bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation: Preparing for the Glow That You Can’t See
Authors: Klein Kelly , Swienton Raymond , Flax Lindsay , Liu E. Liang 
Published: May 2019

Introduction:In 2013, a multinational collaboration met to improve the global and nation-specific preparedness and response in managing casualties from nuclear and radiological disasters. From this meeting, a survey was developed and distributed in both Japanese and English. The results published four years later illustrate a lack of understanding about radiation and risks to the health care provider.Aim:To dispel myths and increase understanding regarding trauma treatment and healthcare risks for healthcare providers during a radiologic event.Methods:IRB approved survey and literature reviewResults:A total of 418 surveys were analyzed. Although 44% of participants acknowledged that they had taken at least one radiological training course, the majority of the respondents were still not comfortable with radiological emergencies.Discussion:Despite the plethora of both online and in-person radiological training availability, healthcare providers are not comfortable with the topic. Based on information from the survey, it is important to dispel myths and educate healthcare providers so that they have reasonable expectations regarding risks and to ensure that they are comfortable coming to work. By doing this, there will be an adequate healthcare presence to help take care of patients who are not only in need of immediate trauma and radiologic exposure care but also with non-affected patients coming for emergent and scheduled health care needs.
Real-Time GIS for Health Disaster Response in the Largest Archipelagic Country
Authors: Alim Ahmad 
Published: May 2019

Introduction:Besides being located on the Pacific Ring of Fire, Indonesia is the largest archipelago country in the world. Some parts of the country are not very accessible. It raises difficulties in controlling and monitoring a disaster response mission remotely in real-time. Muhammadiyah, the Indonesian non-governmental organization (NGO) that has been responding to disaster since 1919, used Geographic Information Systems (GIS) for Health Disaster Response (HDR) in the Lombok Earthquake 2018, in cooperation with ESRI Indonesia, as one alternative to disaster response controlling and monitoring.Aim:To show the benefit of using real-time GIS for HDR in an archipelago country.Methods:While responding to the disaster in Lombok, the Muhammadiyah Health Disaster Response Team was collecting data of patient, medication, problem, need, location, and resource with computers and smartphones, inputting the data that was forwarded to the ArcGIS platform. The Health Disaster Response Team coordinator and Muhammadiyah Board monitored and analyzed the health response through the GIS dashboard in Yogyakarta, 652km far from Lombok Island.Results:Using real-time GIS has been useful for disaster response. It was efficient by cutting flight and other transport costs, connected by the internet, and communicative by graphic and map dashboard. It was a green approach since it was paperless, and analysis-friendly by real-time data compilation and computation.Discussion:One of the big gaps in disaster response monitoring seems to be real-time data. Especially in an archipelago country, it is costly, time-consuming, and resource consuming. Daily big data may be frustrating and can become “white paper syndrome.” One of the good approaches to that is GIS Web services although it must be realized that the internet connection in a rural area can be another challenge. It can be solved by in-gadget data memory that can be delivered while the internet connection is available.
Revised Hospital-MIMMS Course for Japan
Authors: Kaji Arito , Yamamoto Hiromasa , Morimura Naoto 
Published: May 2019

Introduction:HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.Aim:The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.Method:By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.Results:Main points of modification are to:
1.Replace a system peculiar to the UK with a Japanese system.2.Add unique contents of a Japanese disaster.3.Add the important subjects especially in Japan.4.Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.Discussion:Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.
The Role of Emergency Medical Team: Experience Acute Response in Earthquakes and Tsunami at Palu, Central Sulawesi, Indonesia, 2018
Authors: Pramusinto Handoyo , Priambodo Agung , Dewanto Andreas 
Published: May 2019

Introduction:The natural disasters of the earthquake and tsunami occurred in Palu, on September 28, 2018, at around 17.02 WIB. The earthquake measured 7.7 magnitude with the epicenter at a depth of 10 km in the direction of 27 km northeast of the city of Donggala, followed by a tsunami along the coast of Talise town of Palu. Some of the victims of the disaster have died, and in addition to many deaths, there were reported trauma cases such as fractures, torn wounds, and other injuries where many did not receive medical help.Aim:To revitalize hospitals in Palu with the medical assistance team.Methods:Sardjito hospital formed a medical team sent to the disaster area which consisted of 22 members from various disciplines (anesthetists, orthopedic surgeons, general surgeons, neurosurgeons, internal medicine doctors, pediatricians, general practitioners, anesthesia nurses, emergency nurses, surgical room nurses, sanitarians, sterilization officer, technical officers, and nutrition officers). The ICS informed the targets of this emergency response that the following must be accomplished within 2 weeks: revitalize the health care facilities and deliver health care. The sanitarian officer coordinated dealing with the problem of the former corpse in Bhayangkara Hospital by doing disinfectants in the area of the former mortuary. Sardjito Hospital’s medical team revitalized health services in Bhayangkara Hospital by providing 24-hour emergency services and surgery.Results:The medical team of Sardjito general Hospital gave medical service in Bhayangkara Hospital and Torabello Regional Hospital. The total number of treated patients was 158, and most cases of surgery were orthopedics.
Standardized Measurement of Capillary Refill Time using Novel Technology
Authors: Junker Johan , Jonson Carl-Oscar , Henricson Joakim 
Published: May 2019

Introduction:In a patient going into shock, blood is redistributed from the periphery to the central circulation, making an assessment of skin perfusion useful in a prehospital setting. Capillary refill time (CRT) is the time required for a pressure blanched skin site to reperfuse. Currently, CRT is tested by manually applying pressure for 5s to the skin and observing the time before reperfusion. Guidelines state that CRT should be 2-3s in a healthy patient. Shortcomings in this procedure include lack of standardization of pressure, subjective assessment of the time for reperfusion, and not accounting for the patient’s skin temperature.Aim:To develop a standardized objective procedure for testing CRT in the prehospital setting.Method:The study protocol was approved by the Ethics Committee at Linköping University (M200-07, 2015-99-31). An electro-pneumatic device exerting constant force (9N) over 5s was developed. CRT was measured using the Tissue Viability Imager (Wheelsbridge AB, Sweden) which relies on polarization spectroscopy. To simulate hypothermic conditions, healthy volunteers were subjected to low ambient temperature (8°C). Blood loss was simulated using a custom-built lower body negative pressure (LBNP) chamber. In both scenarios, the CRT test was carried out on three test sites (finger pulp, forehead, and sternum).Results:CRT on the finger pulp and sternum was shown to be increased following the hypothermic conditions, but not on the forehead. Skin temperature on the three sites followed the same pattern, with the forehead being virtually unchanged. Tests performed during LBNP revealed an apparent effect on CRT following the simulated blood loss, with prolonged CRT for all sites tested.Discussion:A successful methodology for objective assessment of CRT was developed, which was validated on healthy volunteers following hypothermia or simulated blood loss. Ongoing work will investigate a combination of hypothermia and blood loss to more accurately simulate the prehospital setting.
Survey on the Disaster Prevention System in Rural Areas and Isolated Islands: Preparing for the Nankai Trough Earthquake
Authors: Kodama Takamitsu , Ozawa Kazuhiro , Nakagawa Takashi 
Published: May 2019

Introduction:An expert government committee in Japan decided to revise the chance of a Nankai Trough earthquake in the next 30 years from 70% to between 70 and 80% in 2017. If a mega-earthquake occurs, medical institutions in disaster regions are required to perform self-contained activities during the super-acute phase. Human damage varies depending on whether medical functions can be sustained, particularly in rural areas and isolated islands. Here we examined actual situations.Aim:To identify the issues of a disaster medical system in rural areas and isolated islands that need solving.Methods:Regarding disaster preparedness planning, we conducted a survey on 10 hospitals undesignated as disaster key hospitals of remote area medical care bases (survey group), and 69 hospitals designated as disaster key hospitals (control group) in three prefectures in the Tokai region (Aichi, Mie, and Shizuoka).Results:We received responses from four hospitals in the survey group and 52 hospitals in the control group. The hospitals in the survey group responded that they could accept 74 severe casualties and 85 moderate casualties. We identified problems such as insufficient stockpiling of fuel, water, and oxygen, and lack of a prioritized lifeline supply contract.Discussion:It was predicted that human damage would be relatively minor given smaller populations in rural areas and isolated islands in the Tokai region. However, the number of patients would exceed their acceptance capacity. Moreover, the system for sustaining infrastructure is not adequate for providing medical services. Thus, it was indicated that these regions would be isolated in terms of disaster measures. It is imperative to establish a disaster medical system in rural areas and isolated islands that lack adequate disaster medical systems to manage Nankai Trough earthquakes.
Susceptibility of Host Immunity to Infectious Diseases in the Spacecraft Environment
Authors: Tran Vienna 
Published: May 2019

Introduction:The principles of Disaster and Emergency Medicine are applicable beyond the confines of planet Earth. With the accelerating rate of climate change, natural disasters, and overpopulation, as well as the innate human appetite for knowledge and technological advancement, there has recently been an increased interest in the prospect of long-duration spaceflight with a view to colonize extra-terrestrial bodies, such as Mars. However, there is a need to understand the risk of adverse medical events in the hostile environment of space. For example, previous incidences of infectious disease and immune dysregulation during a short-term mission have threatened to jeopardize the crew dynamic and the mission objectives. The risk of infectious diseases to the astronaut is one of the many knowledge gaps that must be addressed before long-duration flight is considered.Aim:To review how spaceflight impacts an astronaut’s in-flight susceptibility to infectious diseases.Methods:Research was guided by the Microbiology section of the NASA Human Research Roadmap Program. Search terms in the University of Adelaide Library Search database collection included: “infectious diseases + spaceflight,” “astronaut + immunity,” “analog,” and “inflammatory marker.”Results:Studies that have been conducted in-flight and on Earth demonstrate that both the astronaut and the microbe are affected by spaceflight. Stress, microgravity, and the isolated nature of the spacecraft have been found to compromise the immunity of the astronaut, as shown by reduced T cell counts and increased viral shedding of dormant viruses. Microbes have demonstrated rapid adaptation mechanisms, including genetic mutation and increased virulence.Discussion:This paper identifies a significant need for further research into host immunity during spaceflight to mitigate infectious disease risk. It is recommended that in-situ studies and terrestrial space analogs are most effective and that current knowledge on the principles of wilderness and expedition medicine be applied where possible.
A Systematic Review of Earthquake-Related Head Injuries
Authors: Igarashi Yutaka , Matsumoto Narumi , Kubo Tatsuhiko , Nakae Ryuta , Yokobori Shoji , Yokota Hiroyuki 
Published: May 2019

Introduction:Earthquakes have killed around 800,000 people globally in the past 20 years, with head injury being the main cause of mortality and morbidity.Aim:To conduct a systematic review to determine the characteristics of head injuries after earthquakes for better disaster preparedness and management.Methods:All publications related to head injuries and earthquakes were searched using Pubmed, Web of Science, the Cochrane Library, and Ichushi.Results:Thirty-six articles were included in the analysis. Head injury was the third most common cause of injury among survivors of earthquakes. The most common injury after an earthquake occurred was in the lower extremities (36.2%), followed by the upper extremities (19.9%), head (16.6%), spine (13.3%), chest (11.3%), and abdomen (3.8%). Earthquake-related head injuries were predominantly caused by a blunt strike (79%), and were more frequently associated with soft tissue injury compared to non-earthquake-related head injuries and less frequently with intracranial hemorrhage. The mean age of patients with earthquake-related head injuries was 32.6 years, and 55.1% of sufferers were male. The most common earthquake-related head injury was laceration or contusion (59.2%) while epidural hematoma was most common among inpatients with intracranial hemorrhage after an earthquake (9.5%). Early wound irrigation and debridement and antibiotics administration are needed to decrease the risk of infection. Mortality due to earthquake-related head injuries was 5.6%.Discussion:Head injury was the main cause of mortality and morbidity after an earthquake. The characteristics of earthquake-related head injuries differed from those of non-earthquake-related head injuries, including the frequency of multiple injuries, and occurrence of contaminated soft tissue injury and epidural hematoma. This knowledge is important for determining demands for neurosurgery and for adequate management of patients, especially in resource-limited conditions.
Tactical EMS Deployment at the G7 Summit in Charlevoix, Quebec
Authors: St-Arnaud Emmanuelle 
Published: May 2019

Introduction:The G7 Summit was held in Charlevoix, Quebec (Canada) on June 8 and 9, 2018. The Urgences-santé Corporation (USC), in charge of prehospital emergency services in Montreal and Laval, was asked to intervene outside of its usual territory during the Summit, mainly because it has the only tactical medical team in the province of Quebec to be equipped and trained for high-risk situations.Aim:Part of USC’s tactical medical team was deployed to the Charlevoix region from May 29 to June 10, 2018. The team had two responsibilities: act in the event of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack, and in the event of social disturbance or violence, provide care for protestors and the police officers tasked with maintaining and restoring order.Methods:The mission required rigorous preparation to ensure the team’s safety outside its usual area of activity while maintaining full coverage of metropolitan Montreal, where the impacts of the G7 Summit were also felt. Emphasis was placed on intensive coaching of the tactical medics, on joint training, and on the coordination of intervention protocols across EMS, fire and law enforcement.Results:A total of 14 tactical medics and two managers were sent to Charlevoix for the Summit. Before their departure, three joint training days were held, and our training center provided six days of training to our partners.Discussion:While no CBRNE incident or major social disorder occurred during the Summit, USC was able to gain more visibility and therefore reach out to different organizations on site. Close ties were developed with the Sûreté du Québec (provincial police), with whom USC now regularly collaborates during training and interventions. The lessons learned also helped consolidate our extra-territorial deployment procedures.
The University of Colorado Graduate Medical Education Fellowship in Climate Change and Health Science Policy
Authors: Dymond Chelsea , Sorensen Cecilia , Calvello-Hynes Emilie , Lemery Jay 
Published: May 2019

Introduction:Climate change is intricately related to human health and impacts acute and chronic diseases leading to increased demands on the health care system.Aim:The University of Colorado Graduate Medical Education (GME) Fellowship in Climate Change and Health Science Policy (CCHSP) aims to train and equip a new generation of clinicians knowledgeable in climate science, proficient in climate health education, and facile with advocacy skills in order to become leaders in health policy.The CCHSP fellowship is funded by the Living Closer Foundation and hosted through the University of Colorado Department of Emergency Medicine. It is a one to two-year program tailored to the fellow’s specific goals with the opportunity to earn an MPH or MA. Clinical work is supported through the UCHealth network. Site placement occurs at partnering organizations, including the National Institutes of Health, the Centers for Disease Control and Prevention, and fieldwork throughout the world (via Colorado School of Public Health, Harvard FXB Center for Health and Human Rights).The first fellow was recruited in 2017 and has participated in and completed multiple projects: technical contributor to the US Government’s Fourth National Climate Assessment; advocating for women’s health policy in India; authorship of climate change and health resource documents for the World Bank; climate change leadership within SAEM; advocacy work with local and state governments; multiple research publications.Discussion:As climate change continues to impact human health with widespread consequences, we need effective and articulate leaders to affect policy. Although this Fellowship originated in Emergency Medicine, its competencies and structure are replicable for other clinical specialties. Climate change will be one of the core global health challenges for generations. A strong foundation of clinicians who understand its causes and the strategies for adaptation and mitigations are necessary to optimize health outcomes amidst this growing threat.
Use of Clinical Algorithms for Evaluation and Management of Pediatric and Adult Sepsis Patients in Low-Resource Clinical Environments
Authors: Dymond Chelsea , Hill Kimberly Ann , McCullough Chelsea , Dixon Julia , Calvello-Hynes Emilie 
Published: May 2019

Introduction:Acute infection in post-disaster settings is associated with increased morbidity and mortality. Sepsis management in low resource settings is controversial with recent research suggesting that aggressive fluid resuscitation may cause greater harm than benefit. However, the vast majority of international sepsis guidelines still suggest large initial fluid boluses as part of sepsis algorithms.Aim:To create an adult and pediatric sepsis algorithm to be applied in low resource clinical settings. This is part of a larger project to create clinical algorithms to provide standardization of emergency case management for low-resource clinical environments.Methods:A literature search was performed through PubMed identifying and reviewing fluid resuscitation in adult and pediatric sepsis patients in high and low resource clinical environments. The pathways were created based on interpretation of the available evidence-based literature. Focus groups were conducted in Zambia in March 2018 for feedback from local practitioners regarding feasibility of pathways. The pathways were then modified, reviewed by experts peer-review and revised.Results:Final pediatric and adult sepsis clinical algorithms were created and posted to the free web-based application AgileMD™. They will be available via app access, an online platform, or printable pathways for use in the clinical environment.Discussion:The study is currently undergoing IRB approval with a plan for implementation of multiple clinical algorithms at a referral hospital site in Zambia in January 2019. Site direction at Ndola Hospital will be conducted under the leadership of an Emergency Medicine trained physician, who will assist in implementation of algorithms and collection of data. Initial data review will be conducted in May 2019. There will be incremental site visits by organizing researchers throughout the implementation and data collection period. Statistical analysis will examine sepsis associated processes and outcome indicators pre and post-intervention to further delineate sepsis management in low resource clinical environments.