore, several points of concern are linked to the new concepts of “nanotoxicology” and “nanopathology: If a multidisciplinary approach is needed to study nanosciences and nanotechnologies, a multidisciplinary approach also is needed to have a strict control on potential illegal uses of nanosystems. Experts active in various fields, such as academic, industrial, military, and health protection institutions, must work cooperatively to constantly follow the state of the art, note which kind of critical emerging technologies may lead to illicit uses, and control the diffusion of hazardous nanosystems that may be potential precursors of weapons of mass destruction, and cooperate with CBRN emergency prevention organizations in order to plan suitable countermeasures. This presentation will cover some examples of nanosystems applied to defense from non-conventional warfare agents and answer questions regarding potential misuses of basic nanoscience and nanotechnology findings.
(A276) Improving Emergency Medical Care in Nigeria - The Ubth Emt-Paramedic Training Programme
Authors: Iribhogbe P.E.
Published: May 2011

Background

Trauma is the leading cause of death in the age group 15–44 years in Nigeria. The burden of trauma has continued to increase in the subregion. It is estimated that a significant proportion of trauma deaths occur prehospital. The role of the EMT-Paramedics in trauma and emergency care is well established. However the profession has been absent in the West African subregion. There was no training centre for EMT Paramedic professionals until the UBTH established one in 2008.

Objective

To review the UBTH EMT-Paramedic training programme and the implications for trauma and emergency care.

Method

The programme onset, implementation and challenges so far is reviewed in detail with illustrations.

Conclusion

The injection of the EMT-Paramedic professionals into our health system will surely improve our emergency care. The support of the Government at all levels as well support for the training from all Medical professionals is urgently neede.
(P1-8) The Port-Au-Prince 2010 Earthquake - Unique Lessons Learned by Florida One Disaster Medical Assistance Team (FL1 DMAT) in the First International Dmat Deployment
Authors: Mccann D.G.
Published: May 2011

Introduction

The devastating Haiti earthquake of January 10, 2010 resulted in 250,000 dead, more than 300,000 wounded and at least 1.3 million displaced. As the poorest nation in the Western Hemisphere, life in Haiti was already fraught with poverty and one of the highest HIV rates in the world. After the earthquake, life in Haiti became intolerable. As Chief Medical Officer of Florida One DMAT, the author helped to coordinate medical relief operations at the US Embassy in Port-au-Prince beginning within 60 hours of the earthquake. The author and his FL1 DMAT team supported medical relief operations not only at the US Embassy but also at the Toussaint L'Ouverture International Airport for air evacuation of survivors to Miami and at Terminal Varreux for coordination of ingress/egress casualty operations for the USNS Comfort hospital ship.

Results

Unique lessons were learned in this first ever deployment of US DMATs on foreign soil. The presentation will describe the medical operations, the triage process, the challenges of operating on foreign soil, and the results of the relief efforts. Recommendations will be offered to facilitate future international DMAT deployments including development of Standard Operating Procedures (SOPs) for DMAT international deployments and increased coordination between the US Department of State (who have jurisdiction over US assets on foreign soil) and the US Department of Health & Human Services (who are the coordinating governmental department for DMAT operations).
(P1-54) Healthcare Worker's Perception towards Individual and Institution Disaster Preparedness
Authors: Lim G.H.
Published: May 2011

Background and Aim

Disaster and MCI events are occurrences that healthcare institutions must be prepared to respond to at all times. The events of September 11 2001 have rekindled our attention to this aspect of preparedness amongst our healthcare institutions. In Singapore, the SARS experience in 2003 and the recent H1N1 outbreak have thrust emergency preparedness further into the limelight. While priorities had been re-calibrated, we feel that we still lack far behind in our level of preparedness. This study is conducted to understand the perception of our healthcare workers towards their individual and the institution preparedness towards a disaster incident.

Method

A questionnaire survey was done for this study for the doctors, nurses and allied health workers in our hospital. Questions measuring perception of disaster preparedness for themselves, their colleagues and that of the institution were asked. This was done using a 5-point likert scale.

Results

The study was conducted over a 2-month period from 1st August 2010 till 30th September 2010. 1534 healthcare workers participated in the study. 75.3% felt that the institution is ready to respond to a disaster incident; but only 36.4% felt that they were ready. 12.6% had previous experience in disaster response. They were more likely to be ready to respond to future incidents (p = 0.00). Factors that influenced perception of readiness included leadership (p = 0.00), disaster drills (p = 0.02), access to disaster plans (p = 0.04), family support. 80.7% were willing to participate in future disaster incident response training. 74.5% felt that being able to respond to a disaster incident constitute part of their professional competency. However, only 31% of the respondents agreed that disaster response training was readily available and only 27.8% knew where to go to look for these training opportunities.

Conclusion

There is an urgent need to train the healthcare workers to enhance their capability to respond to a disaster incident. While they have confidence in the institutions capability they were not sure of their own capability. Training opportunities should be made more accessible. We should also do more to harvest the family support that these worker value in order for them to be able to perform their roles in a disaster incident.
(P1-64) E-Learning for Staff Education on Managing Catastrophe Plan – Hospital in Sao Paulo – Brazil
Authors: Mizoi C. , Sousa E. , Kina S.O. , Vaidotas M. , Sako Y.K. , Tucherman M. , Barros C.G.
Published: May 2011

Introduction

Staff education and qualification is a safety issue to maintain employees ready to act whenever the catastrophe plan is deflagrated especially since it only happens once in a while. Considering that catastrophe is an unexpected event and most of the time an unusual scenario, the risk of inefficient patient care and unsafe situations for employees and for the environment is high.

Objective

To describe the e-learning as a continuous training methodology to keep staff prepared to manage victims from a catastrophic situation whenever it happens.

Methodology

E-learning is a methodology for distance learning with focused content, pedagogy, technology and instructional system design aimed to deliver education. E-learning has advantages such as: a rapid update, customization of content, access flexibility, continued availability, reduced time for learning, training of a large number of employees with access control and release reporting. The development of e-learning is based on the following phases: analysis of topic relevance, evaluation by expert professional, relevance and applicability as educational strategy, planning and content construction with related areas, development of the storyboard and formatting with an instructional designer. The content of the e-learning Catastrophe Plan include definition of catastrophe, STAR screening method, roles and responsibilities, attendance flows, tests. Its duration was 30 minutes.

Results

During 03 months the e-learning of Catastrophe Plan was available in the intranet to Albert Einstein employees. A total of 3104 employees were trained representing 56% of target public (n = 5541). After this period, the e-learning became constantly available and part of the new employees admission process.

Conclusion

E-learning is an innovative educational methodology that contributes to the retention and generation of knowledge. The care and support team during the simulations in 2010 showed better performance when compared to 2009 due to the capability of this tool to spread the knowledge.
(P1-73) Medical CBRN Training for Military Health Staff and Its Benefits
Authors: Kenar L. , Ortatatli M. , Kunak Z.I. , Oztuna A. , Arziman I.
Published: May 2011

Objective

The increasing threat of the use of chemical, biological, radiological, and nuclear (CBRN) agents requires significant military medical preparedness and response, including training. The initiatives for CBRN training by Gulhane Military Medical Academy, which is under the Health Command of the Turkish Armed Forces, will be discussed, and the training program and educational model for medical CBRN defense will be highlighted.

Method

The training is given to military hospital staff once or twice a year. Hospital staff is trained over a period of five days, with practical issues regarding medical CBRN defense covered during the last two days. A questionnaire is given to trainees at the beginning and at the end to ascertain the adequacy of the course.

Results

So far, this medical CBRN training has been given to 150 military health staff including physicians, nurses, and medical non-commissioned officers. According to the survey, they benefited greatly from this training, and there was a statistically significant increase in CBRN knowledge when the initial and final scores of the survey were compared (x2 = 3.089; p = 0.002).

Conclusion

Through this planned trainings, staff are trying to become well-trained in detection, personal protection, decontamination, and the organization aspects of CBRN defense to apply the proper prophylactic measures, diagnosis, and treatment. Feedback suggests this program also helped “train the trainers”, providing extensive information to other staff working in military hospitals.
(P1-77) Helping Children Cope with Ongoing Stress
Authors: Arbeli Y.
Published: May 2011

Stress is a major health risk factor. The origin of the stress or stressful situations might come from internal and/or external causes. In this presentation, two groups of Israeli children who are living under stressful conditions that are affecting their health, their daily functioning, and their learning abilities will be presented. The first group is a group of children living in a town that has experienced terrorist activities for many years. The other group is children from families that have to leave their permanent home due to the Israeli Parliamentary and governmental decision to withdraw from the Gaza Strip. This plan included forced relocation of approximately 8,000 civilians from their communities to temporary sites elsewhere in Israel, and the dismantling of their homes. Using the classical epidemiological triad model of host-agent-environment, the hazard dynamic and its outcomes will be presented. Activities to help the children cope with the stressful situations also will be presented. The objective of this presentation is to describe exposure to risk factors and responses from public health nurses that are aimed at ameliorating the associated negative heath effects.
(P1-88) Development of a First Hospital Based Trauma Registry at JPN Apex Trauma Center, India
Authors: Gupta A. , Kumar S. , Sagar S. , Singhal M. , Mishra B. , Misra M.C.
Published: May 2011

Although Injury is being looked into as a major public health problem in India, most of the data coming is mortality related data from the National Crime Records Bureau and projections based on that data. There is complete absence if injury related data both surveillance data as well as outcome based data. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi is one of the pioneering centers to understand the need to record the injury related data of all trauma cases which are admitted to the Apex Center, thus establishing a first of its kind hospital based Trauma Registry in India. This trauma registry will serve as a means for collating trauma data that will further help in the evaluation, prevention, and research of trauma care and can be used for quality control and planning future research and injury prevention activities, in India. Later, the center has an objective of networking all regional hospitals for data collection with an aim to establish a National Trauma Registry. Although several trauma registry software's exist from Western hemisphere but the Apex Trauma Center decided to formulate and designed its own Trauma Registry form and develop the related software which includes: Basic Identification; Demographic profile; Brought by personnel and vehicle; Condition at time of arrival; ED Interventions; Detailed Diagnosis; Definitive Procedures; Disposition/ Outcome The Trauma registry is being maintained, under the leadership of a Faculty and the data is collected and entered by the Trauma Nurse Coordinators, who follow the patient from admission to discharge. The data collection for the JPNATC Trauma Registry had started w.e.f. April 2009, but initially there were usual problems of data loss and non-availability of data. This has been overcome gradually and we hope that the registry will attain its full potential in another year or so.
(P1-97) Long-Term Effects of a Flood on the Psychosocial Health of Victims
Authors: Maltais D. , Lachance L.
Published: May 2011

Long term Effects of a Flood on the Psychosocial Health of Victims D. Maltais1 et L. Lachance2, Université du Québec à Chicoutimi, Québec, Canada, 1Département des sciences humaines, 2Département des sciences de la santé In July 1996, floods disrupted the lives of thousands of people living in rural and urban communities in the Saguenay area of Quebec. Data collected three years after the events showed that flood victims experienced more precarious psychological health, with various factors being controlled including sex, age, and life events. Flood victims demonstrated more post-traumatic symptoms, somatic symptoms, social dysfunctions, and depressive symptoms than non-victims. Victims also showed significantly lower levels of psychological well-being than non-victims. In order to identify the long-term impacts of flood exposure, a second study was conducted eight years after the event (2004) with the same groups of victims (N = 129) and non-victims (N = 89). Variance analyses show that urban survivors obtained improved scores on scales measuring PTSD, and depression yet remained significantly more affected than non-victims. Over time, victims also obtained improved scores on the GHQ-28 and the Affect Balance Scale yet also remained significantly different from non-victims on the GHQ-28. Rural victims improved their GHQ scores over time as well, yet maintained significant differences with rural non-victims for the PTSD score. No significant differences were observed over time (time 1 and time 2) or between groups (victims and non-victims) regarding psychological well-being and depressive symptoms in rural area.
(P1-101) Salvage of Traumatized Extremities Restores Morale in Working Class of Society
Authors: Raju V.
Published: May 2011

Introduction

To improve quality of life among subjects with crush injuries of extremities as an outcome of traumata of various aetiology by salvage procedures. To prevent or minimize psycho-social derangement or implications by minimizing partial or total loss of traumatized body parts and restore useful function.

Material

20 year study/observation in trauma of limbs, hands, feet, fingers, toes with partial to near total vascular compromise sustained in road traffic, industrial, domestic, suicidal, homicidal, war wounds, fire work blasts, etc. accidents.

Method

Pre-operative/follow-up counselling of every patient, attendants and employer are of utmost importance. Primary debridement, stabilization, skin cover and serial paraffin-gauge dressings are followed with straps/splints, passive/active range of movement exercises and delayed suture removal. Antibiotic cover with sequential cultures are mandatory.

Facts / Figures

Sepsis is a challenge. Males, youth, hands, Grade II wounds and RTAs dominate incidence. Contamination, delayed presentation, poor compliance and follow-up, poor nutritional status, anaemia, etc., dread salvage. Initial poor tissue perfusion is no indication for early decision to amputate/terminalize.

Results

Compromised vascular crushes in which primary closure was achieved, salvage of limb and appendages was surprisingly possible. Cosmesis in working class is never the priority, but restoration of function and more so the chance of livelihood are. Dexterity and confidence come with practice. Richer the patient, difficult to convince. Psycho-social depression is more with early amputations than in revisions and much less in salvaged groups, commoner in men and unmarried illiterate women. Women adapt better to salvaged parts.

Conclusion

Even a nail lost with its bed is lost for ever, leaving a painful defunct stump. No riches can truly compensate. If soft tissue cover on bony elements and neuro-vascular bundles is achievable, an entire limb may survive and regain near normal function. When crush wounds remain aseptic a decision to amputate can wait.
(P2-4) Prehospital System Development in Jaffna, Sri Lanka
Authors: Bollinger P. , Zimmerman J. , Bertermann K. , Nominathan R. , Woodyard D.R.
Published: May 2011

Introduction

This case study presents the development of a prehospital system in Jaffna, Sri Lanka. The case then outlines the development of the system, examines its first year of operations, and investigates possible reasons for the results of the development of the prehospital system in Jaffna. Finally, the case discusses the continued operations of the system.

Methods

This case study qualitatively researches the development of the Jaffna prehospital care system by looking at indicators of success in human resources, technical knowledge and community awareness. The case study also quantitatively examines the utilization and financial performance of the system during its first year of operation.

Results

According to indicators, the implementation of the model and its functioning can arguably be considered successful in terms of utility, and in many regards financial stability. The system has already responded to over 2,000 emergency calls in its first eleven months of operation. The main ambulance and call center has managed to operate at only a $13.50 USD loss during its first twelve months of operation. It has established quality standards by utilizing trained Emergency Medical Technicians (EMT) and ambulances featuring basic life saving equipment. The system has also integrated itself as a part of the overall health system of the community it is serving.

Conclusions

The system's success in development should be examined as a potential model for implementing prehospital care in a developing and middle-income country setting, while keeping in mind factors outside of the system that were integral to its developmental success.
(P2-6) Evaluation of Air Rescue Missions Using a Helicopter — Analysis from a German Helicopter Base
Authors: Frank M.D. , Aschenbrenner U. , Nitschke G. , Braun J.
Published: May 2011

Introduction

In Germany, emergency medical care is provided by ambulances. Emergency physicians also are used in the German rescue system to ensure primary care. Additionally, rescue helicopters are insertable. The rescue helicopter in Dresden covers the city of Dresden and its surrounding areas, with 517,000 inhabitants and distances up to 70 km. The goal of this study was to evaluate emergency cases in helicopter rescue missions according to primary diagnoses and severity of the mission on the basis of NACA Score.

Methods

Data from all emergencies using the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central computer database (MEDAT®). Data from all emergency cases between January 2006 and July 2010 were analyzed.

Results

There was a total of 6,310 emergencies during the study period, with a significant increase over time. The helicopter was on-scene within 10.9 minutes. In total, 54% of the patients were male. The rate of female patients > 80 years of age was 64.5%. A total of 63.4% of patients suffered life-threatening injuries or dysfunctions and a NACA score ≥ 4. A total of 7.6% of patients were classified in NACA 6 or 7. The most common cause for rescue missions was an acute coronary syndrome (20.4%). Other frequent diagnoses included brain injury (13.3%), unconsciousness (12.5%), stroke (12.9%), general cerebral convulsion (7.9%), polytrauma (6.4%), and cardiac arrest (5.0%). The rate of prehospital endotracheal intubation was 15.1%. In 1.1% of patients, a thoracic drainage was established.

Conclusions

In recent years the number of helicopter rescue missions increased, along with injury severity. The total number of patients with NACA 6 and 7 was extremely high, and demonstrates the need for an efficient emergency medical rescue system that includes helicopters.
(P2-17) “Burning Valentine,” a Simulated Evacuation Exercise of a Burn Unit (BU)
Authors: Dhondt E.L. , Peeters T. , Orlans L.
Published: May 2011

Background

According to the Belgian Hospital Disaster Planning Act, all hospitals are required to have written disaster plans and to routinely conduct annual disaster drills. In 2010, the management of the Military Hospital decided to organize an evacuation exercise of the newly built 24-bed BU.

Aim

To evaluate this new BU's evacuation plan and drills and the overall hospital emergency incident response and command system.

Methods and Results

It was decided to conduct a simulated evacuation exercise following an internal fire, before the BU effectively was put into use, thereby deploying fashioned simulated patients and visitors but bringing into action the regular attending medical, nursing and logistic staff. A multidisciplinary design and organizing team was launched, consisting of the hospitals disaster preparedness coordinator, the EMS-staff, external burn care, emergency incident management and operational engineering experts. The appointed objectives for evaluation were the knowledge of the regular evacuation drills, especially the clearance of an intensive care room; access to evacuation routes; visibility of safety guidelines; mission and tasks of the hospital's first response team and the medical incident manager; communication and information flow and the establishment of the hospital's coordination committee. In the mean time and following lessons learned, a number of mitigation measures have been instituted: adequate identification of evacuated rooms, new configuration of the fire detection alarm, optimized access to stairwells and elevators, adjustment of action cards and specific fire fighting training for hospital staff. Finally the decision was made not to purchase specific evacuation equipment for the movement of patients.

Conclusion

Taking advantage of the BU's provisional vacancy, a simulated hospital evacuation exercise increased the hospital emergency preparedness, awareness and response to disasters within the hospital, in particular in a critical care department, otherwise difficult to assess.
(P2-24) The “Oxygen Bus”: Retrofitting a City Bus with Oxygen Resources to Respond to Hospital Evacuations and Other Disasters
Authors: Weber E.K. , Stein-Spencer L. , Mckinney S.M.
Published: May 2011

Evacuation/Oxygen Bus The Chicago Fire Department (CFD) identified a need to treat multiple stable fire/inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of or fire in any building, hospital, or treatment facility. As a partner with the Chicago Department of Public Health (CDPH) and an active participant in the “Chicago Healthcare System Coalition for Preparedness and Response”, the CFD determined that a bus could be an adjunct in city responses and emergencies. With the support of the Coalition, the CFD approached the Chicago Transit Authority (CTA) to obtain a bus. Once the actual bus was given to the CFD, an operations order was written and the appropriate equipment was purchased. The Evacuation Committee of the Coalition identified equipment and supply needs. Supplies purchased and retrofitted for the bus include modulators for patient oxygen use, oxygen tanks, masks, nebulizers, automated external defibrillators (AEDs), first line advanced life support (ALS) medications, evacuation chairs for moving patients, and special emergency lighting. The bus is able to accommodate thirty five people who require treatment simultaneously. The use of the bus includes but not limited to: (1) hospital evacuation and treatment of stable patients with oxygen and nebulizers prior to transportation to an alternate facility; (2) long-term care facility evacuation and treatment of stable patients with oxygen needs prior to placement and transport to another facility; (3) responding to building fires to treat victims who may need oxygen and nebulizer treatments on site; (4) assisting with the evacuation of home-based, at-risk oxygen dependent patients; and (5) treating evacuated children from specialized treatment facilities who may be oxygen dependent. The outside of the bus has both CFD and CDPH logos to identify that this is a collaborative effort between city agencies and a Healthcare Coalition.
(P2-44) Use of Non-Traditional Technological Methodologies to Advance the Epidemiology & Management of Human Stampedes in Developing Countries: Case Series on Chinese School Stampedes
Authors: Ngai K.M. , Lee W.Y.
Published: May 2011

Objective

Human-stampede events are emerging epidemics with large unplanned or impromptu mass gatherings. They are increasing in frequency worldwide, yet little is known of the epidemiology and other characteristics that would allow for communities to prepare, prevent and properly manage medical outcomes. We report a non-traditional methodology to identify a stampede's epidemiological characteristics using news reports, social networking, and systematic search of the internet. This hitherto unused technological dimension is a useful adjunct to obtain crucial data on mortality and morbidity, improve immediate understanding of the pathophysiology of the event, and provides opportunities to develop public education to remove potential bottlenecks and improve crowd control of these preventable tragedies.

Method

A LexisNexis search was followed by sequential searches of multiple internet-based English-language news agencies and the few research reports available in the scientific literature. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Descriptive analysis was performed for deaths, injuries and location for this abstract.

Results

Following an extensive search of media accounts and research reports, a total of 263 human stampede events were identified worldwide between 1980 and 2011 resulting in 8,268 deaths and over 16,707 injuries. Major Religious assemblages, particularly in India and the Middle East, accounted for the highest number of fatalities. Precipitants of stampedes follow a geographical pattern; In Africa, sporting and political events and in Europe, entertainment venues sparked stampedes. This case series reports 7 incidents in China. All cases occurred in the recess hour of schools, when students formed a bottleneck at narrow staircases, resulting in 27 deaths and 168 injured.

Conclusion

Understanding the triggers in mass gatherings for a human stampede have been greatly aided by advances in social networking, internet and video mobile phones. Particularly in difficult environments which were previously difficult to document. The patterns identified in this study can appreciably add to community level preparedness, prevention and improved clinical understanding and management at prehospital and hospital levels.
(P2-50) Surviving a Severe Train Crash
Authors: Forsberg R.M. , Saveman B.
Published: May 2011

Background

Previous disaster studies mainly focused on analyzing the experience from a psychological or psychiatric perspective. The occurrence of post-traumatic stress disorder also has been the central issue when studying survivors of train crashes. Research concerning being involved in train crashes is scarce.

Objective

The aim of this study was to explore the experience of surviving a severe train crash.

Methods

In 2004, a severe train crash occurred in the south of Sweden. Approximately 78 passengers were on the train. All of them were injured, and two of the passengers died. Fourteen of the survivors agreed to be interviewed five years after the crash. The interviews were narrative, transcribed verbatim, and analyzed using a phenomenological-hermeneutical method. First, a naive reading of the text, later, a structural analysis, and finally a comprehensive understanding in which the other phases were considered and discussed with relevant literature.

Results

The preliminary results show a naive understanding of being in the pre-crash, crash and post-crash phases. Four themes were recognized: (1) life is going on like being on a railway track; (2) the train derails, so do I; (3) back on track again; and (4) life goes on in a new track. The results will be elaborated and discussed together with the comprehensive understanding.

Conclusions

Surviving a severe train crash changes life immediately as well as five years later.
(P2-54) Legislation Shaped by an Emergency: Methanol Poisoning Experience at Kenyatta National Hospital, Kenya
Authors: Akida A.W. , Isinta M. , Ndiawo F.O. , Agedo D. , Tsinanga J.
Published: May 2011

Introduction

Methanol poisoning is an uncommon medical emergency linked with consumption of traditional brews made with methanol and formalin and associated with high-mortality rates.

Objectives

Healthcare workers will review the latest worldwide trends of methanol poisoning cases, explain the factors perpetuating methanol poisoning in Kenya, describe the pathophysiological concepts associated with methanol intoxication, and discuss the latest measures to combat methanol poisoning in Kenya and their worldwide applicability.

Background

Methanol intoxication is an acute illness resulting from consumption of toxic quantities of methanol. The largest tragedy occurred in September 2006 in Nicaragua. A total of 800 fell ill, 46 were killed. In the US, the last incidence was in 1951. Cases were reported in Africa, Tunisia, Tanzania, Uganda, but Kenya, it runs the most rampant. The majority of victims (79%) are young males, (22–30 years of age). Most are single, childless, and have a low-educational status. Motivating factors for intoxication include stress, idleness, peer-pressure, availability of alcohol, and curiosity.

Pathophysiology

Toxicity results from liver enzymatic metabolism of methanol to formaldehyde and formic acid causing severe metabolic acidosis. Common features include inebriation, abdominal pains, bilateral blindness, and complications, including severe renal failure and death. The goals of management include comprehensive assessment, laboratory works, and radiography. Ethanol, fomepizole, and folate are the all-important antidotes.

Recommended Measures

Kenyatta National Hospital, the main recipient of these emergencies established emergency measures other than public awareness campaigns. Nationally, policies embrace an inter-sectoral Approach - Medical Services and Public Health Ministries will avail resources and build health worker capacity in research and continuous education. Recently, local brews were legalized through the Alcoholic Drinks Control Act 2010 for quality control. Ministries of Education and Youth Affairs will coordinate and initiate youth development and support programs to create employment.