bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resurgence of Vector-Borne and Vaccine-Preventable Diseases in Venezuela in Times of a Complex Humanitarian Health Crisis: A Regional Menace
Authors: Tami Adriana , Grillet Maria Eugenia , Paniz-Mondolfi Alberto , Oletta José , Llewellyn Martin S , Hernández-Villena Juan V , Márquez Marilianna ,   on behalf of the working group on emerging and re-emerging diseases in Venezuela
Published: May 2019

Introduction:Venezuela has plunged into a humanitarian, economic, and health crisis of extraordinary proportions. This complex situation is derived from dismantling of structures at the institutional, legal, political, social, and economic level affecting the life and wellbeing of the entire population.Aim:This study aims to assess the impact of Venezuela’s healthcare crisis on vector-borne and vaccine-preventable diseases and the spillover to neighboring countries.Methods:Since October 2014, there is a paucity of official epidemiological information in Venezuela. An active search of published and unpublished data was performed. Venezuela and Latin America data were sourced from PAHO Malaria Surveillance and from Observatorio Venezolano de la Salud. Brazil and Colombian data were accessed via their respective Ministries of Health.Results:Economic and political mismanagement have precipitated a general collapse of Venezuela’s health system with hyperinflation rates above 45,000%, people impoverishment, and long-term shortages of essential medicines and medical supplies. In this context, the rapid resurgence of previously well-controlled diseases, such as vaccine-preventable (measles, diphtheria) and arthropod-borne (malaria, dengue) diseases has turned them into epidemics of unprecedented magnitudes. Between 2000-2015 Venezuela witnessed a 365% increase in malaria cases followed by a 68% increase (319,765 cases) in late 2017. The latest figures have surpassed 600,000 malaria cases with a prediction to reach 1 million by the end of 2018. Measles and diphtheria have recently re-emerged after a progressive interruption of the national immunization program, with vulnerable indigenous population being particularly affected. In response to Venezuela’s rapidly decaying situation, a massive population exodus is ongoing towards neighboring countries causing a spillover of diseases.Discussion:Action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. Global and hemispheric health authorities should urge the Venezuelan government to allow establishing a humanitarian channel to bring relief.
Training Emergency Department Charge Nurses Through Tabletop Exercises
Authors: Weeks Beth 
Published: May 2019

Introduction:In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.Aim:To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.Methods:A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.Results:ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.Discussion:Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.
Use of Moulage in Multi-Disciplinary Mass Casualty Incident (MCI) Training: Cost-Effective Tool or an Expectation?
Authors: Rihter Sasha , Coppersmith Veronica 
Published: May 2019

Introduction:A 2018 poll by the American College of Emergency Physicians shows 93% of surveyed doctors believe their emergency department is not fully prepared for patient surge capacity in the event of a natural or man-made disaster. While an emergency disaster plan is activated during any incident where resources are overwhelmed, many US emergency physicians today think of a mass casualty incident (MCI) as the inciting event. To better prepare our communities, an MCI simulation took place in Chicago 2018 with participation from local and federal representatives. Included were Chicago fire, police, and emergency medical services agencies, emergency medicine physicians, resident participants, and medical student volunteer victims.Aim:The study’s aim was to determine whether resource intensive moulage was an expected component or a beneficial adjunct, if moulage-based training would improve physician preparedness, and if such a training would increase the likelihood of future involvement in local disaster preparations. Analysis was performed on pre- and post-training surveys completed by participants. By reviewing the benefits versus cost, future MCI simulation planners can efficiently use their funds to achieve training goals.Methods:Thirty-two emergency medicine physicians were surveyed before and after a five-hour training session on October 20, 2018, which included 89 moulage victims. Twenty-four after-event surveys were completed. All completed surveys were utilized in data analysis.Results:Of polled participants, a 68% improvement in general preparedness was achieved. While only 19% of participants cited current involvement in their facility’s disaster planning in pre-event survey, the likelihood of involvement after training was 8.2/10. Overall, the importance of moulage an essential component to such trainings remained constant.Discussion:Moulage is an expected and crucial element to MCI training and should be incorporated as extensively as resources allow. MCI trainings improve physician preparedness and potentially increase physician involvement in disaster planning at home institutions.
Reviewing Disasters: Hospital Evacuations in the United States from 2000 to 2017
Authors: Sharma Aishwarya , Mace Sharon 
Published: May 2019

Introduction:Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.Aim:The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.Methods:Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.Results:There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.Discussion:Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.
Beyond EMT 2 Minimum Standards
Authors: Stephens Dianne , Thomas Jane 
Published: May 2019

Introduction:The World Health Organization’s (WHO) minimum standards are used to verify Emergency Medical Teams (EMTs) internationally. The National Critical Care and Trauma Response Center (NCCTRC) was one of the first few EMT 2 verified teams globally.Aim:The NCCTRC aims to innovate and provide leadership in the provision of best practice clinical care in the EMT 2 setting in disaster-affected countries.Methods:The NCCTRC developed a clinical governance framework and committee with a view of improving practice in the deployed environment. A gap analysis against the Australian National Standards was done and a decision was made to proceed with accreditation against the ACHS EQUIP 6 framework.Results:The process of accreditation required a self-assessment that identified gaps in our guidelines and care processes thereby leading to innovative projects to meet the criterion in a sustainable way for the deployed field hospital environment. The NCCTRC has developed adapted clinical tools to manage pressure injury, falls risk, handover, hand hygiene, audits, and consumer feedback.Discussion:The deployed field hospital environment can meet national accreditation standards for clinical care. The WHO minimum standards were introduced in 2013 and serve as a marker of the minimum requirements in the field. The challenge is to do better than the minimum. This study demonstrated that it is possible to adapt hospital accreditation standards to the field environment and provide a higher, safer quality of care to affected populations. EMT teams should maintain their clinical care standards from their home environment wherever possible in the field hospital environment. Striving to provide the best and safest care is the duty of care for vulnerable populations.
Development of a Mobile Laboratory for Sudden Onset Disasters
Authors: Marr Ian , Stephens Dianne , Baird Rob , Francis Josh , Read David , Coatsworth Nicholas 
Published: May 2019

Introduction:Clinical diagnostics in sudden-onset disasters (SOD) has historically been limited. With poor supply routes, lack of a cold chain, and challenging environmental conditions, many diagnostic platforms are unsuitable.Aim:We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type II emergency medical team (EMT) field hospital.Methods:Available diagnostic platforms were reviewed and selected against infield need. Platforms included HemoCue301/WBC DIFF, i-STAT, BioFire multiplex RT-PCR, Olympus BX53 microscopy, ABO/Rh Grouping, and specific rapid diagnostic tests (RDT). This equipment was trialed in Katherine, Australia and Dili, Timor-Leste.Results:During the initial deployment, validation of FilmArray rt-PCR multiplex tests was successful on blood culture, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) haemoglobin values were compared on Sysmex XN 550 (r = 0.94). Analysis of HemoCue WBC DIFF samples had some variation when compared to Sysmex XN 550, (neutrophils r = 0.88, lymphocytes r = 0.49, monocytes r = 0.16, eosinophils r = 0.70, basophils r = 0.16). i-STAT showed non-significant differences for CHEM4 (n=10), CG8 (n = 10), and TnI (n = 5) against Vitros 250. A further trial of BioFire rt-PCR testing in Dili, Timor-Leste diagnosed 117 causative pathogens on 168 FilmArray test cartridges.Discussion:This mobile laboratory represents a major advance in SOD. Setup of the service was quick (<24hr) and transport to site rapidly. Training was simple and performance consistent. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostics.
The Evaluation of the World Health Organization’s Minimum Dataset in Disaster Health Management in the Association of Southeast Asian Nations
Authors: Limpaporn Sansana , Silapunt Phumin , Wuthisuthimethawee Prasit 
Published: May 2019

Introduction:The Minimum Data Set (MDS) developed by the World Health Organization (WHO) has been widely used among medical practitioners in International Emergency Medical Team (I-EMT) as tools to collect health information and statistics in disaster health management. The I-EMT submits MDS to the Emergency Medical Team Coordination Cell (EMTCC) for the planning of responses. The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the ASEAN’s project that has applied MDS to its activities with the main purpose of strengthening informational management during a disaster.Aim:The study aims to evaluate the performance of MDS after being utilized in the Regional Collaboration Drill (RCD) organized by the ARCH Project in July 2017.Methods:The performance of MDS has been evaluated by ten International Emergency Medical Team (I-EMT) of ASEAN Member States who participated in the RCD.Results:The assessment forms were returned by ten I-EMTs, and all respondents addressed several points for the revision of MDS (10/10), including the format and the content of the MDS. Concerning the format, respondents stated that the fonts are too small (3/10), and spaces for recording additional information are needed (3/10). On the other hand, the majority of respondents suggested that some of the contents within the MDS are still unclear or some terminologies are needed to be further clarified (6/10), especially with the referral form (5/10).Discussion:The current version of the MDS utilized for the EMT coordination should be edited and revised for its optimal usage. Applying MDS to disaster simulation is an efficient approach to test its application.
International Humanitarian Law and Review of Recurrent Violations Including Chemical Weapons Use
Authors: Atti Sukhshant , Arquilla Bonnie 
Published: May 2019

Introduction:The basis of International Humanitarian Law (IHL) is the Theory of Natural Law, which states that the laws of morality and the ability to use reason in the determination of inalienable human rights, are innate to humans, and cannot be taken away by any states or laws. IHL is an agreement among nation-states that applies to situations of conflict to protect civilians and guides conduct in time of war. IHL extends protection to civilian medical personnel. The recent escalation in chemical weapons use by states has violated IHL and the 1997 Chemical Weapons Convention (CWC) treaty, with little repercussion from the international community.Aim:We review the increase in chemical weapons use, international chemical weapon treaty violations, and violations of IHL against medical personnel.Methods:A review was conducted of existing medical and grey literature for sources discussing chemical agents, their history, and violations of laws prohibiting their production, stockpiling, or use. The following publications were reviewed: PubMed, EBSCHost, and Google Scholar.Results:The use of sarin, chlorine, and mustard gas against civilians has been confirmed multiple times in Syria by the United Nations since 2011. Physicians for Human Rights mapped 537 attacks, both violent and chemical, against 348 different medical facilities in Syria from March 2011 to July 2018. Since March 2011, at least 847 civilian medical personnel have reportedly been killed. Many were killed by government forces as part of a war strategy creating further incapacitation. Most recently, Medecins Sans Frontiers concluded its Yemen mission due to repeated attacks, including two in one week in October 2018.Discussion:There must be recognition and emphasis on the health severity of such attacks and the violations of IHL and the CWC. Physicians must use their unique positions for advocacy and call for action in upholding international treaties.
“What Do You Know About Zika?”: Investigating Women at a Primary Healthcare Facility in a Small Municipality in Brazil
Authors: Miranda Elaine , Santos-Pinto Claudia , Antunes-de-Lima Clarice , Osorio-de-Castro Claudia 
Published: May 2019

Introduction:In Brazil, poverty-stricken population groups were the most affected by Zika virus (ZIKV). Women and children are fragile links that need focused attention, especially in relation to health care.Aim:To investigate vulnerable, at-risk women in relation to their awareness of the ZIKV infection knowledge about the disease.Methods:With evidence-based risk communication literature and consequences of ZIKV infection, a data collection instrument with open-ended questions was developed. Women from a small municipality in west-central Brazil, most from a rural setting, were interviewed at primary health care centers in April 2018. Interviews were recorded and transcribed. A preliminary analysis ensued.Results:Forty women were interviewed. The average age was 42.3 (21-74 yrs) and 39 women had at least one child. The average number of people living in the same home was 3.8 (1-18) and 24 homes (60%) had one to four children. Fourteen women (54%) were beneficiaries of income supplementation programs. Two interviewees mentioned they had never heard of Zika and eight (20%) had no actual knowledge to convey. Other groups had some knowledge about ZIKV. Fifteen (37.5%) associated ZIKV with mosquito bites and another 15 with pregnancy or birth defects. Ten women (25%) mentioned dengue or chikungunya, but only 7 (17.5%) were aware of symptoms. Only eleven women (27.5%) declared public health workers as information sources.Discussion:Positive aspects of awareness and knowledge were the tentative relationship some women made between pregnancy risk and exposure to mosquitoes, and with dengue or chikungunya. However, given ample media coverage and the severity of the epidemic, it is noteworthy to point out that all aspects were mentioned by fewer than half of the women. Health workers were not represented as relevant sources of information. Future in-depth content analysis of interviews may reveal important issues for risk communication strategies for this population.
Axis Dimensional Analysis of Religious Mass Gathering Human Stampede Reports
Authors: Alhadhira Abdullah A , Molloy Michael S , Hart Alexander , Issa Fadi , Alossaimi Bader , Fletcher James , Voskanyan Amalia , Sarin Ritu , Ciottone Gregory R 
Published: May 2019

Introduction:Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.Aim:To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.Methods:Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.Results:34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.Discussion:HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.
They have Arrived! How Dallas, Texas Provided Shelter-Based Onsite Medical Care to Evacuees from Hurricane Harvey
Authors: Flax Lindsay A. , Liu E. Liang , Klein Kelly R. , Fowler Raymond L. , Swienton Raymond E. 
Published: May 2019

Introduction:After Hurricane Harvey and the flooding that ensued, 3,829 displaced persons were transported from their homes and sheltered in the Dallas Convention Center. This large general population sheltering operation was medically supported by the onsite Mega-Shelter Medical Clinic (MMC). In an altered standard of care environment, a number of multi-disciplinary medical services were provided including emergent management, acute pediatric and adult care, psychiatric/behavioral services, onsite pharmaceutical, and durable medical equipment distribution, epidemiologic surveillance, and select laboratory services.Aim:To describe how onsite medical care in the adapted environment of a large population shelter can provide comparable services and limit the direct impact on the local medical community.Methods:A retrospective chart review of medical records was generated for all clinical encounters at the MMC. Data were sorted by daily census, disease surveillance, medical decision making, treatment, and transport destinations.Results:40.7% of registered evacuees utilized the MMC accounting for a total of 2,654 clinic visits by 1,560 unique patients representing all age groups. During the sustained MMC operations, 8% of patients required emergency transport and 500 additional patient transports were arranged for clinic appointments. No deaths occurred and no iatrogenic morbidity was reported.Discussion:Medical care was provided for a large number of evacuees which mitigated the potential impact on the local medical infrastructure. The provision of medical services in a large population shelter may necessitate adaptation to the standard of care. However, despite the nontraditional clinical setting, care delivery was not compromised.