bluuebunny/crossref_metadata_2025_split huggingface dataset:
A New Strategy for Swiftwater Rescue from Roadways during Urban and Small Stream Flash Flooding
Authors: Jaslow David , Zecher Derek , Synnestvedt Ryan , Melly Kevan , Overberger Ryan 
Published: May 2019

Introduction:The swiftwater rescue (SWR) concept of operations (CONOPS) is to access as many victims as quickly as possible using strategies and tactics that maximize safety and minimize risk to all involved. “Reach, throw, row, go” has defined the primary water rescue strategy for 50+ years. However, this paradigm, originally designed for rescue from swimming pools, ponds and lakes, slow-moving rivers, and the ocean, is not conducive to SWR incidents involving submerged vehicles, which is the most common scenario during urban and small stream flash flooding.Aim:To present a new SWR strategy for urban and small stream flood response.Methods:Water rescue strategies and tactics were mapped against the SWR CONOPS to determine which ones are most likely to be successful in the rescue of victims trapped in submerged vehicles.Results:Rescue should be attempted via high water vehicles (HWVs) whenever possible, followed by watercraft and “go rescues” using advanced line systems techniques and/or tethered rescuers, dependent on incident characteristics. Positioning HWVs at the incident site permits rescuers to access victims quickly from the rear or sides of the vehicle, thereby reducing rescuer time in floodwaters. Multiple sequential rescues can be made since victims are held and medically monitored in the cargo area rather than transporting them to shore individually.Discussion:SWR from submerged vehicles is unique among emergency incidents because neither shelter-in-place nor self-evacuation are tenable options until the water recedes. "Reach" and "throw" rescue attempts are only possible if the victim is close to shore. Watercraft operations, whether motorized or manually pulled, can be technically complex, require numerous rescuers, and typically take 30-60 minutes per vehicle. Use of HWVs meets the CONOPS for SWR on flooded roadways since this strategy facilitates the rescue of multiple victims quickly while reducing the time rescuers spend in the water.
The Role of Primary Health Networks and General Practitioners in Disasters: Nepean Blue Mountains Primary Health Network’s Preparedness Guide
Authors: Reay Lizz , Burns Penny 
Published: May 2019

Introduction:Disasters are part of the Australian landscape. Bushfires, floods, cyclones, and drought reoccurring consistently across the continent. Primary Health Networks (PHNs) and general practitioners (GPs) are scattered across Australia and are inevitably involved when disasters strike their local communities. Limited guidance exists to guide their systematic involvement within the broader disaster response system. In October 2013, large bushfires swept through the NSW Blue Mountains. The response was unusual in its inclusion of NSW general practice networks within the response system, most crucially the local (now) Nepean Blue Mountains Primary Health Network (NBMPHN).Methods:The lessons learned by GPs and NBMPHN during the fires highlighted the need for GP preparedness to improve recovery outcomes. This led to the development of a living discussion document “Emergency management: the role of the GP,” created with input from the various GP groups. More recently, a PHN emergency preparedness guide aimed at strengthening communication and formalizing the role of the PHNs and GPs before, during, and after a natural disaster.Results:Clarity and implementation of a process for disaster preparedness have enabled a more proactive and coordinated approach to local emergency management with a distinct role for both the PHN and local GPs when responding to a natural disaster.Discussion:This presentation discusses lessons learned and the preparedness strategy now in place in the Nepean Blue Mountains PHN region, and launches the emergency preparedness guide that can be used and adapted by GPs and other PHNs across Australia.
Averting ‘Albo-Geddon’: Challenges to Metro South Health Emergency Response to Invasive Mosquito Detections in a Complex Stakeholder Environment
Authors: Jarvinen Kari , Montgomery Brian , Shillig Greg , McCall Bradley 
Published: May 2019

Introduction:Invasive mosquito species present significant organizational and health risks of covert disease outbreaks (dengue, Zika, or chikungunya) following an incursion into novel geographies. In Australia, detections at international First Points of Entry will trigger a multi-agency response to prevent escape into nearby urban environments that are largely unmonitored. Brisbane’s mosquito surveillance and response systems were challenged in 2017-2018 by the unprecedented frequency of detections in imported oversized tires that stretched the biosecurity response with escape opportunities.Aim:Describe the unique challenges to Metro South Public Health Unit within a complex stakeholder environment represented by federal, state, and municipal agencies.Methods:We present as a case study of an invasive mosquito detection that escalated to a public health incident of statewide significance through an incident management team structure. We focus on describing the significant governance and logistic challenges to the emergency mobilization of Metro South Health staff.Results:Since mid-December 2017 biosecurity have reported 12 detections of invasive mosquito species (Aedes aegypti, Ae. albopictus, Ae. japonicus) in infested tires arriving in Brisbane. Each emergency response was successful due to amendments to operational protocols and policy review. The legacy is a permanent enhancement of local mosquito monitoring, improved response systems, and greater operational preparedness.Discussion:The organizational impact of invasive mosquitoes is likely to be underestimated and under-resourced in jurisdictions beyond their expected distributions. Our experiences demonstrate the value of a clear and shared understanding of interagency emergency frameworks to effectively integrate each response. Resolution of uncertainties around organizational roles and responsibilities, and interpretations of guidelines, implementation strategies for mosquito surveillance, and control in novel contexts will require organizational agility and robust partnerships. Strategic re-focus is recommended to embed robust preventative measures and review of policy to mitigate the risk and impact of emergency responses to future invasive mosquito detections.
Pseudo Epidemic of Diarrhea Incidence: A Month Post Tsunami in Central Sulawesi, Indonesia
Authors: Tias Endarti Ajeng , Radjak Abdul , Handito Agus , Adisty Marlina , Ronoatmodjo Sudarto 
Published: May 2019

Introduction:On Friday, September 28, 2018, the 7.4 Richter Scale earthquake hit Central Sulawesi and was followed by a tsunami. Within a month after the unpredictable earthquake and tsunami, a 773 aftershock earthquake was noted. These events took a major toll on the population in the affected areas. 2,086 people died and more than four thousand people were injured. 1.373 people went missing and 206.494 were evacuated. Surveillance data from November 4, 2018, to October 24, 2018, showed that an increased number of illnesses such as diarrhea was the second leading reported cases. Data showed that the number of diarrhea cases was 3.350 with two peaks of epidemic curves on October 10 and 22, 2018.Aim:To verify the diarrhea outbreak after the tsunami in Palu, Donggala, and Sigi District.Methods:Verification of medical records at six selected primary healthcare institutions with the highest number of cases of diarrhea.Results:A pseudo-epidemic of diarrhea occurred. A high number of diarrhea cases occurred due to double reporting and misdiagnosed cases. Investigation reports showed that liquid defecation was considered diarrhea even though it occurred less than three times a day. The follow-up activity was contacting data entry managers to revise data, disseminate findings during the daily meeting of the health-related officers, and broadcasting findings through a WhatsApp group of provincial and district surveillance officers. Post-investigation, the number of diarrhea incidences was lower and the peak was not shown on the epidemic curve. It can be interpreted that a diarrhea outbreak did not occur in the tsunami-affected area in the Palu, Donggala, and Sigi districts.Discussion:During a time of disaster, a chaotic situation led to improper data collection. Data verification should be conducted to assure the validity of reported data.
Relating the All Hazard Approach of Hospitals to that of Public Authorities
Authors: van der Torn Pieter , Geene Roel , den Hartog Dennis 
Published: May 2019

Introduction:Hospitals and the healthcare sector suffer from chronic work overload and personnel shortages in many nations. This poses strong incentives to rationalize all activities not directly related to care, such as the preparations for disasters and other hazards. One such rationalization is to turn from a rule-based to a risk-based approach. However, the risk landscape of hospitals and the relationship to the risk landscape of public authorities are ill-defined. Health Care Coalitions (HCCs) are in a good position to fill this gap and serve as an intermediary. We developed a scheme for defining the risk landscape of HCCs and its members and performed a prioritization process.Aim:Objectives were to develop a knowledge platform of hospitals on risk assessment, promote integrated risk management by the HCC and its members, and determine the limiting (response) state for all relevant hazards.Methods:We put maximum effort in limiting the time consumption for hospitals and align with the regular practices in hospitals for business continuity management. Strong points included the cooperation with the public authorities for safety and for health, a stepwise development of risk awareness and stepwise guidance for the assessment by hospitals, and formalization of the scenario-selection and choice of priorities by the HCC board.Results:A gross list of (>230) safety hazards was produced along with a netlist of (>80) hazards relevant to health care. In addition, an impact-scale for the continuity of care serving as a measurement stick for all health care sectors was developed. Risk diagrams were developed to present the results in a simple and clear format.Discussion:The HCC risk landscape served its purpose in improving the mutual understanding with the public authorities. The formal assessment provides a solid basis for operational planning, education, training, and future investments.
Safer Hospitals in North Queensland - Assessment of Resilience
Authors: Luke Jenny , Franklin Richard , Aitkin Peter , Dyson Joanne 
Published: May 2019

Introduction:Hospitals are fundamental infrastructure, and when well-designed can provide a trusted place of refuge and a central point for health and wellbeing services in the aftermath of disasters. The ability of hospitals to continue functioning is dependent on location, the resilience of buildings, critical systems, equipment, supplies, and resources as well as people. Working towards ensuring that the local hospital is resilient is essential in any disaster management system and the level of hospital resilience can be used as an indicator in measuring community resilience. The most popular measure of hospital resilience is the World Health Organisation’s Hospital Safety Index (HSI) used in over 100 countries to assess and guide improvements to achieve structurally and functionally disaster resilient hospitals. Its purpose is to promote safe hospitals where services “remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.” It identifies likely high impact hazards, vulnerabilities, and mitigation/improvement actions.Aim:The HSI can be a valuable tool as part of the 2015-2030 Sendai Framework for Disaster Risk Reduction. However, to date, it has been used infrequently in developed countries. This project pilots the application of the HSI across seven facilities in a North Queensland health service (an area prone to cyclones and flooding), centered on a tertiary referral center, each providing 24-hour emergency health services.Results:Key indicators of resilience and the result of the audit will be discussed within geographical and cultural contexts, including the benefits of the HSI in augmenting existing hospital assessment and accreditation processes to identify vulnerabilities and mitigation strategies.Discussion:The research outcomes are to be used by the health service to improve infrastructure and provide anticipated community benefits, especially through the continuation of health services post disasters.
DisasterSISM: A Multi-Level Blended Learning Program in Disaster Medicine for Medical Students
Authors: Ragazzoni Luca , Conti Andrea , Caviglia Marta , Maccapani Fabio , Corte Francesco Della 
Published: May 2019

Introduction:Disaster medicine has been identified as a fundamental discipline for health professionals. In Italy, the role of physicians during disaster response is officially recognized by the Italian Code of Medical Ethics and by the Ministry of Education. Nevertheless, few Italian medical schools include this discipline in their curricula.Aim:With the aim of teaching basic knowledge of disaster medicine to Italian medical students, Research Center in Emergency and Disaster Medicine (CRIMEDIM) and Italian Medical Students’ Association (SISM) developed DisasterSISM, a nationwide training project in disaster medicine.Methods:DisasterSISM consists of three courses: Basic, Advanced, and Train-of-Trainers (ToT). The Basic courses are managed by medical students who are trained during the one-week intense ToT. All courses are delivered using innovative training methodologies, such as e-learning, peer education, table-top exercises, and virtual reality simulations.Results:From 2012 to 2018, a total of 122 courses (111 Basic, 5 Advanced, and 6 ToT) have been delivered. DisasterSISM reached 37 out of 45 Italian medical schools, training more than 2,500 students. A survey conducted after the end of each course showed that participants considered the knowledge in Disaster Medicine essential for their future profession, regardless of the specialty chosen. Students also expressed their appreciation about the blended-learning approach, with a predilection for virtual reality simulations. The comparison between the entrance and the final exam scores showed a significant increase in knowledge.Discussion:In six years, DisasterSISM reached the majority of Italian medical schools, providing disaster medicine knowledge to hundreds of undergraduates. Considering the fast growth and diffusion of the project, the significant increase of knowledge, and the positive feedback received from participants, we suggest that the DisasterSISM model be implemented in other countries to widely disseminate information about prevention and disaster preparedness among medical students and health professionals.
Red Cross and Red Crescent Health Information System (RCHIS): Functional Design and Usability Testing Protocol
Authors: Moore Roxanne , Archer Laura 
Published: May 2019

Introduction:The Red Cross and Red Crescent Health Information System (RCHIS) combines the functionality of an Electronic Medical Record (EMR), Health Information System (HIS), as well as Human Resource and stock management system. Its purpose is to facilitate patient quality of care, early warning for outbreak detection, accountability/reporting, and resource management. Short-term, emergency medical teams and support staff responding to acute clinical needs in a humanitarian context are the intended end users.Aim:To explain the functional design principles and usability testing protocol implemented in initial RCHIS design and development phases to ensure technological fit within the humanitarian medical context.Methods:RCHIS development followed the patient-user journey, with each patient/staff interaction encapsulated by a microservice. The integration of multiple microservices enabled RCHIS to mimic various patient journeys. The functional scope of each microservice was designed by medical end-users and was further used for access management. The value and variable design, including validation rules, were led by health informaticians and existing medical standards. Intuitiveness and ease of use guided User Interface design, with targeted medical end-user feedback collected on a twice-monthly basis in addition to early design workshops, field immersion, and post-development pilot testing.Results:Support and implementation of RCHIS were not inherently guaranteed. As such, the process of co-designing with end users had the primary benefit of ensuring effective scope and technological fit given the humanitarian context, but also the secondary benefit of improving internal acceptability and advocacy.Discussion:The added value of digital health records as a quality assurance mechanism is well documented. However, the increased workload and reduced employment satisfaction affiliated with the rise of EMRs illustrated a need to re-evaluate current design and use within clinical settings. The design and development approach taken for RCHIS is one attempt to improve human-computer interaction in the clinical setting.
Use of a Novel Electronic Patient Care Record System at Mass Gathering Events by St. John Ambulance Victoria
Authors: Gao Crystal , Lim Zheng Jie , Freestone Brendan , Austin Kristy , McManus Rob 
Published: May 2019

Introduction:The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.Aim:Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.Methods:A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.Results:It was found that the use of ePCR:
1.Allowed for collection of relevant data to assist in future planning of MGEs2.Aids the overall coordination of first aid delivery at MGEs
-faster relaying of patient information to event commanders-reduction of paperwork-improved ability to locate first aid crews using GPS tracking3.Received positive feedback from first aiders, event organizers, and patrons4.Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our membersDiscussion:These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.
Hemorrhage-control Tourniquets: How Intuitive are They?
Authors: Ochs Nicole , Sexton Martha , McKenzie Nicole , Rega Paul , Ziehr Jonathon , Parquette Brent , Fink Brian 
Published: May 2019

Introduction:According to the Federal Bureau of Investigation (FBI), there were fifty active shooter incidents in 2016 and 2017. In the first five months of 2018, there have been 23 school shootings where someone was injured or killed. Hemorrhage-control tourniquets have proven their life-saving capability in the military and civilian EMS. Now, they are being advocated for use by civilians – the true “first responders.” Since Combat Application Tourniquets (CATs) are strap-and-windlass devices, the question remains whether a naïve population can intuitively apply them efficaciously.Aim:To determine the efficacy (speed, correct placement) of a CAT by an interprofessional group of healthcare students naïve to tourniquet hemorrhage control.Methods:Consenting students attempted to apply a CAT to a standardized patient with a simulated hemorrhaging brachial artery. No instruction was given except for the directions included in the package. Timing began upon removal of the tourniquet from the package and ended when the participants stated they completed their attempt. Errors in application were documented. Afterward, students received education and an opportunity to properly re-apply the tourniquet. The completion times of the students were compared to ten emergency medical technicians (EMT-P), serving as subject matter experts. Errors in application were categorized.Results:50 students from the following professions participated: Medicine, Nursing, Public Health, and Respiratory Therapy. The mean time of tourniquet application was 96.16 seconds (range: 25.12-226.31). This was statistically different from the EMT-Ps’ time of 42.83 seconds (range: 23.89-82.94). Additionally, only five (10%) placed the tourniquet correctly. Errors included improper location and windlass misuse or non-use. The instructions were frequently critiqued for being difficult to read and containing confusing graphics.Discussion:Provision of commercial tourniquets in public access areas must be accompanied by civilian education and the creation of CAT instructions that are simplistic, comprehensible, and suitably graphic.
Hunger in Latin America: What Can We Do?
Authors: Ponte Silvana Dal , Menezes Daniel 
Published: May 2019

Introduction:Hunger is a global problem and has increased in recent years. In Latin America, hunger continues in high numbers. Although the level of hunger is relatively low compared to other regions, this increase in Latin America is mainly explained by the economic slowdown in South America. Also, climate changes are already weakening the production of the main crops in tropical and temperate regions.Aim:Report the numbers of hunger in Latin America.Methods:A cross-sectional study with reports of the World Health Organization’s hunger figures, September 2018.Results:The number of hungry people in the world has increased for the third consecutive year and affects 821 million people, according to a report released by UN agencies. This corresponds to one in nine people in the world. In Brazil, the figures indicate that more than 5.2 million people spent a day or more without consuming food by 2017, which corresponds to 2.5% of the population. In Latin America and the Caribbean, hunger has also increased and affects some 39 million people.Discussion:Hunger is a catastrophic problem in Latin America. Involving professionals in food and nutrition to try to reduce these numbers appears to be a good strategy because just as the doctor treats the disease, the involvement of other specialists to address the cause of the problem can bring long-term benefits. A social project for this purpose that mobilizes chefs and nutritionists is in progress in Brazil.