bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Two Types of Personal Protective Equipment (PPE) Doffing Process: Frequency and Sites of Contamination
Authors: Jian-ping You , Sha Yang , Hong-Xia Luo , Hui-Lan Zhang 
Published: May 2019

Introduction:Personal protective equipment (PPE) is a necessary item in the period of unknown and high-risk emerging infectious disease. It is not only the necessary requirement of strict isolation, but also the last line of defense to protect medical staff.Aim:Compare the differences between contaminated frequency and sites under two types of PPE doffing.Methods:Recruited 56 health care workers (HCWs) who worked in clinical to follow the different PPE removal guidelines issued by the Chinese Center for Disease Control (CDC) and the World Health Organization (WHO) final resolution for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion (Glitter Bug Potion, On Solution Pty Lt). Then we recorded the frequency and sites of contamination of personnel after removal of contaminated PPE by the method of visual observation.Results:According to China’s CDC process, the parts that are easily contaminated during PPE removal are: left hand and wrist (7 times), left calf (7 times), front chest center and left and right chest (6 times each) and left abdomen (5 times). Contaminated parts of the PPE process in accordance with the WHO process from high to low were: right hand and wrist (13 times), left hand and wrist (12 times), middle of the abdomen (10 times), left chest (9 times), and left abdomen (6 Times). There was no statistical difference between the two kinds of PPE piercing and removal (Z=1.177, P > 0. 05).Discussion:Under the guidance of the two processes recommended by China CDC and WHO, there was no significant difference in the frequency of pollution after removing PPE. It is speculated that the PPE recommendation processes issued by WHO and China CDC are effective for personal protection against fulminating infectious diseases.
Confusion, Chaos, and Bridging the Gap: A Prospective Study Gauging Disaster Triage Methodologies and Usage Across First Responder Professions
Authors: Adelman Brenna 
Published: May 2019

Introduction:Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.Aim:Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.Methods:A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.Results:Results of this study are pending.Discussion:Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.
The Core Concepts of an Integrated Information System for Disaster Medical Assistance Teams: Ten-Year Experience in Taiwan
Authors: Hsien Wu Chih , Hao Lin Chien , Fu Chen Hsin , Fuh Yuan Shih Frank , Tai Cheng Ming , Kuo Chou Wei , Chieh Liu Hung , Hsien Hsu Shu 
Published: May 2019

Introduction:Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.Aim:In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.Results:During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.Discussion:Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Critical Care Specific Medical Materials Preparedness in the Emergency Department for Mass Shooting Disasters
Authors: Morris Stephen 
Published: May 2019

Introduction:There has been a dramatic increase in the number of mass shootings (loosely defined as an incident with four or more indiscriminate victims) in the United States (1). Additionally, the use of high-caliber, military-style weapons, has become more common in civilian shootings. These trends should influence how emergency departments prepare for disasters, including an inventory of what critical care medical materials (supplies) are readily available in the event of a disaster.Aim:To demonstrate the need for the adoption of medical materials planning for disasters to account for new injury patterns from mass shootings.Methods:A review of injury patterns from recent mass shootings was conducted using available literature (2). The average number of victims presenting to the emergency department in these events was reviewed. Estimation of critical care specific medical materials in the emergency department required for the management of an “average” number of victims with the typical injury pattern of these events was conducted.Results:Some critical care specific medical materials: intubation equipment, chest tubes, and central venous catheters may be in short supply during a mass shooting event.Discussion:Emergency physicians must anticipate and prepare for new disaster trends such as mass shootings and high caliber weapons injuries. This includes having specialty medical supplies readily available in sufficient amount. Normal stocking of critical care specific medical materials may be inadequate in a mass shooting event based on the available literature.
Deuce and a Half with a Twist: Repurposing Old Technology to Save Lives in Swiftwater Rescue during Urban and Small Stream Flash Flooding
Authors: Jaslow Sonia , Jaslow David , Zecher Derek , Synnestvedt Ryan , Zahustecher Nathaniel , Melly Kevan , Overberger Ryan 
Published: May 2019

Introduction:Vehicles stranded in rising water account for the majority of swiftwater rescues (SWR) during urban and small stream flash flooding. Multiple simultaneous SWR incidents are commonplace during severe storms. Historically, SWR teams have pursued a “reach, throw, row, go” strategy. However, reach and throw attempts are usually futile. Boat operations and/or in-water rescue attempts can be technically complicated, time-consuming, and a drain on rescuer resources.Aim:To design an ideal SWR modality for use during urban and small stream roadway flooding.Methods:SWR objectives, strategy, and tactics were mapped against various transportation modalities to develop the safest solution for urban and small stream flood response.Results:High water vehicles (HWV), such as the “deuce and a half” 6 × 6 military truck, represent a new standard for SWR practicality and safety as they can reduce rescuer time in-water. HWVs are heavy and high enough to be stable on roadways in most flash flooding conditions. A properly designed emergency response package includes a fording kit, multi-directional floodlights for nighttime operations, public safety radios, and a siren that doubles as a public address system to coach victims as a rescue is initiated. Deployable ladders enable rescuer egress from and victim access to a covered lighted cargo bed that holds PPE, throw bags, and rescue rings; a deployable “boat in a bag” for victims who require ferrying; and a heated seating area where medical evaluation can be conducted while staying dry.Discussion:SWRs are dangerous resource-intensive incidents which account for more rescuer morbidity/mortality than all other technical rescue sub-types combined. These incidents will increase in frequency and severity worldwide due to climate change and overdevelopment. If rescue conditions are still tenable, HWVs are the most efficient and effective platform for conducting SWR from flooded roadways while decreasing safety risks to first responders and victims.
Developing a Public Health Risk Assessment Toolkit for Mass Gatherings and Trialling for an International Multi-Sport Mass Gathering Event
Authors: Bloomer Ellen , Endericks Tina 
Published: May 2019

Introduction:Risk assessment for mass gatherings (MGs) is undertaken to enable public health authorities to systematically identify and assess the generic characteristics of an MG, which introduce or enhance particular threats and develop measures to reduce or mitigate these threats. The World Health Organization Collaborating Centres on Mass Gatherings and Global Health Security (WHO CCs) produced a comprehensive guide to MGs called “Public Health for Mass Gatherings: Key Considerations” (KC2). This is being converted into an eLearning resource. A public health risk assessment toolkit is being developed by the WHO CCs to complement and guide organizers in their planning process for the health risks associated with an MG event. Preparations for the Birmingham 2022 Commonwealth Games (BCG) are underway and it is important to involve a public health element in the planning for the BCG.Aim:To develop a public health risk assessment toolkit for MGs and pilot it as part of the planning process for the BCG.Methods:Based on KC2 principles, methods included developing and finalizing a public health risk assessment toolkit for MGs. This study also piloted the toolkit for the BCG.Results:A toolkit will be developed. Key learning will be documented on how the toolkit can be improved. The pilot will identify the key public health risks for the BCG, and assess how to mitigate them.Discussion:The development of this toolkit will be an innovative contribution to the resources available for those organizing MGs. It will support organizers to conduct risk assessments and thus maximize the potential for health from the event. Piloting the toolkit for the BCG is an opportunity for validating it, and provides valuable learning for its use in future events. It will support the risk assessment process for the BCG and share learning regarding the key risks for this event.
Developing Collaboration Quality Indicators for Major Incidents in an Underground Mine
Authors: Gyllencreutz Lina , Karlsson Sofia , Saveman Britt-Inger 
Published: May 2019

Introduction:The underground mining industry has one of the most hazardous industrial occupations, and requires an increased level of preparedness for injury incidents. The most important outcome for seriously injured victims is the reduction in morbidity and mortality. Receiving effective and timely care may mean the difference between life and death. However, mines are usually located in a rural area and the incident site may be deep underground which makes it an extraordinary challenge for the rescue services. A successful rescue response in an extraordinary milieu demands a high level of inter-organizational cooperation skills at the incident site.Aim:To analyze statements of collaborate activities during a major incident exercise in the underground mine industry, essentially for patient outcome.Methods:A Delphi technique was performed, asking opinions from experts in iterative rounds to generate, understand, and form consensus on group opinion around this complex issue. The experts were personnel from disaster medicine (n=3), emergency and prehospital medicine (n=10), rescue service (n=16), and mine industry (n=9), all with operative command positions.Results:Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important inter-organization cooperation activities to optimize patient outcome from an injury incident in an underground mine. This resulted in 63 statements. The statements included information about: early alarm routines, collaborative support and efforts of early life-saving interventions, relevant resources and equipment, command and control room, and functions. In round two participants shared and communicated decisions about safety, situation awareness, and guidelines for response. All statements reached consensus among the experts in round three.Discussion:These inter-organizational statements are considered important by experts, and could be used to evaluate collaboration in major incident exercises. Hence, the statements can also be quality indicators for reporting results from major incident management.
Development of a New Triage Method to Prioritize Patients Arriving at the Emergency Room
Authors: Natsukawa Tomoaki , Deguchi Ryo , Akita Naoki , Uemori Sadayori , Miki Toyokazu , Kato Noboru 
Published: May 2019

Introduction:By prioritizing emergency patients, triage facilitates the timely provision of care to the largest possible number of patients arriving at an emergency room (ER). Previous triage methods include the Canadian and Japan Triage and Acuity Scales. Since these methods sort patients into five categories, multiple patients are often categorized into the same category. Furthermore, since these scales adopt original complex algorithms to determine the triage category, triage personnel need to be very familiar with the algorithm. Hence, a simple triage method is needed to prioritize ER patients.Aim:To develop a new triage method to prioritize patients arriving at the ER.Methods:Patients aged ≥13 years who arrived at the ER of Yodogawa Christian Hospital without being transported by ambulance between January 2016 and October 2018 were assessed. We analyzed correlations between the items included in the triage sheet and admission. We calculated risk ratios (RRs) of the items that were significantly related to admission. The RR of an item was considered its score, and the triage score was calculated by summing the individual RR scores for each patient. We performed receiver operating characteristic (ROC) analysis of admission and triage scores.Results:Among 20992 patients, 2030 patients (9.7%) were admitted to the hospital. The triage scores of all the patients ranged from 26.5 to 62.3. According to the ROC analysis, the area under the curve was 0.791 and the optimal cutoff value for the triage score was 32.7 (sensitivity: 0.74, specificity: 0.70).Discussion:Since this research was based on data from a Japanese secondary level emergency hospital in an urban area, our triage method can be adapted to the many ERs in Japan that share a similar background. The method used to develop this triage method can also be used to develop triage methods for ERs with different backgrounds.
Establishment of Palliative and End-of-Life Care Services in Sri Lanka
Authors: Perera Clifford , Ramadasa Udayangani , Wijeratne Chandrika , Karunanayake Panduka , Chang Thashi , Pathirana Gamini , Karunathilake Ravini , Perera Suraj , Guruge Kalyani , Randenikumara Sankha 
Published: May 2019

Introduction:Sri Lanka has a rapidly aging population with an exponential rise in chronic morbidity. There had been no parallel development of palliative and end-of-life care-specific approach in health care.Aim:To implement sustainable palliative and end-of-life care services in Sri Lanka through the existing systems and resources by advocacy, collaboration, and professional commitment.Methods:Sri Lanka Medical Association established a volunteer task force for palliative and end-of-life care (PCTF) in October 2016, which comprised of multi-disciplinary health care professionals, legal fraternity, and civil society. PCTF identified the need for sensitizing the general public on the importance of palliative care, for standard guidelines and formal training for practicing health care professionals engaged in hospital and community-based palliative care. These needs are addressed through activities of PCTF in collaboration with the Ministry of Health.Results:Representing the National Steering Committee of Palliative Care, the members of the PCTF were instrumental in developing the National Strategic Framework to fill the major gap of affordable quality palliative care in the country. PCTF also published the “Palliative Care Manual for Management of Non-Cancer Patients” as a preliminary guide for health care professionals. The draft document on the End-of-Life Care Guidelines has been formulated and is currently being reviewed by the relevant medical and legal stakeholders. PCTF has organized CME lectures on palliative care all over the country for health care professionals, and also conducted lectures, exhibitions, and mass media programs to sensitize the public on palliative care.Discussion:Within a brief period, PCTF has played a key role to recognize palliative care by contributing to policy making, training, and public sensitization in palliative and end-of-life care in Sri Lanka.
Evaluating Full-Scale Exercises to Optimize Patient Outcome in an Underground Mine
Authors: Gyllencreutz Lina , Karlsson Sofia , Saveman Britt-Inger 
Published: May 2019

Introduction:Major incident exercises are expensive to plan and execute, and often difficult to evaluate objectively. There is a need for a generic methodology for reporting results and experiences from major incidents so that data can be used for analysis, to compare results, exchange experiences, and for international collaboration in methodological development. Most protocols use data describing the incident hazards, prehospital and hospital resources available and alerted transport resources, and communication systems. However, the successful management of a rescue response during a major incident also demands a high level of command skills.Aim:The aim of this study was to analyze the command and collaboration skills among the emergency service on-scene commanders and the mine director for safety and security during a full-scale major incident exercise in an underground mine.Methods:The commander functions were observed during a full-scale major incident exercise. Audio and video observations and notes were analyzed using a study-specific scheme developed through a Delphi study, including inter-agency collaborative support and efforts of early life-saving interventions; relevant resources and equipment; and shared and communicated decisions about safety, situation awareness and medical guidelines for response. After the exercise additional interviews were made with those responsible for the command functions.Results:Preliminary results indicate that most decisions were not taken in collaboration. Elaborated results will be presented at the conference.Discussion:Command and collaboration skills can benefit from objective evaluations of full-scale major incident exercises to identify areas that must be improved to optimize patient outcome.
Evolution of United States Legislation to Facilitate Bystander Response to Opioid Overdose
Authors: Fletcher James , Molloy Michael , Hart Alexander , Voskanyan Amalia , Sarin Ritu R , Ciottone Gregory R. 
Published: May 2019

Introduction:Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.Aim:To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.Methods:Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.Results:All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).Discussion:Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.