bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the San Diego County Firestorm on Emergency Medical Services
Authors: Vilke Gary M. , Smith Alan M. , Stepanski Barbara M. , Ray Leslie Upledger , Murrin Patricia A. , Chan Theodore C.
Published: August 2016

Background:

In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.

Methods:

A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.

Results:

During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.

Conclusion:

Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.
“Operation Child-Safe”: A Strategy for Preventing Unintentional Pediatric Injuries at a Hurricane Katrina Evacuee Shelter
Authors: Brandenburg Mark A. , Ogle Mary Beth , Washington Beth A. , Garner Mike J. , Watkins Sue A. , Brandenburg Karin L.
Published: August 2016

Introduction:

Children represent a vulnerable population, and special considerations are necessary to care for them properly during disasters. Comprehensive disaster responses include addressing the unique needs of children during mass-casualty incidents, such as the prevention of unintentional injuries. Early in the morning of 04 September 2005, approximately 1,600 Hurricane Katrina and/or flood survivors from NewOrleans, including approximately 300 children, arrived at Camp Gruber, an Oklahoma National Guard base in Eastern Oklahoma.

Problem:

The primary function of Camp Gruber to train support personnel for the Oklahoma National Guard. This is not a child-safe environment. It was hypothesized that the camp contained numerous child injury hazards and that these hazards could be removed systematically using local child injury prevention experts, thereby preventing unintentional injuries to the displaced children.

Methods:

On 08 September, “Operation Child-Safe” was launched by the Pediatric Injury Response Team to identify and remove pediatric injury hazards from Camp Gruber. Injury prevention experts from the Safe Kids Tulsa Area (SKTA) Chapter, the closest pediatric injury prevention group in the region, spearheaded the operation. Several visits were required to remove all of the injury hazards that were identified.

Results:

Many hazards were identified and removed immediately, while others were addressed in a formal letter to the Camp Gruber Commander for required consent to implement changes. Hazards identified in the camp included, but were not limited to: (1) dangerous chemicals; (2) choking hazards; (3) open electrical outlets; and (4) missing smoke detectors. Bicycle helmets, car seats, strollers, portable cribs, and other safety-related items were passed out to families in need. A licensed daycare facility also was established in order to give the adult guardians a break from constant supervision. Over the course of one month, only one preventable injury (minor head injury) was reported during camp operations, and this particular injury occurred two days before “Operation Child-Safe” was initiated (Day 3 of camp operations).

Conclusions:

In the aftermath of an event that displaces large numbers of people, it is likely that children will be exposed to numerous injury hazards. Volunteers with expertise in child injury prevention are needed to make an evacuee shelter safer for children.
Tsunami ECHO Team Response
Authors: Grantham Hugh
Published: August 2016

The ECHO Team was the second Australian team to arrive to Banda Aceh, Indonesia in response to the Southeast Asia Earthquake and Tsunami. The ECHO Team continued the work of the first Australian Team which consisted of members of the Alpha and Bravo Teams. The ECHO team left Australia on 08 January 2005. The following describes some of the more significant logistical challenges encountered by the ECHO Team.The issues the ECHO Team confronted were those expected during a mission to help to manage a disaster.
Control of Hemorrhage in Critical Femoral or Inguinal Penetrating Wounds—An Ultrasound Evaluation
Authors: Blaivas Michael , Shiver Stephen , Lyon Matthew , Adhikari Srikar
Published: August 2016

Introduction:

Exsanguination from a femoral artery wound can occur in sec-onds and may be encountered more often due to increased use of body armor. Some military physicians teach compression of the distal abdominal aorta (Abdominal Aorta) with a knee or a fist as a temporizing measure.

Objective:

The objective of this study was to evaluate if complete collapse of the Abdominal Aorta was feasible and with what weight it occurs.

Methods:

This was a prospective, interventional study at a Level-I, academ-ic, urban, emergency department with an annual census of 80,000 patients. Written, informed consent was obtained from nine male volunteers after Institutional Research Board approval. Any patient who presented with abdominal pain or had undergone previous abdominal surgery was excluded from the study. Subjects were placed supine on the floor to simulate an injured soldier. Various dumbbells of increasing weight were placed over the distal Abdominal Aorta, and pulsed-wave Doppler measurements were taken at the right common femoral artery (CFA). Dumbbells were placed on top of a tightly bundled towel roughly the surface area of an adult knee. Flow measurements at the CFA were taken at increments of 20 pounds. This was repeated with weight over the proximal right artery iliac and distal right iliac artery to eval- uate alternate sites. Descriptive statistics were utilized to evaluate the data.

Results:

The mean velocity through the CFA was 75.8 cm/ sec at 0 pounds. Compression of the Abdominal Aorta ranging 80 to 140 pounds resulted in no flow in the CFA. A steady decrease in mean flow velocity was seen starting with 20 pounds. Flow velocity decreased more rapidly with compression of the prox- imal right iliac artery, and stopped in all nine volunteers by 120 pounds of pressure. For all nine volunteers, up to 80 pounds of pressure over the distal iliac artery failed to decrease CFA flow velocity, and no subject was able to tolerate more weight at that location.

Conclusion:

Flow to the CFA can be stopped completely with pressure over the distal Abdominal Aorta or proximal iliac artery in catastrophic wounds. Compression over the proximal iliac artery worked best, but a first responder still may need to apply upward of 120 pounds of pressure to stop exsanguination.
Who Should Worry for the “Worried Well”? Analysis of Mild Casualties Center Drills in Non-Conventional Scenarios
Authors: Leiba Adi , Goldberg Avi , Hourvitz Ariel , Weiss Gali , Peres Michal , Karskass Ahuva , Schwartz Dagan , Levi Yehezkel , Bar-Dayan Yaron
Published: August 2016

Introduction:

A mass toxicological event (MTE) caused by an act of terrorism or an industrial incident can create large numbers of ambulatory casualties suffering from mild intoxication, acute stress reaction (ASR), and exacerbation of chronic diseases or iatrogenic insult (such as atropine overdose). The logistical and medical management of this population may present a challenge insuch a scenario. The aim of this article is to describe the concept of the Israeli Home Front Command (HFC) of a “Mild Casualties Center” (MCC) for a chemical scenario, and to analyze the results of two large-scale drills that have been used to evaluate this concept.

Methods:

Two large-scale drills were conducted. One MCC drill was located in a school building and the second MCC drill was located in a basketball stadium. These medical centers were staffed by physicians, nurses, and medics, both military (reservists) and civilian (community, non-hospital teams). Two hundred simulated patients entered the MCC during each of the drills, and drill observers assessed how these patients were managed for two hours.

Results:

Of the casualties, 28 were treated in the “medical treatment site”, 10 of which were relocated to a nearby hospital. Only four casualties were treated in the large “mental care site”, planned for a much higher burden of “worried well” patients. Documentation of patient data and medical care was sub-optimal.

Conclusion:

A MCC is a logistically suitable solution for the challenge of managing thousands of ambulatory casualties. The knowledge of the medical team must be bolstered, as most are unfamiliar with both nerve gas poisoning and with ASR. Mild casualties centers should not be located within hospitals and must be staffed by non-hospital, medical personnel to achieve the main task of allowing hospital teams to focus on providing medical care to the moderate and severe nerve gas casualties, without the extra burden of caring for thousands of mild casualties.
The First 24 Hours of the World Trade Center Attacks of 2001—The Centers for Disease Control and Prevention Emergency Phase Response
Authors: Cruz Miguel A. , Burger Ronald , Keim Mark
Published: August 2016

On 11 September 2001, terrorists hijacked two passenger planes and crashed them into the two towers of the World Trade Center (WTC) in New York City. These synchronized attacks were the largest act of terrorism ever committed on US soil. The impacts, fires, and subsequent collapse of the towers killed and injured thousands of people.Within minutes after the first plane crashed into the WTC, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, initiated one of the largest public health responses in its history. Staff of the CDC provided technical assistance on several key public health issues. During the acute phase of the event, CDC personnel assisted with: (1) assessing hospital capacity; (2) establishing injury and disease surveillance activities; (3) deploying emergency coordinators/liaisons to facilitate inter-agency coordination with the affected jurisdictions; and (4) arranging rapid delivery of emergency medical supplies, therapeutics, and personal protective equipment. This incident highlighted the need for adequate planning for all potential hazards and the importance of interagency and interdepartmental coordination in preparing for and responding to public health emergencies.
Roadmap for the Protection of Disaster Research Participants: Findings from the World Trade Center Evacuation Study
Authors: Qureshi Kristine A. , Gershon Robyn R.M. , Smailes Elizabeth , Raveis Victoria H. , Murphy Bridgette , Matzner Frederick , Fleischman Alan R.
Published: August 2016

Introduction:

This report addresses the development, implementation, and evaluation of a protocol designed to protect participants from inadvertent emotional harm or further emotional trauma due to their participation in the World Trade Center Evacuation (WTCE) Study research project. This project was designed to identify the individual, organizational, and structural (environmental) factors associated with evacuation from the World Trade Center Towers 1 and 2 on 11 September 2001.

Methods:

Following published recommended practices for protecting potentially vulnerable disaster research participants, protective strategies and quality assurance processes were implemented and evaluated, including an assessment of the impact of participation on study subjects enrolled in the qualitative phase of the WTCE Study.

Results:

The implementation of a protocol designed to protect disaster study participants from further emotional trauma was feasible and effective in minimizing risk and monitoring for psychological injury associated with study participation.

Conclusions:

Details about this successful strategy provide a roadmap that can be applied in other post-disaster research investigations.
Leadership as a Component of Crowd Control in a Hospital Dealing with a Mass-Casualty Incident: Lessons Learned from the October 2000 Riots in Nazareth
Authors: Pinkert Moshe , Bloch Yuval , Schwartz Dagan , Ashkenazi Isaac , Nakhleh Bishara , Massad Barhoum , Peres Michal , Bar-Dayan Yaron
Published: August 2016

Introduction:

Crowd control is essential to the handling of mass-casualty incidents (MCIs).This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals.

Methods:

Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered.The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed.

Results:

During 10 days of riots (01–10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the “immediate care” location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control.

Conclusions:

During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management control crowds. It may be advisable to train medical teams and hospital management to recognize potential leaders, and gain their cooperation in such an event. To optimize such cooperation, community leaders also should be acquainted with the roles of public health agencies and emergency services systems.
Mental Health Problems following the 2005 Earthquake in Kashmir: Findings of Community-Run Clinics
Authors: Chadda Rakesh Kumar , Malhotra Anil , Kaw Nanaji , Singh Jaspreet , Sethi Hem
Published: August 2016

Introduction:

Events such as earthquakes are followed by significant psychiatric morbidity due to the enormous damage caused to life, health, property, and other resources in the affected area. In October 2005, a devastating earthquake occurred in Kashmir in India. A team of mental health professionals visited the earthquake stricken area to provide mental health services five weeks after of the event.

Methods:

The team conducted clinics at >30 sites in different villages in the area. This paper describes the mental health problems encountered in those communities.

Results:

All patients seen in the clinics had their houses destroyed by the earthquake.Nearly one-fourth had suffered serious physical injuries and 12% had lost one of their family members. Common psychiatric diagnoses included adjustment disorders (39.6%), depressive episode (22.6%), and other stress disorders (21.8 %). Only 10 (3.3%) patients were found to suffer from posttraumatic stress disorder (PTSD), though PTSD-like symptoms were reported by more than two-thirds of the patients.

Conclusions:

Adjustment disorders, depression, other stress reactions, and PTSD-like symptoms were the common mental health problems five to six weeks following an earthquake.
Editorial Comments—Mental Health Problems following Earthquake in Kashmir: Findings of Community Run Clinics
Authors: Amaratunga Carol
Published: August 2016

The article by Chadda et al is particularly deserving in that it describes a universal, social imperative to address the mental health and well-being of affected populations following a horrendous disaster caused by natural hazards. The inclusion of mental health workers, psychologists, and psychiatrists in postdisaster recovery and response efforts is not always feasible, but in recent years the importance of recognizing these professionals as “front line responders” has been gaining currency. By addressing the extent and typology of mental health needs of survivor populations (e.g., adjustment disorders, depression, and stress reactions, such as post-traumatic stress disorder (PTSD) symptoms), the business of recovery and reconstruction can begin. This paper sufficiently captures the extent of psychiatric morbidity in the affected Kashmiri populations following the October 2005 earthquake in India.The authors visited >30 rural and remote sites and met with >300 survivors who had lost their homes, loved ones, and who also had suffered physical injury and mental health trauma. It is a remarkable testament to human resiliency that the vast majority of the earthquake survivors described in this paper, including those who live in an ongoing state of civil unrest due to political conflict, did not present full PTSD mental health disorders. Prehospital and Disaster Medicine deserves praise for supporting the work of our colleagues in the south. Thanks to the WADEM for the inclusion of this empirically based study, as it contributes to our understanding of human resiliency following disasters caused by natural hazards in a meaningful way.
Development of an “All-Hazards” Hospital Disaster Preparedness Training Course Utilizing Multi-Modality Teaching
Authors: Collander Brett , Green Brad , Millo Yuri , Shamloo Christine , Donnellan Joyce , DeAtley Craig
Published: August 2016

Objectives:

The objectives of the study were to develop and evaluate an “all-hazards” hospital disaster preparedness training course that utilizes a combi-nation of classroom lectures, skills sessions, tabletop sessions, and disaster exercises to teach the principles of hospital disaster preparedness to hospital-based employees.

Methods:

Participants attended a two-day, 16-hour course, entitled Hospital Disaster Life Support (HDLS). The course was designed to address seven core competencies of disaster training for healthcare workers. Specific disaster situations addressed during HDLS included: (1) biological; (2) conventional; (3) radiological; and (4) chemical mass-casualty incidents. The primary goal of HDLS was not only to teach patient care for a disaster, but more important-ly, to teach hospital personnel how to manage the disaster itself. Knowledge gained from the HDLS course was assessed by pre- and post-test evaluations. Additionally, participants completed a course evaluation survey at the conclu-sion of HDLS to assess their attitudes about the course.

Results:

Participants included 11 physicians, 40 nurses, 23 administrators/direc-tors, and 10 other personnel (n = 84). The average score on the pre-test was 69.1 ±12.8 for all positions, and the post-test score was 89.5 ±6.7, an improve-ment of 20.4 points (p <0.0001, 17.2–23.5).Participants felt HDLS was edu-cational (4.2/5), relevant (4.3/5) and organized (4.3/5).

Conclusions:

Identifying an effective means of teaching hospital disaster pre-paredness to hospital-based employees is an important task. However, the opti-mal strategy for implementing such education still is under debate.The HDLS course was designed to utilize multiple teaching modalities to train hospital-based employees on the principles of disaster preparedness. Participants of HDLS showed an increase in knowledge gained and reported high satisfaction from their experiences at HDLS. These results suggest that HDLS is an effec-tive way to train hospital-based employees in the area of disaster preparedness.
How and Why Do You Declare a Major Incident?
Authors: Smart Colin John , Maconochie Ian
Published: August 2016

Introduction:

The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of pro-fessional backgrounds in the United Kingdom determine from an initial visu-al assessment of a scene that a MI should be declared.

Methods:

Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted.

Results:

One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3.

Forty-six participants had attended a MI previously.The results for declar-ing a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing the MI. Those who had >10 years of service in emergency services were more likely to declare a MI in Scenario 2 and 3.

Conclusions:

The main problem with the existing system is the interpreta-tion and subjective nature of the word “major”. Specialists incorporate many individual factors into using the word. Future research should focus on the development of a system tied to more objective analysis.
Lessons Learned from Chlorine Intoxications in Swimming Pools: The Challenge of Pediatric Mass Toxicological Events
Authors: Lehavi Ofer , Leiba Adi , Dahan Yehudit , Schwartz Dagan , Benin-Goren Odeda , Schwartz Rama , Augarten Arie , Ben-Ari Josef , Ben-Yehuda Yoram , Weiss Gali , Levi Yeheskel , Bar-Dayan Yaron
Published: August 2016

Introduction:

The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of “chemical” events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway pro-tection and early intubation; (4) undressing and decontamination at the hos-pital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlo-rine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of theIsraeli Guidelines for Mass Toxicological Events.

Methods:

Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis Through-Components, Interactions, Results (DISAST-CIR).

Results:

The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the vic-tims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mild-ly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites.

Conclusions:

Event management differed from the standard Israeli toxico-logical doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protec-tive gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients.
Global Warming: Polar Bears and People— Implications for Public Health Preparedness and Disaster Medicine: A Call to Action
Authors: Bey Tareg , von Weizsäcker Ernst U , Koenig Kristi L
Published: August 2016

Global warming has been hotly debated over the last two decades among scientists, economists, legal experts, philosophers, and politicians. Yet, the medical and public health communities are relative newcomers to understanding this global threat to humanity. As we celebrate Earth Day on 22 April 2008, there is an opportunity to educate physicians and other healthcare providers involved in mitigating, preparing for, responding to, and recovering from disasters about the medical and health implications of global warming.
Foreign Field Hospitals in the Recent Sudden-Onset Disasters in Iran, Haiti, Indonesia, and Pakistan
Authors: Schreeb Johan von , Riddez Louis , Samnegård Hans , Rosling Hans
Published: August 2016

Introduction:

Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters.

Problem:

In the aftermath of sudden-onset disasters, FFHs have been focused on providing emergency trauma care for the initial 48 hours following the sudden-onset disasters, while they tend to be operational much later. In addition, many have remained operational even later. The aim of this study was to assess the timing, activities, and capacities of the FFHs deployed after four recent sudden-onset disasters, and also to assess their adherence to the essential criteria for FFH deployment of the World Health Organization (WHO).

Methods:

Secondary information on the sudden-onset disasters in Bam, Iran in 2003, Haiti in 2004, Aceh, Indonesia in 2004, and Kashmir, Pakistan in 2005, including the number of FFHs deployed, their date of arrival, country of origin, length of stay, activities, and costs was retrieved by searching the Internet.Additional information was collected on-site in Iran, Indonesia, and Pakistan through direct observation and key informant interviews.

Results:

Basic information was found for 43 FFHs in the four disasters. The first FFH was operational on Day 3 in Bam and Kashmir, and on Day 8 in Aceh. The first FFHs were all from the militaries of neighboring countries. The daily cost of a bed was estimated to be US$2,000. The bed occupancy rate generally was <50%. None of the 43 FFHs met the first WHO/Pan-American Health Organization (PAHO) essential requirement if the aim is to provide emergency trauma care, while 15% followed the essential requirement if follow-up trauma and medical care is the aim of deployment.

Discussion:

A striking finding was the lack of detailed information on FFH activities. None of the 43 FFHs arrived early enough to provide emergency medical trauma care. The deployment of FFHs following sudden-onset disasters should be better adapted to the main needs and the context and more oriented toward substituting for pre-existing hospitals, rather than on providing immediate trauma care.
Earthquakes and Trauma: Review of Triage and Injury-Specific, Immediate Care
Authors: Gautschi Oliver P. , Cadosch Dieter , Rajan Gunesh , Zellweger René
Published: August 2016

Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.
Disaster Medical Assistance Teams: What Psychosocial Support is Needed?
Authors: Stevens Garry , Byrne Simon , Raphael Beverley , Ollerton Richard
Published: August 2016

Objective:

The objective of this preliminary study was to evaluate the perceptions of internationally deployed Disaster Medical Assistance Team (DMAT) personnel regarding the psychosocial support needs of these teams.

Methods:

The DMAT questionnaire was sent to 34 members of Australian medical teams involved in deployments to the 2004 Southeast Asian tsunami and the 2006 Java earthquake. Twenty personnel (59%) completed this survey, which reviewed key deployment stressors, specific support strategies, and the support needs of team members, their families, and team leaders. A key aspect of the survey was to determine whether the perceived psychosocial needs would be supported best within with existing provisions and structures, or if they would be enhanced by further provisions, including the deployment of mental health specialists.

Results:

There was strong support for brief reviews of stress management strategies as part of the pre-deployment briefing, and access to written stress management information for both team members and their families. However, more comprehensive provisions, including pre-deployment, stressmanagement training programs for personnel and intra-deployment family support programs, received lower levels of support. The availability of mental health-related training for the team leader role and access to consultation with mental health specialists was supported, but this did not extend to the actual deployment of mental health specialists.

Conclusions:

In this preliminary study, clear trends toward the maintenance of current mental health support provisions and the role of the DMAT leader were evident. A follow-up study will examine the relationship between teamleader, psychosocial support strategies and team functioning.
Toward More Efficient Multinational Work on Rescue and Aid for Disasters: Lessons Learned during the Aceh Tsunami and Yogya Earthquake
Authors: Rahardjo Eddy , Wiroatmodjo Karijadi , Koeshartono
Published: August 2016

Introduction:

In the aftermath of the magnitude 9 Sumatra-Andaman earthquake and Indian Ocean tsunami of 2004, a huge number of international responders launched rescue and relief missions in Aceh Province of Indonesia. Thousands of voluntary personnel came to help the wounded, assist with recovery, and rebuild damaged communities. As is often the case with disasters, the necessary disaster management manpower was not immediately athand. Consequently, rescue and relief missions did not coordinate with one another, and chaotic inefficiency prevailed.

Just a little over a year after the 2004 earthquake and tsunami, a second disaster occurred in Indonesia following a major earthquake that occurred in May 2006 on Indonesia's most populous island. The May 2006 earthquake killed 5,000 people in Yogyakarta Province, located in the central region of Java Island.
Building Integrated Mental Health and Medical Programs for Vulnerable Populations Post-Disaster: Connecting Children and Families to a Medical Home
Authors: Madrid Paula A. , Sinclair Heidi , Bankston Antoinette Q. , Overholt Sarah , Brito Arturo , Domnitz Rita , Grant Roy
Published: August 2016

Introduction:

Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and >200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks (“villages”) under the auspices of the [US] Federal Emergency Management Agency (FEMA).

Problem:

The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde.

Methods:

The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program (“Operation Assist”) to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented.

Results:

Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents.

Conclusions:

There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.
Primary Triage, Evacuation Priorities, and Rapid Primary Distribution between Adjacent Hospitals—Lessons Learned from a Suicide Bomber Attack in Downtown Tel-Aviv
Authors: Pinkert Moshe , Lehavi Ofer , Goren Odeda Benin , Raiter Yaron , Shamis Ari , Priel Zvi , Schwartz Dagan , Goldberg Avishay , Levi Yehezkel , Bar-Dayan Yaron
Published: August 2016

Introduction:

Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.

Methods:

Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.

Results:

A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.

Conclusions:

When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.
Effects of Simulation on Emergency Vehicle Drivers' Competency in Training
Authors: Lindsey Jeffrey T. , Barron Ann E.
Published: August 2016

Introduction:

The number of accidents involving emergency vehicles is a major concern for emergency service providers.

Objectives:

This study assessed the effectiveness of adding a driving simulator to a traditional training program.

Methods:

The sample consisted of students attending the National Emergency Medical Services Academy in Lafayette, Louisiana. Each participant self-scheduled two days in which he or she would attend the driving portion of the training class. A total of 52 participants were in the control group and 50 participants were in the treatment group. In addition to the classroom training, the treatment group used a driving simulator prior to driving on the competency course.

Results:

The treatment group took significantly less time to drive through the competency course on the first run than did the control group. It also acquired significantly fewer penalty points on the first run and required significantly fewer runs to complete the course.

Conclusions:

Simulators can be effective training tools for teaching emergency vehicle drivers.
Knowledge and Attitudes of the Out-Of-Hospital Emergency Care Consumers in Santo Domingo, Dominican Republic
Authors: Báez Amado Alejandro , Giraldez Ediza , Lane Peter L. , Pozner Charles , Rodriguez Juan , Rogers Selwyn
Published: August 2016

Introduction:

Prehospital emergency services are a vital public service, and consumer access to the system is an important factor in their use. The Dominican Republic recently experienced “the epidemiological transition” leading to increased morbidity and mortality secondary to traumatic and cardiac conditions—thus, increasing the need for prompt and adequate delivery of emergency medical care.

Methods:

A survey was administered to 90 subjects from diverse backgrounds, all living in Santo Domingo. Survey items included questions on emergency medical services (EMS) systems knowledge (i.e., access numbers), confidence in the system, first-aid education and prior experience with the EMS system. Chi-square was used to measure statistical significance for categorical variables and Student's t-test for continuous variables (JMP 2.0 software was used for statistical processing).

Results:

A total of 90 subjects were surveyed. The average age of respondents was 36 ± 12 years SD. More than one-fifth (22.2%) of respondents did not know the established universal emergency number (9-1-1), and 37.8% responded that they would access a different telephone number in case of a medical emergency.

Conclusions:

Important deficiencies and access-to-care concerns were interpreted from the results. An adequate understanding of the current state of prehospital care could lead to creation of policies by system administrators to further improve the delivery of emergency medical care. This study will assist system administrators in future design and policy issues.
Characteristics of Emergency Medical Technicians Involved in Ambulance Crashes
Authors: Studnek Jonathan R. , Fernandez Antonio R.
Published: August 2016

Objectives:

This study utilizes a [US] national sample of emergency medical services (EMS) professionals to explore the hypothesis that demographic and work-related characteristics are associated with involvement in ambulance crashes.

Methods:

In 2004, a cohort of nationally registered EMS professionals was surveyed to determine ambulance crash involvement during a 12-month period. Involvement in an ambulance crash was the outcome variable of interest. Demographics such as age, community size, service type, call volume, time spent in an ambulance, and current sleep problems were analyzed as independent variables. A multivariate logistic regression model identified variables associated with involvement in an ambulance crash within the past year.

Results:

Surveys were received from 1,775/5,565 (32.0%) participants; 1,297 (73.1%) met the inclusion criteria. A total of 111 (8.6%) of participants reported being involved in an ambulance crash within the past 12 months. When controlling for call volume and time in an ambulance, the odds of involvement in an ambulance crash within the past year were significantly higher for younger EMS professionals and those reporting sleep problems.

Conclusions:

Results from this analysis suggest age and sleep problems are associated with involvement in an ambulance crash. Future studies should investigate interventions to minimize the effects of these associations.
Acute Stress Symptoms, Dissociation, and Depression Among Rescue Personnel 24 Hours after the Bet-Yehoshua Train Crash: The Effects of Exposure to Dead Bodies
Authors: Ben-Ezra Menachem , Palgi Yuval , Essar Nir , Sofer Hilik , Haber Yeela
Published: August 2016

Introduction:

The immediate impact of exposure to severe wounds, dead bodies, and immediate threat to life has been understudied. Most studies focus on the acute stress disorder and/or post-traumatic stress disorder phases in order to assess rescue personnel's symptomatology, and tend to neglect the immediate exposure to elements of the disaster.

Hypothesis:

Rescue personnel who had a history of previous exposure to dead bodies would exhibit higher levels of acute stress symptoms, dissociation, and depressive symptoms within the 24 hours following a traumatic event.

Methods:

Twenty-three rescue personnel participated in the search and excavation of dead and mutilated bodies following the Bet-Yehoshua train crash in Israel.The rescue personnel group was divided based on previous exposure to dead bodies. Each participant completed a demographic questionnaire, which included a question on perceived threat to life, the impact of event scale revised, the dissociative experience scale, and the center of epidemiologic studies depression questionnaire. Student'st-tests, along with multivariate analysis of covariance (MANCOVA) were conducted in order to learn which factors are related to psychiatric symptomatology following the immediate exposure to such stressors.

Results:

Among rescue personnel, those with previous exposure to dead bodies did not differ in their levels of acute stress symptoms, dissociation, and depressive symptoms from those who were not previously exposed to dead bodies.

Conclusions:

These results may suggest the possibility that the impact of exposure to dead bodies does not emerge in the acute stress reactions (ASR) phase (up to 24 hours after the event), but later when people have time to process the trauma. Another possibility is that the rescue coping mechanisms of detachment may serve as a buffer for the horrific sights encountered during the ASR period.
Hospital Preparedness in Earthquake Zones: A Must
Authors: Ammar Ahmed
Published: August 2016

It is important that medical and paramedical teams responding to earthquakes and treating victims understand the following: (1) the definition of an earthquake; (2) the consequences of an earthquake; and (3) the common international terms used.

Earthquake An earthquake is the shaking or trembling of the earth, which may be natural or man-made (e.g., due to atomic explosion) in origin. An earthquake is a sudden, strong movement or slipping of the earth's crust that result in a sudden release of energy. Earthquakes occur at certain locations where the tectonic plates which form the earth's crust, coincide. Populations that live near these zones or on these plates always must be prepared for earthquakes and their consequences. The direct impacts of earthquakes may be seen in several forms, such as shaking, ground ruptures, landslides, avalanches, fires, soil liquefaction, tsunamis, and/or flooding.
Near-Infrared Laser Spectroscopy as a Screening Tool for Detecting Hematoma in Patients with Head Trauma
Authors: Ghalenoui Hossein , Saidi Hossein , Azar Mazyar , Yahyavi Seyyed Taha , Razavi Hamid Borghei , Khalatbari Mahmoudreza
Published: August 2016

Introduction:

Among imaging techniques, computed tomography (CT) is a reliable method for detecting intracranial hematomas in patients with head trauma, but it is not generally available in special circumstances like prehospital situations and harsh conditions such as those following an earthquake.

Objective:

The objective of this study is to determine if near-infrared spectroscopy (NIRS) is useful for performing CT scans on patients with closed head trauma that present to medical centers that do not have the ability to perform a CT scan or in prehospital or harsh situations. Near-infrared spectroscopy and CT scan were compared according to sensitivity and specificity.

Methods:

This was an observational, prospective study. One hundred forty-eight patients admitted to Rasool Akram General Hospital in Tehran, Iran with head injuries during a one-month period were studied using NIRS and CT. The observational, prospective study was conducted and sensitivity, specificity, positive and negative predictive values of NIRS were calculated. Chi-square and Kappa analysis was performed, and ap-value <0.05 was considered significant.

Results:

According to the CT scan findings, 54 (36.5%) of the patients developed intracranial hematoma. The NIRS examination showed that 69 patients (46.6%) might have intracranial hematoma. The number of true negatives was 73 and the number of false negatives was six patients. The sensitivity and specificity of NIRS examination was 88.9% and 77.7%, respectively.

Conclusions:

This study speculates that NIRS may be a useful screening tool to detect intracranial hematoma. This capability could be useful in special situations like in a deprived area, medical centers without CT scan capabilities, prehospital situations, and in harsh conditions like those after an earthquake or other disasters that causes increased numbers of victims with closed head trauma.