bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Emergency Department Expansion on Emergency Department Patient Flow
Authors: Kim Min Joung , Park Joon Min 
Published: May 2019

Introduction:Overcrowding in the emergency department (ED) has been a global problem for a long time, but it is still not resolved.Aim:To determine if an ED expansion would be effective in resolving overcrowding.Methods:This was a retrospective study comparing two 10-month periods before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The existing ED consisted of 45 beds in the adult area and eight beds in the pediatric area. After the construction, the number of beds was not increased, but a fast track area was newly established in the adult area, and a 25-bed ward for emergency hospitalized patients was opened.Results:The number of patients visiting the ED increased from 77,078 to 87,927. The proportion of patients who returned home without treatment significantly decreased from 11.5% to 0.9% (p<0.001). The number of adult patients increased from 40,814 to 60,720, but the number of patients who could be treated on the bed decreased (22,166 (54.3%) vs. 17,776 (29.3%), p<0.001). The number of pediatric patients was similar in both periods. Median ED length of stay (LOS) of total patients increased from 193.0 min to 205.8 min (p<0.001). Of the 18,900 hospitalized patients during post-period, 1,255 (6.64%) were admitted to the emergency ward, and the boarding (from admission decision to hospitalization) time of the admitted patients decreased from 239.2 min in the pre-period to 190.9 min in the post-period by 38.3 min. However, more time was required for admission decision in the post-period (216.8 vs. 253.3, p<0.001).Discussion:The ED expansion allowed more patients to be treated, and the emergency ward reduced boarding times of admitted patients. However, due to the increase in the number of patients, the time required for medical treatment increased.
The Experience of a Mass Casualty Incident Call in a Tertiary Hospital after the 2018 Hualien Earthquake
Authors: Cheng Hsing Chia , Niu Kuang Yu , Ho Ming Han 
Published: May 2019

Introduction:After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.Aim:This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.Methods:The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.Results:Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).Discussion:MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.
Health Care Provision during a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery
Authors: Johnston Amy , Wadham Jasmine , Polong-Brown Josea , Aitken Michael , Ranse Jamie , Hutton Alison , Richards Brent , Crilly Julia 
Published: May 2019

Introduction:During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.Aim:To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.Methods:A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.Results:Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.Discussion:This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
HESPER SW: A Web-Based Tool to Assess Needs
Authors: Hugelius Karin , Semrau Maya , Holmefur Marie 
Published: May 2019

Introduction:The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) evaluates experienced needs among disaster-affected populations and has been frequently used in both humanitarian emergencies and research. Today, the use of this tool is increasing among people affected by crises and emergencies. Web-based methods have shown to reduce several methodological and practical challenges in disaster health research.Aim:This project aims to develop and evaluate HESPER SW (a self-administered, web-based version of the HESPER scale).Methods:Alternative reliability and test-retest validity of HESPER SW were evaluated using different analytic statistical methods.Results:The first analysis suggests that HEPSER SW is a reliable and valid instrument which is easy to use and that it reduces several methodological and practical challenges in disaster health research.Discussion:HESPER SW can be used both for humanitarian and research purposes and offers a quick, self-administered, web-based, and scientifically robust way to investigate experienced needs in populations affected by disasters or humanitarian crises.
The Human Disaster and the Urgency of the Intersetorial Join Between Public Social Policies: Lives that are Lost and Stories that Repeat Themselves
Authors: Bellini Maria Isabel Barros , Marques Nadianna 
Published: May 2019

Introduction:The human disaster is a permanent challenge for the Brazilian government because the difficulties faced are related to the lack of interface between public policies, resulting in fragile analyses of risk and non-prevention, being that annually several Brazilian lives are lost in disasters that continue to happen.Aim:The article is the result of research and presents the analyses of health policy, actions, and programs developed to anticipate the fire victims of the Nightclub Kiss concert hall that took place in 2013 (Santa Maria, Brazil). The objective was to investigate and analyze the disasters and human disasters, especially the fire of Nightclub Kiss when 242 young people died. Causes and determinants were analyzed in order to subsidize public policies, in particular, the health policy.Methods:A qualitative case study supported by the critical dialectic method with semi-structured interviews, focus group, documentary analysis, and bibliographic review.Results:The experiences accumulated throughout history show that disaster situations require public policies to be able to act readily, resolve, and pay attention to the needs of the population involved. Disasters are increasingly recurrent episodes and generate deep social consequences that mark human life. Managing a human disaster remains a challenge for the health policy in Brazil. The difficulties faced are related to the lack of interface with other public policies. The urgency to incorporate intervention/action strategies into health plans is important. Implementation of prevention and training programs, and adopting strategies and protocols for the whole network of attention is critical.Discussion:It is important to emphasize the importance of broadening the theoretical definitions by overcoming the divergences of the concepts adopted between the theoretical and operational field, by elaborating a review of the Brazilian legislation in order to broaden and contemplate the needs of different people.
Human Factor and Disasters: Possible Equations
Authors: Bellini Maria Isabel Barros , da Silva Ines Amaro , Gershenson Beatriz , Correa Michele Cardoso 
Published: May 2019

Introduction:This research starts from the assumption that work accidents, in addition to fortuitous or individual phenomena, imply social and organizational factors, and highlights the social character of the production of the accident at work. For this reason, this study investigates the living conditions and the ways of workers in the oil and gas industry in Brazil.Aim:To analyze the human factors in the relationship with work accidents on oil platforms from the social dimensions.Methods:It is qualitative research and it has as instruments of collection the focal group and individual interviews with workers and managers of the platforms, participant observation, and documentary analysis.Results:The research is still being carried out, but some reflections are possible so far: accidents at work depend on the direct or indirect relationship of workers with the work process itself, the modalities of production of work, and management of work. Possible causes underlying the accident are the quality of life and the conceptions of health and safety. Associated with it are social constructs and the multifactorial causes of occupational accidents including the relations between acts and unsafe conditions.Discussion:The increase in outsourcing and the decrease in training quality, as well as the prioritization of production, targets the detriment of meeting safety criteria. There is a need to reassess labor management, safety policies, and outsourcing processes. Lack of awareness of the proper use of safety equipment and the organization of the work environment are major causes of work-related accidents. The human factor focuses on the individual, group, organizational, and social dimensions in complex interactions. The identification of social processes between working groups in empirical reality, the influence of elements of culture, organizational management, and their impacts on relations and on safe work performance allows an understanding of social risks.
Immunization Readiness of a Deploying Emergency Medical Team
Authors: Morrow Melanie , Sekulich Hollie , Trewin Abigail , Archer Peter 
Published: May 2019

Introduction:It is a requirement for a World Health Organization verified Emergency Medical Team (EMT) that all members be immunized against common diseases in the deploying region. Most jurisdictions use private suppliers such as travel doctors for immunization services. When a deployment is announced, members are nominated by their jurisdiction under the condition they are fully immunized. It is up to the individual to monitor their immunization status.Aim:To determine how many members nominated for deployment were fully immunized.Methods:Nominated members sent their completed vaccination record to a central location for assessment of their immunization status. The following data were recorded: vaccination status, last-minute booster doses required, and the number of emails sent by the assessor in processing the records. The number of phone calls made and received were not recorded.Results:To complete the skills matrix for a field hospital containing an emergency department and operating theater (an EMT type 2), 61 members were nominated. At the time of assessment, 32 (52%) were fully immunized, requiring no further booster doses (vaccinations or serology tests). Three members were removed from the deployment as they were not fully immunized. Last-minute booster doses were required by 27 (44%) members, with a total of 74 booster doses administered (range 0-5). 19 of the booster doses administered were immunizations required to work in any health facility in Australia. The most common vaccines requiring booster doses were rabies (n=21) and typhoid (n=15). 58 emails were sent over a period of 5 days to 24 members to clarify vaccination status.Discussion:This deployment highlighted a gap in members’ perception of their immunization status, leading to delays in deployment readiness for the team. A new electronic system where vaccine status tracking occurs in real time should address this issue.
Impact Scale for the Continuity of Care in Contingency Management Situations - Operationalization of the Crisis Standards of Care
Authors: Geene Roel , van der Torn Pieter , den Hartog Dennis 
Published: May 2019

Introduction:A common language is needed to compare the impacts of incidents, crises, and disasters among health care coalition members, such as emergency medical services, general practitioners, and hospitals. A generic impact scale was developed, based on the Crisis Standards of Care, and was put to the test during the 2017 and 2018 winter/flu-seasons.Aim:To define an impact scale for the quantitative assessment of the hospital response to incidents, crises, and disasters.Methods:An impact scale has to be generally applicable to be useful in the context of a health care coalition. It should be applicable to all hazards and all parties in proactive and reactive, real-time settings. In addition, the scale should be easy to understand and score and should be independent of the various information systems in use. The Crisis Standards of Care were chosen as basis and were operationalized in a seven-point Likert-scale for expert-based scoring: “No impact,” “Buffer capacity needed,” “Buffer capacity sufficient,” “Unusual adaptations to care needed,” “Unusual adaptations sufficient,” “Disturbance of continuity of care inevitable without external assistance,” and “Disturbance of continuity of care inevitable.”Results:During the 2017 and 2018 winter/flu-seasons, crisis managers of ten hospitals scored the scale almost daily for three months. This served as a regional monitor and created the possibility to distribute patients and resources more evenly over the hospitals and with the care sector.Discussion:The impact scale improved communication and mutual understanding between hospitals and with other health care organizations, and is expected to have helped in maintaining the continuity of care during the 2017 and 2018 winter/flu-seasons. More research is needed on the reliability of the response. Nevertheless, the scale has since become an integral part of the regional contingency planning.
Inter-Authority and Cross-Border Cooperation Using the Tetra Digital Radio Network
Authors: Silfvast Tom , Pekkonen Tomi 
Published: May 2019

Introduction:The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.Methods:The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.Results:Pending configuration of necessary talk groups, the system will be functional and in use in 2019.Discussion:Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.
Measuring the Masses: Guidelines for Publication of Case Reports on Mass Gatherings
Authors: Turris Sheila , Rabb Haddon , Callaghan Christopher , Munn Matthew Brendan , Ranse Jamie , Lund Adam , Chasmar Elizabeth 
Published: May 2019

Introduction:The science supporting event medicine is growing rapidly. In order to improve the ability of researchers to access event data and improve the quality of publishing mass gathering cases, it would be of benefit to standardize event reports to permit the comparison of similar events across local and national boundaries. These data would support the development of practice standards across settings.Aim:The authors propose the creation of a publication guideline to support authors seeking to publish in this field.Method: Derivation study via analysis of published case reports using the Delphi process.Results:Data elements were inconsistently reported within published case reports. Categories of variables included: event demographics (descriptors of date, time, genre, activity, risks), attendance and population demographics, data related to climate and weather conditions, composition and deployment of an onsite medical team, highest level of care available onsite, patient demographics, patient presentations and measures of impact on the local health care system such as transfer to hospital rates. Of note, there was a high incidence of “missing” variables that would be of central interest to researchers.Discussion:Approaches to standardizing the collection and reporting of data are often discussed in the health care literature. The benefits of consistent, structured data collection are well understood. In the context of mass gathering event case reporting, the time is ripe for the introduction of a guideline (with accompanying guidance notes and dictionary). The proposed guideline requires the input of subject matter experts (in progress) to enhances its relevance and uptake. This work is timely as there is ongoing work on improving an international event medicine registry. If the evolution of both proceeds in lockstep, there is a good chance that access to a rigorous data set will become a reality.
Medical Activity Training using SDF Ship at Wide Area Disaster
Authors: Mimura Seiji 
Published: May 2019

Introduction:We have repeatedly trained to use the SDF ship as a temporary medical facility during acute disasters. The Maritime Self Defense Force has various types of ships: supply ship (Oumei type), transport ship (Osumi type), and escort ship (hinge type, whip type) which has a large hangar and a treatable medical compartment.Methods:The points of training are collaboration between the SDF and the commander’s line of medical personnel, construction of a method of contact with the outside, construction of contact method inside the ship, kind of patient, medical contents, use of medical zone, method of transporting to the ship, method of transporting to the outside of the ship, positioning of the ship in the afflicted area, etc.Results:Assuming the Nankai Trough Earthquake, the activities of SDF vessels in coastal areas are affected by the extent to which the functions of medical institutions in inland areas are kept, how transportation methods can be secured, and how many injured people there are.Discussion:As a result of the examination thus far, the range of activities of SDF vessels is limited. The function of the ship is considered to be offshore SCU, hospital evacuation support, etc. Tight collaboration and training with the SDF are necessary in the future.
Medical Measurement Against the Mega-Disaster: The Necessity of Systematization of the Disaster Medicine or the Disaster Medicine Compendium
Authors: Haraguchi Yoshikura , Tomoyasu Yozo , Tsubata Tohru , Ishihara Tetsu , Sakai Motohiro , Nagata Iyasu 
Published: May 2019

Introduction:The large number of casualties during major or mega-disasters are a global problem.Aim:The role of medicine against mega-disasters is analyzed from a worldwide perspective.Methods:Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.Results:These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).Discussion:Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.