bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Strategy to MCI Management
Authors: Lin Yun-Kuan , Lai Pei-Fang , Niu Kuang-Yu 
Published: May 2019

Introduction:On February 6, 2018, a 6.0 magnitude earthquake struck Hualien, a county of East Taiwan. Hualien Tzu Chi Hospital, the only tertiary hospital in East Taiwan, activated the mass casualty incident (MCI) call and received 144 patients that night. Our operation did not perform satisfactorily despite regular MCI drills. Thus, a new strategy to cope with the increasing frequency of disaster-related MCIs was developed.Aim:To facilitate the management of disaster-related MCIs, we developed a novel Disaster Response System which includes a triage system combining Simple Triage and Rapid Treatment (START) and Five-Level Taiwan Triage and Acuity Scale (TTAS), a novel registration system for MCIs, and anonymous patient identification and reporting system.Methods:We begin the triage with the START method and then shift to the TTAS. The new registration system only needs the patient’s gender, age, and triage category. Patients are then assigned to different treatment areas accordingly. Further dispositions are applied after initial stabilization management. To identify the anonymous disaster victims, we take photographs of victims after clean-up and display them on an electronic bulletin with the patient list to the families in our emergency department. Real-time casualty statistics are collected automatically and synchronized to the governmental administrative system.Results:This novel Disaster Response System reduces the time from patient arrival to definite treatment and disposition in a simulated mass casualty incident exercise. The victim identification bulletin provides clear information to those who are seeking their family, and thus, avoids the chaos of the scene.Discussion:From the experience of the earthquake-related MCI, we found that inadequate training causes time mis-triage and treatment delays. Our Disaster Response System facilitates the workflow with an easily practiced algorithm, reveals on-time and easily accessible information to the public, and altogether improves our MCI management.
Perceptions of Climate Change and Disaster Risk in Oceania
Authors: Cuthbertson Joseph , Archer Frank , Rodriguez-llanes Jose-Manuel , Robertson Andrew 
Published: May 2019

Introduction:This study profiles climate change as an emerging disaster risk in Oceania. The rationale for undertaking this study was to investigate climate change and disaster risk in Oceania. The role of this analysis is to examine what evidence exists to support decision-making and profile the nature, type, and potential human and economic impact of climate change and disaster risk in Oceania.Aim:To evaluate perceptions of climate change and disaster risk in the Oceania region.Methods:Thirty individual interviews with participants from 9 different countries were conducted. All of the participants were engaged in disaster management in the Oceania region as researchers, practitioners in emergency management, disaster health care and policy managers, or academics. Data collection was conducted between April and November 2017. Thematic analysis was conducted using narrative inquiry to gather first-hand insights on their perceptions of current and emerging threats and propose improvements in risk management practice to capture, monitor, and control disaster risk.Results:Interviewees who viewed climate change as a risk or hazard described a breadth of impacts. Hazards identified included climate variability and climate-related disasters, climate issues in island areas and loss of land mass, trans-nation migration, and increased transportation risk due to rising sea levels. These emerging risks are reflective of both the geographical location of countries in Oceania, where land mass due to rising oceans has been previously reported and climate change-driven migration of island populations.Discussion:Climate change was perceived as a significant contemporary and future risk, and as an influencing factor on other risks in the Oceania region.
Pharmaceutical Prescribing Patterns and Costs During Hurricane Harvey Shelter Operations in Dallas, Texas
Authors: Liu E. Liang , Joseph Alysha , Flax Lindsay A. , Fowler Raymond L. , Klein Kelly R. , Swienton Raymond E. 
Published: May 2019

Introduction:Hurricane Harvey made landfall in southeast Texas in August 2017, causing unprecedented flooding throughout the Texas coastal region. Residents of affected regions were forced to evacuate to nearby unaffected areas, including Dallas, TX, where a large shelter operation was opened for 23 days to care for those evacuees. Retrospective evaluation of pharmaceutical prescribing patterns for the evacuees who self-presented to the Megashelter Medical Clinic (MMC) established in the shelter contributes to developing evidence-based planning strategies for healthcare delivery in the post-disaster setting.Aim:To describe the pharmacy needs of a displaced population following a large-scale evacuation after a hurricaneMethods:De-identified prescription records written and filled at a shelter pharmacy were reviewed, looking at both cost and category of medications dispensed over time.Results:Approximately 41% of evacuees with a total of 2,654 visits utilized the MMC clinic, resulting in 1,590 prescriptions filled with an associated cost of $78,039. The most commonly prescribed drug categories were cardiovascular (21.2%), neuropsychotropic (15.6%), infectious disease (12.5%), and endocrine (9.6%). While the most commonly dispensed were antihypertensives, diabetes treatment-related prescriptions, antibacterials, antidepressants, and NSAIDs, the costliest individual prescriptions were antiretrovirals and antipsychotics.Discussion:Prescribing patterns for the MMC differed from normal prescribing patterns of a general population. Of the prescriptions dispensed at the MMC, pharmaceutical prescription patterns suggest the immediate needs of evacuees differ from later needs. There is a greater need for chronic disease management in the early phase of shelter operations, and an increasing need for neuropsychotropic and infectious disease prescriptions over time. Understanding overall patterns of drug utilization over the duration of the shelter provides valuable insight on post-disaster medical resource utilization in evacuee populations.
A Pilot Investigation of the Effect of Transport-Related Factors on Care Quality in a Moving Ambulance
Authors: Prytz Erik , Åkerstedt Zandra , Lidestam Björn , Lampi Maria , Jonson Carl-Oscar 
Published: May 2019

Introduction:Providing patient care in a moving ambulance can be difficult due to various transport-related factors, (e.g., accelerations, lateral forces, and noise). Previous research has primarily focused on cardiopulmonary resuscitation (CPR) performance effects but has neglected to investigate other care interventions.Aim:To test a range of different care interventions during different driving scenarios.Methods:A workshop with ambulance practitioners was held to create a list of care interventions to be tested. Two ambulance practitioners were recruited to drive an ambulance on a closed test-track while performing care interventions on simulation models. Three driving scenarios of differing difficulty were used. Main outcome measures were estimates of workload using the NASA Task Load Index (TLX) and task difficulty. G-forces and video-data were also collected.Results:Estimated workload increased overall as the difficulty of the driving scenario increased, as did task difficulty estimates. However, some care scenarios and interventions were affected less. For example, placing intravenous access increased greatly in difficulty, whereas saturation and blood pressure measurements had more modest increases. TLX scores showed that the primarily estimated physical workload and effort that increased, but also mental and temporal demands for some care scenarios. The more difficult driving scenarios primarily increased the variability of measured G-forces but not necessarily the overall driving speed, indicating that force variability is an important factor to study further.Discussion:The study was intended as an initial pilot test of a wide range of care interventions. It will serve as input to future, larger studies of specific interventions and transport-related factors. Overall, this small pilot indicates that more interventions than only CPR should be studied in moving ambulances to investigate potential performance effects. This is important for traffic, patient, and work safety for ambulance workers and patients.
A Pilot Study of Surge Capacity in the Metropolitan Area of South Korea
Authors: Yoon Young-hoon , Kim Jung-Youn , Heo Gwang-ryol , Sim Bo-Sun , Moon Sung-Woo 
Published: May 2019

Introduction:Seoul is the third most densely populated area in the world except for the city-state. However, a national disaster plan has not yet been established.Aim:From September 2017, representatives of seven regional emergency medical centers in Seoul met monthly and decided to investigate basic data for the future establishment of surge capacity planning.Methods:Staff, supply, space, and systems for surge capacity were surveyed in seven hospitals. The additional surveyed data were as follows: hospital incident command system and actual operational experience; performance of disaster drill; safety and security plan; estimation of surge capacity in normal operating conditions and extreme operating conditions; alternative therapeutic spaces; back-up plan to call non-duty medical staff; decontamination equipment; contingency plan for stuff shortage; etc.Results:All the hospitals reported they have hospital incident command systems and held disaster drills every year, however, the two hospitals (28.5%) had no real experience of hospital incident command system activation. Five hospitals (71.4%) did not have a safety and security plan. They replied they can treat average 7.7 emergency patients (Korean Triage and Acute scale (KTAS) ≤ 3), 10 non-emergent patients (KTAS>4), 0.9 surgical patients and 0.7 unstable patients simultaneously in normal operating conditions. In extreme operating conditions, they replied they can treat average 26.4 emergency patients (KTAS ≤ 3), 54.3 non-emergent patients (KTAS>4), 37 surgical patients and 2.3 unstable patients simultaneously. The two hospitals (28.5%) had no alternative therapeutic spaces, no back-up plan to call non-duty medical staff and no contingency plan for stuff shortage. Three hospitals (42.9%) did not have decontamination equipment.Discussion:The survey revealed the basic data for surge capacity planning in Seoul. Data from hospitals other than regional emergency medical centers should be collected for the completion of disaster plans.
Social Media in Disasters
Authors: Doyle Constance , Mace Sharon 
Published: May 2019

Introduction:Individuals may not receive messages via usual sources. Social media such as Facebook, LinkedIn, Twitter and social networking groups have been useful in the notification, information dissemination, safe notices, and reunification.Methods:A survey of the literature and of social media sites to determine what possibilities of notification, information exchange, marked safe, and reunification information that can be helpful in disasters.Results:Social media is useful during all phases of a disaster: pre-disaster notification, information dissemination during disasters, and safe notices/reunification post-disasterDiscussion:Social media is internet-based and requires a device that needs power. There is widespread internet access to various forms of social media, such as email, various broadcast sources, and social networking sites. Social media may provide pre-disaster warnings (weather alert app, reverse 911), evacuation/sheltering information, blocked routes, open gas stations, stores with supplies, hotels/motels with rooms, and shelter locations. Social networking groups were full of messages informing others they could shelter someone fleeing the California wildfires and recent hurricanes. Volunteers can be alerted and responses collected via social media groups. Social media may reach individuals earlier than official announcements, although sometimes accuracy may be in question. Rumor and malignant information source as well as inaccurate information are possible and may need to be managed. Separation is common during disasters. Knowing if their loved ones are safe and well, then reunifying is critical, especially for the vulnerable: children/infants, elderly, and disabled. Reunification systems need safeguards for vulnerable individuals who may be exploited or abused during disasters. In previous disasters (Hurricanes Maria, Mark, and others; California wildfires), when usual communication was nonfunctional due to downed power lines or damaged/destroyed substations; social media was deluged with individuals giving names and identifying information for family and others and asking whether anyone has seen or heard from them.
A Study to Determine the Nature and Risk Factors for Road Traffic Injuries
Authors: Vaid Harvinder kaur 
Published: May 2019

Introduction:In 2010, an estimated 1.3 million road traffic injury (RTI) deaths occurred worldwide, accounting for about 2.5% of all deaths. Mortality in serious injuries is 6 times worse in a developing country such as India compared to a developed country. Strengthening and undertaking research on the public health burden and impact and understanding the risk factors of trauma is the need of the hour.Aim:To identify the nature of injury in terms of causes and severity of injury.Methods:Using a quantitative approach, a retrospective cross-sectional survey was conducted at the emergency and trauma center in Ram Manohar Lohia (RML) Hospital, New Delhi. The information of all the injured patients seeking health care during the past one year from October 2015 - September 2016 at Emergency and trauma center was collected from the trauma registry forms filled at the time of registration.Results:A total of 1952 cases of road traffic injury sought health care during the study period. The average number of cases reported per day was five. Maximum of the cases (40%) were reported between 12-6PM. Among the injured, 82% were males and the majority of victims were between 20-30 years age group followed by 30-40 years.Discussion:Trauma services need to be coordinated in infrastructure and human resources so that the right patient is taken to the right hospital at the right time. This calls for a lead agency at the district, state, and finally national level. Safety education regarding road safety should be imparted, especially to all victims, relatives, and the general public to make the care comprehensive. Students in schools and colleges should also be the target for intense safety education.
Train Related Injuries: Growing Concern in Developing Countries and Five-year Experience at Level-1 Trauma Center in India
Authors: Bagaria Dinesh , Banerjee Niladri , Ud Parvez Mohi , Gupta Amit , Joshi Mohit , Sagar Sushma 
Published: May 2019

Introduction:Indian railway systems are fourth largest in the world, and cause on average 15 deaths daily due to various intentional and unintentional reasons. This study presents a 5-year retrospective data analysis of polytrauma patients with train-related injuries.Aim:To highlight key lessons learned from data analysis to inform better safety measures and laws.Methods:Trauma registry data between 2012 and 2016 were analyzed for patients with train-related injuries. Data from 726 patients were analyzed for demographics, event, injuries, management, and final outcome. ISS was used to quantify the extent of injury.Results:Mean patient age was 33 years with an 86% to 14% male to female ratio. 62% of patients were in the 20- to 40-year age group. Average time of arrival at health facility post-injury was 3.3 hours. Half of the patients were trespassers. Mean ISS was 11.65. Chest injuries were present in 24.6% of patients, with half requiring interventions like ICD insertion or surgery. 20% of patients underwent amputations of extremities. 40% of patients needed admission to the ICU. 3.5% died in the Emergency Department (ED). Mean hospital stay was 17 days with an in-hospital mortality of 17.4%.Discussion:This analysis is the largest to date showing comprehensive injury patterns and outcomes of train-related injuries from a developing country. Patients injured on the platform and off the platform had the same severity of injuries. This analysis shows the need for safety measures and strict law enforcement both at the station and at the track.
Triage Problem Among the Ambulance Crew (Paramedic) in Japan
Authors: Nakata Keiji 
Published: May 2019

Introduction:At various accidents or disaster sites, rescue, first aid, and transport to hospitals has been provided by ambulance crews (paramedics). In the case of mass casualties, they also need to operate triage for injured people.Aim:To consider and reveal challenges in triage by ambulance crews (paramedics) on-site.Methods:Interviews of seven ambulance crews (paramedics) and their instructors were conducted and their answers were analyzed.Results:(1.) Triage black tags: declaring “deceased: not able to survive” might give a heavy mental burden and psychological responsibility. Legal protection and an interstitial rule will be necessary in the future. (2.) Missed triage: the ambulance crew cannot perform a triage that may develop a legal problem. It is always important to prevent ambulance crews from being charged. (3.) Triage education and training: there are few triage trainings at fire departments although the number of emergency medical responses is increasing compared to fire response. It will be necessary to increase time of the triage education and training in near future. (4.) Command system (characteristic rank system in the fire department): There is a problem with the rank system in fire departments since confusion occurs when a commander of the First Aid Station is not a licensed paramedic. The ambulance crew (paramedic) usually consists of the three different ranked people. Individual operations are difficult during operation. Education for the paramedic executive is necessary for the fire organization.Discussion:For the triage by ambulance crew (paramedic), legal protection by medical control operation is required, and it may lead to a reduction of heavy mental burden. Triage training is needed to improve the training of triage. The ambulance crew (paramedic) operates under the fire department command system. However, at the time of disaster, the ambulance crew (paramedic) should also work under the medical command system.
Using the Past to Prepare for the Future: A 2018 Pilot Study to Improve the Hospital Response for Mass Casualties via a Multi-Dimensional Approach
Authors: Contreras George W. , Pohlman Kevin , Mandel-Ricci Jenna , Markenson David , Reilly Michael 
Published: May 2019

Introduction:Recent mass shooting events remind us of the importance of hospitals’ preparedness to manage a large number of patients in a short period of time. While prehospital systems triage for field interventions and priority of transport, they were not designed to triage for the scarce resources of a hospital. Therefore, upon arrival to hospital, clinicians must then quickly determine how to best assess and provide life-saving interventions based on their limited resources.Methods:In collaboration with the Greater New York Hospital Association (GNYHA), the Center for Disaster Medicine at New York Medical College piloted an interactive and intensive eight-hour course at four New York State hospitals that covered critical areas such as: current literature on Mass Casualty Events and Triage, review of hospital emergency management, hospital-based triage principles, a MCI exercise in the emergency department, a surge capacity tabletop exercise, and use of ultrasound. While targeted towards physicians to foster team-based care and learning, nurses, physician assistants, and hospital administrators also participated in the pilot course.Results:Sixty persons from four hospitals participated in the pilot phase. Preliminary findings post-training reveal the following: 58% of participants expressed greater confidence in distinguishing between emergency department triage and triage during disasters; 59% of participants expressed greater confidence in performing initial triage of victims; 49% of participants expressed greater confidence in describing the use of ultrasound-guided triage; and 95% of participants reported an enhancement in their ability to perform their clinical role.Discussion:Preliminary findings reiterate the ongoing need for hospitals to provide training to their staff in the unique aspects of hospital triage and surge management using tools specifically designed in order to be prepared for the rapid influx of a large number of patients. A multipronged training model is a positive approach to help hospitals prepare for large-scale disasters.
Utilization of the Multi-Pathogen Approach in an Online Program for Prehospital Responders in High Consequence Infectious Diseases
Authors: Jenkins J Lee , Bissell Richard , Wilson Lucy 
Published: May 2019

Introduction:The prehospital disaster and emergency medical services community stands on the front-line in the response to events such as novel influenza, multi-drug resistant tuberculosis, and other high consequence diseases such as the Ebola Virus Disease.Aim:To address provider and community safety, we developed an online educational program utilizing a Multi-Pathogen Approach to infectious disease personal protective equipment (PPE) deployment by prehospital providers. Such vigilance starts with syndromic recognition and quickly transcends to include operational issues, clinical interventions, and public health integration.Methods:The University of Maryland, Baltimore County (Maryland, USA), Department of Emergency Health Services partnered with the Maryland State Department of Health (USA), to develop an online educational curriculum. The curriculum was developed through an expert panel consensus group including prehospital providers and is hybrid in design and includes awareness level training and procedural guidance.Results:Currently deployed online, this educational content demonstrating the use of the Multi-Pathogen Approach is accessible open-access via YouTube worldwide on computers, tablets, and smartphones. This curriculum is also accessible for continuing medical education to over 50,000 prehospital, hospital, and clinic personnel throughout Maryland and the National Capital Region of the United States. The curriculum consists of twelve modules of didactic and live videotaped demonstrations.Discussion:The development of the Multi-Pathogen Approach for the deployment of PPE and the use of online education modules has given prehospital providers an easily accessible open-access tool for high consequence disease management. The development of educational efforts such as these can help ensure better patient care and prehospital EMS system readiness.