bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Disaster Coordination and Communication Plan in Nepal: Hub and Satellite Concept
Authors: Bajracharya Sumana , Shrestha Ashis 
Published: May 2019

Introduction:One lesson learned from the 2015 Nepal earthquake was the need for a more coordinated effort between hospitals to improve disaster response. To improve the coordination, the concept of a hub and satellite system was introduced.Aim:Describe the implementation of a hub and satellite system in the disaster management plan to improve coordination and communication between hospitals and the health system during a disaster.Methods:A standard hospital disaster management plan was developed and validated with governmental and non-governmental agencies. Twenty-five hub hospitals within Nepal were identified. Smaller hospitals surrounding hub hospitals were identified as satellite hospitals. A plan was made to address communication and coordination between hub-satellite hospitals and ministry of health involving resource sharing, capacity analysis, and development of deployment teams in each hub. An output-based workshop was planned. Each hospital’s existing plans were evaluated before the workshop with a checklist containing essential components of disaster management. Each hospital was oriented and allowed to fill up a standardized template of a disaster management plan, after which their disaster management plan was reevaluated. The newly developed plan was then tested with a tabletop exercise function. The trainings were conducted from September 2017 to October 2018.Results:Disaster management plans were made in 110 hospitals, including nine hub hospitals and 101 satellite hospitals in three of seven provinces in Nepal. Evaluation of a pre-workshop score for the existing disaster plan was 18/32, and the score of the disaster plan post-workshop was 30/32 on average. The average score for hospitals for the tabletop exercise was 68.2% (53.8% to 84.6%).Discussion:A hub-satellite system-based disaster management plan has been developed and implemented in more than 100 hospitals in Nepal. Workshops for these hub and satellite hospitals improved their communication, coordination, and planning to improve disaster preparedness and future response.
Life Expectancy Negatively Correlates with Disaster Risk Index
Authors: Egawa Shinichi , Nakamura Yayoi , Suda Tomomi , Sasaki Hiroyuki 
Published: May 2019

Introduction:Sendai Framework for Disaster Risk Reduction 2015-2030, for the first time, describes how disaster affects the health of people. Japan is prone to natural hazards, but at the same time, Japan has achieved one of the highest life expectancies (LE) in the world. After experiencing many disasters, Japan seems to have achieved resilience against disasters. Thus, we tested a hypothesis that high LE correlates with low disaster risk.Methods:We compared LE from the World Health Organization's (WHO) Global Health Observatory and the Index for Risk Management’s (INFORM) disaster risk index, or World Risk Index (WRI), of each country using JMP software. INFORM risk index varies from 0-10, while WRI varies from 0-1, where a higher value means higher disaster risk in both systems. INFORM risk index considers hazard and exposure, vulnerability, lack of coping capacity, and lack of reliability. WRI considers exposure, susceptibility, lack of coping capacity, and lack of adaptive capacity, including logarithmized LE as a part of adaptive capacity.Results:The overall INFORM risk index was negatively correlated with LE (p<0:0001). Although natural hazard did not correlate with LE (p=0.7), the human hazard, vulnerability, and lack of coping capacity negatively correlated with LE (p<0.0001, respectively). Health-related indicators, which confirm the vulnerability and lack of coping capacity, were negatively correlated with LE. Cluster analysis of LE and INFORM risk of six categories resulted in four clusters of countries, suggesting that health development and disaster risk reduction are independent determinants. WRI also correlated with LE, but there are many outliers compared to the INFORM risk index.Discussion:High LE can be a good complementary indicator of low disaster risk. Strategies to achieve better health that contribute to high LE are also effective and important strategies for disaster risk reduction.
The Use of Simulation Games and Tabletop Exercises in Disaster Preparedness Training of Emergency Medicine Residents
Authors: Rodriguez Rivera Lourdes , Rodriguez Rivera Cynthia , Zabala Soler Alberto , Pagan Rivera Rey , Rodriguez Luis , Garcia-Gubern Carlos 
Published: May 2019

Introduction:Emergency physicians play a frontline role in hospital disaster responses and require appropriate training.Aim:The aim of the current study was to pilot and compare the effectiveness of two emergency preparedness teaching interventions: the first employing traditional lecture-based instruction (LEC) and the second utilizing interactive simulation/game-based teaching (SIM).Methods:A two-group randomized pre- and post-test design was implemented into the didactic curriculum of the Emergency Medicine (EM) Residency Training Program at the San Lucas Episcopal Hospital in Ponce, Puerto Rico. Residents (n=23) completed either a LEC (control) or SIM teaching module (single day, one to two hours) focusing on emergency preparedness concepts, disaster-related clinical decision-making, and physician responsibilities during hospital disaster protocols. Knowledge-based multiple-choice exams and scenario-based competency exams were administered at three different time points: one-week pre-intervention, immediately post-training, and two-weeks post-training. Test scores were compared between groups at each time point using the Mann-Whitney U test.Results:Following the teaching interventions, no significant differences were found between the LEC group versus the SIM group in knowledge-based exam performance (LEC 81.1%[9.4] vs. SIM 74.9%[12.1]; U=42.50, p=0.15) and scenario-based exam performance (LEC 80.0%[9.7] vs. SIM 80.2%[9.2]; U=62.00, p=0.83), suggesting both teaching methods were similarly effective. Indeed, knowledge-based exam scores improved two-fold and scenario-based exam scores improved by over 50% immediately following training relative to baseline exam scores. Two-weeks post-training, a significant decrease in scenario-based exam performance was found in the LEC group relative to the SIM group (LEC 63.1%[11.6] vs. SIM 75.4%[11.5]; U=91.50, p=0.036), suggesting residents who train with simulations show greater retention of scenario-based concepts compared to those who train with lecture-based training alone.Discussion:The current study highlights the potential dual value of incorporating simulation training in EM emergency preparedness curriculums in improving both knowledge and concept retention of physician disaster responsibilities.
Exploring the Feasibility of Wearable Technologies to Provide Interactive Telepresence Sub-Specialist Support to Remote Clinicians Treating Patients with Traumatic Injuries
Authors: Santomauro Chiara , McCurdie Tara , Pollard Cliff , Shuker Matthew 
Published: May 2019

Introduction:Some patients presenting to rural or regional hospitals may be deteriorating so rapidly that emergency procedures might be necessary before transfer to specialist facilities. Such interventions might include placement of an ICC, establishing a surgical airway, evacuation of an EDH, laparotomy, or intra-abdominal packing. The treating clinician may have had little or no experience in the procedure. Interactive telepresence technology offers further point of care support to the treating clinicians through the virtual presence of a specialist from a major trauma center.Aim:To explore the feasibility of wearable interactive telepresence technology that can provide sub-specialist support to remote clinicians treating patients with traumatic injuries.Methods:Thirty-seven wearable near-field display devices and annotation software applications were tested against a set of pre-specified technical and user experience requirements. A shortlist of three devices and two software applications underwent usability evaluations with a convenience sample of 24 junior clinicians and sub-specialists. The junior clinicians trialed the wearable devices and the sub-specialists trialed the annotation applications in three simulated trauma scenarios. Measures included participants’ ratings of acceptance and workload, technical issues encountered (e.g. frequency of call drop-outs), and anecdotal comments.Results:Participants’ subjective ratings of the solutions and anecdotal feedback were positive. However, there was no clear solution that satisfied the functionality and ease-of-use requirements for all participants. For example, the solutions that were rated more favorably by the junior clinicians were rated less favorably by the sub-specialists, and vice versa.Discussion:This work provided preliminary evidence of the feasibility and usefulness of interactive telepresence technology in healthcare. A second phase of usability testing is currently underway to explore additional device and software combinations, including those with augmented reality functionality. Future phases of the project will evaluate the solutions under higher-fidelity conditions followed by in-situ trials across selected regional centers.
Hospital Information Technology Considerations for No Notice Disasters
Authors: Little Charles 
Published: May 2019

Introduction:Modern hospital systems are highly dependent on computerized information technology (IT) systems. The integration of laboratory and radiology ordering and resulting cannot be easily replicated with a “paper” processes. This poses challenges for no-notice events, where the rapid registration of patients is a must for effective clinical care. This weakness in hospital response has been demonstrated in events such as the Boston Marathon bombing, the Aurora Theater (to be discussed), and Las Vegas shootings.Aim:To discuss lessons learned in configuring IT systems for disasters.Results:A integrated system of IT system preparation was implemented at the University of Colorado Hospital. This system has been demonstrated to be effective in multiple real-world events.Discussion:Four areas of IT preparedness are needed for hospital IT response to disasters. First is rapid disaster registration with prepared disaster medical record numbers and packets. The medical records must be active in the hospital IT environment, and a visit or case number must be preassigned or rapidly generated. The medical record number alone in the IT environment will allow the initiation of test ordering. The packet should include preprinted labels, a demographic data sheet, and downtime charting and ordering forms. The second item for response is templated order sets to allow rapid ordering of multiple studies such as laboratory, and especially radiology, without having to reenter clinical information. The third is a method of patient care charting scalable, from paper to electronic, depending on the patient volume, acuity, and workstation access. The fourth is a method for patient care in the IT downtime in a disaster setting. Simple inexpensive measures will allow rapid placement of patients in the IT environment and therefore allow rapid and accurate test ordering and resulting.
Tracking Patients in an Earthquake Response: The Bad, the Better, and the Best
Authors: Grainger Paula 
Published: May 2019

Introduction:Tracking patients through health systems is fundamental to coordinated care provision. However, it is an inconsistent element of emergency preparedness. This presentation presents findings of a study undertaken after the 2011 Christchurch Earthquake, and the resultant nationally implemented changes.Aim:The intent was to investigate options to improve patient tracking in a mass casualty event. By looking at one scenario involving a mass casualty presentation with the central responder disabled by electricity loss, standards of practice were outlined and made scalable to meet the needs of various events.Methods:Clinical and clerical staff involved in the event’s patient tracking were interviewed. Data were analyzed using thematic analysis and reported using the structure, process, and outcomes framework.1Results:Structures were material and human resources. Material resources were identification number systems, technological requirements, disaster-specific documents, minimum data for entry, digital/paper/hybrid registration systems, and digital-paper integration. Human resources were role allocation, and familiarity of plans, roles, processes, tools, and facilities. Process identified the activities to manage unidentified patients, triage, registration, and ongoing tracking processes. Outcomes were management of patient flow, patient-care provision, and patient-family reunification.Initial implementation was local. Structures and processes were agreed upon, with varying response levels according to the incident scope, while staying as close to business as usual for familiarity. National implementation followed via a Ministry of Health working group involving different district health boards. The group developed a consensus on the minimum data to be entered and the process to merge patient identities of initially unidentified patients. Written tools were shared for standardization.Discussion:With inter-agency and inter-organization emergency response, standardized processes and information are required. Collaboration prior to events can mitigate issues when an event occurs.
Efficacy of Video-Based Instructions for Laypeople Bleeding Control Education
Authors: Jonson Carl-Oscar , Andersson Felix , Prytz Erik 
Published: May 2019

Introduction:The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.Aim:The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.Methods:A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.Results:Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.Discussion:Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.
A Framework for Planning for High-Volume High-Acuity Traumatic Mass Casualty Incidents
Authors: Maslanka Meghan , Mouille Ann , Aiken James , Elder Jeffrey 
Published: May 2019

Introduction:In response to the Pulse Nightclub and Las Vegas mass shootings, staff from our Emergency Department (ED) at University Medical Center New Orleans designed a mass casualty incident (MCI) protocol aimed at preparing the entire hospital for high-volume, high-acuity incidents of unprecedented proportions. As we researched this effort, we discovered that no publically available framework currently exists to assist hospitals with creating their own comprehensive, functional MCI protocol.Aim:To develop a framework to assist hospitals with creating MCI plans tailored to fit the needs of their individual facility.Methods:Our hospital spent several years creating and refining an MCI protocol that is both comprehensive in addressing each service’s needs and efficient for the staff expected to use it. Upon achieving the desired outcome of a well-functioning and tested protocol, the main contributors of the project met to create a consensus document on how we would approach the task with the benefit of hindsight.Results:Our document is meant to serve as a framework for hospitals looking to build their own plan. It is not a template, but rather a guide on how to build an individualized plan that includes critical components that are key for success. It breaks the process down into manageable steps that are presented in an order that maximizes efficiency and includes important points to consider for each step. It encourages the user to tailor the protocol to their own unique needs.Discussion:By sharing a framework based on our own best practices and lessons learned, we hope to make it easier for other hospitals to create MCI protocols and to open a dialogue with hospitals that have additional or differing opinions to share. Most importantly, we hope to inspire hospitals to work together as we race to prepare for worst-case scenarios of increasing magnitude.
Lessons from the Brussels Terrorist Attack
Authors: Möhler Andreas 
Published: May 2019

Introduction:On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.Methods:A field perspective and experience feedback from the Emergency Medical Response.Results:The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.Discussion:Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.
Disaster Planning for the Urban Homeless Population in the United States
Authors: Morris Stephen , Bartlett Emily 
Published: May 2019

Introduction:Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1Methods:A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.Results:Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.Discussion:Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.
2018 Natural Disaster Response in Japan
Authors: Kondo Hisayoshi , Koido Yuichi , Uesgi Hirotaka , Kohayagawa Yoshitaka , Takahashi Ayako , Kawashima Yuzuru , Misaki Miho , Chishima Kayako , Toyokuni Yoshiki 
Published: May 2019

Introduction:Japan experienced several major disasters in 2018.Aim:Evaluation of medical response was conducted and problems determined to solve for future response.Methods:An evaluation conducted on DMAT responding report of Northern Osaka Earthquake, West Japan Torrential Rain Disaster, Typhoon Jebi, and Hokkaido Iburi East Earthquake.Results:DMAT responded 58 teams for Osaka Northern Earthquake, 119 teams for West Japan Torrential Rain Disaster, 17 teams for Typhoon Jebi, 67 teams for Hokkaido Iburi East Earthquake. At the Osaka Northern Earthquake, by comparing the report of seismic diagnosis, results and, a magnitude of each region, hospital damage was evaluated. At the West Japan Torrential Rain Disaster, a flood hazard map was used to expect inundation at hospitals. At the Hokkaido Iburi East Earthquake, information of hospital generator was gathered and planned assistance for loss of power. Water supply cessation in the West Japan Torrential Rain Disaster and loss of power in the Hokkaido Iburi East Earthquake influenced hospital functionality. More precise preparation for hospital management in the event of a loss of power and water supply situation required in not only in local government but also each hospital. For the West Japan Torrential Rain Disaster, we experienced the same type of major disasters in the past, but could not manage accordingly. For the Hokkaido Iburi East Earthquake, we applied what was learned from the West Japan Torrential Rain Disaster.Discussion:Disaster medical operation was supposed to be managed with information from the Emergency Medical Information System (EMIS). However, 2018 disasters provided lessons that require a full understanding of disaster prior information and expected disaster damage information to manage disaster assistance. To accomplish effective disaster assistance, information must be gathered of supplies and assistance required by hospitals. An effective system to facilitate lessons learned needs to be developed