bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of endomyocardial biopsy in children
Authors: Cowley Collin G. , Lozier John S. , Orsmond Garth S. , Shaddy Robert E. 
Published: May 2019

Endomyocardial biopsy in children remains important in the evaluation of cardiomyopathy, myocarditis, and rejection following cardiac transplantation. We sought to evaluate the morbidity associated with endomyocardial biopsy on the basis of a large experience from a single institution.We reviewed records of all endomyocardial biopsies performed at our institution. Complications were defined as adverse events resulting from the biopsy requiring intervention or additional observation. We also reviewed the most recent echocardiogram from all the patients for the presence and severity of tricuspid valvar regurgitation.Between November 1986 and April 2002, we performed 1051 endomyocardial biopsies in 135 patients ranging in age from 9 days to 18 years. The internal jugular vein was the site of vascular access in 68% of the procedures. There were 10 acute procedural complications requiring intervention or additional observation. Severe tricuspid regurgitation developed in two patients who had undergone multiple biopsies after cardiac transplantation, one of whom underwent subsequent replacement of the tricuspid valve. There were no deaths or cardiac perforations. The total incidence of morbidity was 1.1%. No demographic or procedural factors were identified to be predictive of complications.In experienced hands, therefore, endomyocardial biopsy can be safely performed in children with very low morbidity.
Mortality in Nursing Home Evacuations in the United States from 1995-2017
Authors: Mace Sharon , Caicedo Daniel , Sharma Aishwarya 
Published: May 2019

Introduction:There are an estimated 15,600 nursing homes with a total of 1.4 million residents in the United States. The number of residents will continue to increase due to the aging population, and the associated morbidities will make it difficult to evacuate them safely.Aim:This study is the first of its kind to provide an analysis of the number of nursing home deaths caused by external and internal events following evacuations.Methods:Information from the databases Lexis Nexis and PubMed were compiled and limited to news articles from 1995-2017. The gathered information included the reason for evacuation, injuries, deaths, and locations within the United States.Results:From 1995 to 2017, there was a total of 51 evacuations and 141 deaths in nursing homes. 27 (53%) evacuations were due to external events which resulted in a combined 121 (86%) deaths, and 24 (47%) evacuations were due to internal events which resulted in a combined 20 (14%) deaths. Hurricanes were responsible for the majority of deaths during evacuations, followed by fires and floods. The number of evacuations and deaths increased the greatest between 2005 to 2008.Discussion:External events have the greatest impact on loss of life. Internal disasters are about equal in the number of incidents, however, external events have a much greater mortality rate. Exact numbers on injuries, morbidity, and mortality are difficult to ascertain, but it appears to be related to natural disasters. In view of the increasing likelihood of natural disasters related to global warming, a drastic improvement of standard evacuation procedures of long-term nursing homes is critical to decreasing mortality of nursing home residents. There also needs to be a nationally standardized method of reporting evacuations in order to better analyze data on nursing homes.
Surgical Procedures Performed by Emergency Medical Teams in Sudden-Onset Disasters: A Systematic Review
Authors: Coventry Charles , Holland Andrew , Vaska Ashish , Ivers Rebecca , Read David 
Published: May 2019

Aim:To describe the types of surgical procedures performed by emergency medical teams (EMTs) with general surgical capability in the aftermath of sudden-onset disasters (SODs) in low- and middle-income countries (LMICs).Methods:A search of electronic databases (PubMed, MEDLINE, and EMBASE) was carried out to identify articles published between 1990 and 2018 that describe the type of surgical procedures performed by EMTs in the impact and post-impact phases a SOD. Further relevant articles were obtained by hand-searching reference lists.Results:16 articles met the inclusion criteria. Articles reporting on EMTs from a number of different countries and responding to a variety of disasters were included. There was a high prevalence of procedures for extremity soft tissue injuries (46.8%) and fractures (28.3%). However, a significant number of genitourinary/obstetric procedures were also reported.Discussion:Knowledge of the types of surgical procedures most frequently performed by EMTs may help further determine the necessary prerequisite surgical skills required for the recruitment of surgeons for EMTs. Experience in basic plastic, orthopedic, urological, and obstetric surgery would seem desirable for surgeons and surgical teams wishing to participate in an EMT.
August 24th, 2016 Central Italy Earthquake - Validation of “Modified Utstein Template for Hospital Disaster Response Reporting,” A New Tool for Reporting Hospital’s Reaction to Disasters
Authors: Paganini Matteo , Ragazzoni Luca , Rossitto Fabio , Vecchiato Aurora , Bonfini Rita , Mucciante Maria Vittoria , Nisii Alessandra , Corte Francesco Della , Ingrassia Pier Luigi 
Published: May 2019

Introduction:After Action Reports analyze events and recommend actions to facilitate preparedness and response to future similar disasters. However, there is no consensus among the templates developed to collect data during disasters and little is known about how to report hospital responses.Aim:The hypothesis was that the use of a new assessment tool for hospital response to natural disasters facilitates the systematic collection of data and the delivery of a scientific report after the event.Methods:A data collection tool, focused on hospital response to natural disasters, was created modifying the “Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters”,1 and tested the reaction of the hospitals involved in the response to the Central Italy earthquake on August 24th, 2016.Results:Four hospitals were included. The completion rate of the tool was of 97.10%. A total of 613 patients accessed the four emergency departments, most of them in Rieti hospital (178; 29.04%). Three hundred and thirty – six patients were classified as earthquake-related (54.81%), most of which with trauma injuries (260; 77.38%).Discussion:The new reporting tool proved to be easy to use and allowed to retrospectively reconstruct most (97.10%) of the actions implemented by hospital responders. Details about activation, patient fluxes, times, and actions undertaken were easily reconstructed throughout in-field interviews of hospital managers and patients’ charts. Patients were uniformly distributed across the four hospitals, and the hospital capabilities were able to cope with this mass influx of casualties. The Modified Utstein Template for Hospital Disaster Response Reporting is a valid tool for hospital disaster management reporting. This template could be used for a better comprehension of hospital disaster reaction, debriefing activities, and revisions.
Crisis State of Medical Readiness and Citizen Preparedness Importance for Radiological and Nuclear Incidents
Authors: Swienton Raymond E. , Liu E. Liang , Flax Lindsay A. , Klein Kelly R. 
Published: May 2019

Introduction:In 2017, members of our workgroup published on the readiness for nuclear and radiological incidents among emergency medical personnel.1 Our findings, along with a review of pertinent literature, suggest that the state of medical preparedness for these incidents is in crisis. A 2018 publication addressing nuclear terrorism preparedness relegates medical preparedness to a low priority and describes it as potentially dangerous.2 The crisis status of medical preparedness for these incidents is addressed.Aim:To establish a prepared medical workforce and trained public for those at risk from nuclear or radiological disasters.Methods:This Institutional Review Board (IRB)-approved survey published an article and used a relevant literature review.Results:Readiness for nuclear and radiological incidents is lacking in multiple areas including education, training, identifying medical needs, willingness to come to work, and perception of relative risk among medical personnel.1 Confounding this is recent prominent publication downplaying and discouraging medical preparedness for nuclear terrorism.2 The importance of a readied workforce and a prepared public is identified.Discussion:In 2013, we formed a multi-national workgroup focused on preparing health professionals and the public for clinical management of casualties during nuclear and radiological disasters. Modeling has demonstrated predictable casualty injury and illness patterns suggesting that early appropriate medical response will save lives. Readiness demands an educated, skillful, and willing-to-engage medical workforce. Our 2017 publication identified several areas that place medical preparedness at risk.1 A significant risk to medical preparedness may lie in prominent publications discouraging the pursuit.2 We firmly believe that medical preparedness is essential and begins with a prepared public.
Disaster First Responder Training: A Train-the-Trainer Veterans Program to Combat PTSD
Authors: Kincaid Jenevieve , Reno Elaine , Lemery Jay , Miner Todd 
Published: May 2019

Introduction:There are many health challenges faced by those returning from military service. Posttraumatic stress disorder (PTSD) is a serious problem in veterans. PTSD is a risk factor for suicide in veterans. Standard treatments include medication and talk therapy. Non-traditional treatments include civil service and leadership training.Aim:Assess the effectiveness of Veteran Focused Train-the-Trainer (TTT) Community Disaster Response and First Aid (DRAFA) Programs in promoting health, wellness, reintegration, and decreasing PTSD symptoms of veterans.Methods:A longitudinal cohort study was conducted using a convenience sample of veterans living in Denver, Colorado or Reno, Nevada. The sample size was over 50 (N=50+), with 25+ case-matched veterans at each location. This is an ongoing project lasting through the end of 2020. Inclusion criteria selected veterans interested in DRAFA training and education. Exclusion criteria disqualified those who are not a veteran or those unable to perform physical tasks required by curriculum. The null hypothesis was that there is no relationship between the DRAFA TTT program and the health, well-being, and reintegration of veterans back into their communities. Statistical tools used were SPSS Statistics (Version 25) and NVivo 12-12.2.0.3262. Research activities were conducted under the auspices of the University of Colorado and guided by the principles of the Institutional Review Board (IRB).Results:Results are being evaluated using a mixed methods impact model. The main outcomes measured health, wellness, and reintegration using Veterans RAND-12 Health Quality of Life Survey, the Military to Civilian Reintegration Survey, and a satisfaction survey. Preliminary analysis may indicate a correlation between participation in the DRAFA TTT program and improved health/wellness outcomes, better reintegration into society, and decreased PTSD.Discussion:There is growing evidence that expedited structured reintegration programs in community preparedness and disaster leadership roles for veterans alleviate PTSD symptoms and improves quality of life.
Key Elements of Civil-Military Disaster Rescue Operation in China
Authors: Guo Haitao , Guo Shusen 
Published: May 2019

Introduction:In China, many disaster rescue operations need cooperation between civil forces and military forces. Understanding the key elements of civil-military disaster rescue operations is a basic problem faced by Chinese rescuers and scholars.Aim:To summarize the key elements of civil-military disaster rescue operations in China.Methods:On July 17, 2016, an expert round-table meeting was held on our campus to discuss some basic problems in disaster research. The participants arrived at a consensus that the key elements of civil-military disaster rescue operation under Chinese cultural context should be carefully analyzed using Six Sigma (Why, Who, What, When, Where, and How, 5W1H)Methods:The minutes of the meeting was summarized into a brief report.Results:(1) Why to rescue - it is the responsibility of modern government to protect its people; (2) Who are the rescuers - individuals or groups with passion and ability to do such work, but they should be organized properly; (3) What to do - make vital systems of the community run normally as soon as possible; (4) When to rescue - different disasters have different laws, but it is better to render help in the golden hour; (5) Where to rescue - it depends on the input process (material, human resources, etc.) and output process (patients, waste material, etc.) of the rescue operation, not merely confined to the disaster site; (6) How to rescue - cooperation among all branches of social sectors is vital to succeed, especially civil-military cooperation. Military force is the backbone force in an austere environment.Discussion:The discipline of disaster medicine is developing rapidly in China. The research and evaluation framework should be established carefully. Civil forces and military forces should have an identical understanding of the same question. This abstract is only part of the research framework.
Evolving Strategy and Incident Management Systems in Hard to Reach Areas and Fragile Security Settings: The Case of Ebola Response in the Democratic Republic of Congo
Authors: Yao Nda Konan Michel , Ndjoloko Tambwe Bathe 
Published: May 2019

Introduction:DRC Ministry of Health declared the 9th outbreak of Ebola Virus Disease (EVD) in the Equator province on May 8, 2018, that ended on July 25, 2018. There were 54 cases with 38 confirmed, 33 deaths (61%), and 21 survivors in three “zones de santé” (districts). On August 1, 2018, the 10th EVD outbreak of the country was declared in the Ituri and North Kivu provinces. This one is the most important outbreak ever experienced. By November 18, 2018, 373 cases were reported with 326 confirmed and 214 deaths (58%) in two provinces including 14 “zones de santé.” While the 9th outbreak occurred in hard-to-reach areas, the 10th is occurring in fragile security settings, requiring specific strategic/operational approaches.Aim:To describe strategic and operational approaches including IMSs used to address these deadly outbreaks.Methods:A case study methodology using response strategy documents and observations was used, coupled with the use of operation review exercises.Results:The response strategy evolved continuously taking into account the epidemiological context, including geographical spread. It also took into account cultural, political, and sociological (community resistances) sensitivities. Conditions of pre-existing health system and services were considered. The prevailing security context (armed groups) was taken into account. The evolving situation impacted implementation of response areas including critical interventions like setting up confirmation and treatment centres, rapid response teams, and IMS structures. Areas of response were reviewed continuously, including response structures with further decentralization, outreach, or locally delegated interventions to ensure geographical access and continuity in response services.Discussion:Response areas to deal with EVD outbreaks are well known. However, an effective response requires a continuous adjustment of the strategy and a flexible response structures with related IMSs based on regular deep situation analysis. Social sciences still have a critical role to play for that purpose.
Helping the Helpers: A Focus on Provider Mental Health
Authors: Jaffe Eli , Herbst Raphael 
Published: May 2019

Introduction:Emergency medical services (EMS) is a high-stress profession, which can lead to deterioration in provider mental health over time. EMS providers may find themselves in a situation where they are not only treating the general public, but also each other. Until now, there has been no active training or emphasis on provider mental health. This has taken its toll and can lead to PTSD (post-traumatic stress disorder) in field providers and managers alike.Aim:Identifying and managing stressors is crucial to longevity in the field of EMS. Managers must have the ability to broach sensitive matters with their subordinates, and effectively debrief them following such stressful incidents.Methods:Magen David Adom held a two-day seminar for its administration, from which they learned signs and symptoms of PTSD, how to approach teams who had been in stressful situations, and how to properly debrief the teams. The seminar culminated in mass casualty incident (MCI) drills, where there were 4 active scenes. Scene 1 had a team that was physically injured. Scene 2 had a team which cared for the team from scene 1. Scene 3 had a team suffering from emotional stress and ceased to function. Scene 4 had only wounded civilians. The drill focused on provider emotions and used actors and props to simulate an exceedingly complex MCI situation.Results:Following the drill, a debriefing was held and it was found that all of the points of interest had been noted and properly dealt with.Discussion:Holding a successful drill assisted in providing participants with an accurate sense of such stressful situations in which their subordinates find themselves on a daily basis. The debriefing session succeeded in identifying potential stressors for field providers and teaching the participants the appropriate way to approach such sensitive matters.
Review of Effectiveness of the Foreign Medical Team Deployment in Nepal Earthquake, 2015
Authors: Pandey Ashok , Pandey Achyut Raj , Dhimal Meghnath , Jha Anjani 
Published: May 2019

Introduction:Nepal experienced a massive earthquake on 25th April, 2015 measuring 7.8 Richter scale followed by large aftershock on 12th May that further added to the destruction, especially in Sindhupalchowk and Dolakha. On request of Government of Nepal, international community extended financial and technical assistance to overcome the impact of the earthquake. Foreign Medical Teams (FMTs); now known as emergency medical team, from different countries and volunteers from within the country had helped in health service delivery.Aim:to get a clear picture of Strengths, Weaknesses/Gaps and Areas of Improvement that would be very important in making the response better in any future events of such scale when discussed and shared with all relevant stakeholders in Nepal.Methods:It was a multi-method study. Both quantitative and qualitative approaches were used to have an in-depth overview of the research question and the objectives set for the study. Records and reports relating Foreign Medical Team Coordination Committee (FMTCC) and meeting minutes of Health Emergency Operation Centre were reviewed.Results:Total of 8,962 deaths and 22,302 injuries occurred following earthquake of which 8,864 deaths and 21,156 injuries occurred in the most affected 14 districts of Nepal. In FGD and KIIs, most of the participants highlighted the earthquake had a huge impact on infrastructures. A large number of casualties were reported immediately after earthquake. Health facilities were overloaded with injured patients. One hundred and thirty-seven FMTs from 36 countries worked in Nepal to provide medical relief.Discussion:Timely preparation and readiness of the procedures to handle the FMTs including their registration process, medical licensing procedures, procedures of coordinating mechanisms with the district, case management and treatment guidelines to be followed by the FMTs are crucial to have a better health sector response including that of FMTs.
Helping Runners Under Extreme Heat: The 2017 Montreal Half-Marathon Experience
Authors: D’ulisse Nicola 
Published: May 2019

Introduction:The 2017 Montreal Half-Marathon was held on September 24th despite a record-breaking, out-of-season heatwave. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), was tasked with coordinating and delivering prehospital response for over 15,000 runners at a time when the province’s paramedics were on strike.Aim:USC’s mission was to ensure runner safety under extreme conditions with limited staffing. In conjunction with the event’s medical teams, we implemented a new approach that oriented patients to the event’s clinic with the aim of limiting ambulance transports off-site and thus optimizing resources by promoting a “treat and release” principle.Methods:Emergency response was organized around the event’s clinic, which offered a level of care comparable to proximate emergency departments, including mass-cooling capacities. This capacity allowed us to modify provincial protocols, and thus prioritize treating patients on-site instead of transporting them to a hospital. Consequently, the prehospital response on the course could be assured with only 15 ambulances (staffed by managers) and a single team deployed at the event’s clinic, acting as transport officers. Heatstroke identification protocols were reinforced for the safety of the runners and spectators.Results:A total of 1,071 participants received medical attention, including 24 who were treated for a heat-related incident. On the course, 32 were evaluated by paramedics and 20 were transported to the event’s clinic. Only 7 patients were transferred from the clinic to a hospital, of which only one was for a heat-related incident. No deaths resulted from the race.Discussion:By anticipating and preparing for the extreme heat, the coordinated prehospital response safely reduced off-site transports, minimizing treatment delays for patients, and maximizing the use of on-site resources. We attribute this success to a strong collaboration with the race organizers, the presence of an on-site clinic, and an increase in prehospital resources.
The Impact of Japan Heatwave on Community Emergency Medicine in 2018
Authors: Iwasaki Yohei , Kasai Kosuke , Hirukawa Kenichi , Kawakami Masato 
Published: May 2019

Introduction:Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.Aim:To assess the impact of the 2018 Japan heatwave on community emergency medical service.Methods:Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.Results:The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.Discussion:The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.