bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-Cost High-Efficiency Joint Training Program
Authors: St-Arnaud Emmanuelle 
Published: May 2019

Introduction:As the second largest metropolitan area in Canada, Montréal has its share of risks for disasters and major incidents. In such events, the interoperability of emergency services is critical to effective interventions. As the emergency medical service (EMS) for the cities of Montréal and Laval, the Urgences-santé Corporation (USC) has close ties with several emergency partners on the territory, including police and fire departments. These different organizations have joined forces to develop a tabletop exercise program (TEP) to train operational managers to initiate a better-coordinated response on joint interventions.Aim:The TEP was designed to enhance interoperability in the field by improving communication and the understanding of the roles, responsibilities, methods of coordination and decision-making in each of the organizations involved. The aim is for all of USC’s operational managers to participate in at least one exercise of the TEP within the first year of the program.Methods:Selection criteria were established to gather, for each exercise, managers that are likely to work with one another on a real intervention. The TEP was also designed in such a way that its implementation would require few resources and yield minimal impact on regular operations.Results:After four pilot exercises to fine-tune the approach, the program was launched on October 5, 2018. We have now run eight exercises, each involving one or more USC supervisor. The response has been very favorable from the participants as well as their directors.Discussion:In the short term, the TEP helps managers understand their counterparts’ key issues, and has already yielded improvements in our joint interventions. In the longer term, the program will help identify specific training needs to better equip responders.
Management of Dead in Mass Disasters: A Review of Sri Lankan Perspectives since 2004
Authors: Perera Clifford 
Published: May 2019

Introduction:Sri Lanka has experienced a multitude of natural and man-made disasters during the last five decades. Man-made destructions were common during the 30-year-long conflict period. Though the local system in the country was able to manage the dead in such circumstances, the South-Asian tsunami in 2004 highlighted the limitations and deficiencies of the system that was in place to handle the management of the dead during major disasters. Though the first Disaster Management Act was introduced in 2005, it has no mentioning regarding management of dead in mass disasters. Inappropriate handling of the dead could hinder the establishment of the identity of the dead, loss of valuable forensic evidence, and dignified burial. Hence, the families could experience difficulties in calming insurances and inheritance, resulting in economic hardships. In this backdrop, the forensic community strongly felt the necessity of stipulating best practices in managing dead.Aim:To critically assess the measures taken to improve the standards of managing dead in mass disasters in Sri Lanka over the past 15 years.Methods:The process of drafting guidelines for management of dead was initiated with a series of consultative meetings with the Disaster Preparedness and Response Unit of the Ministry of Health, the Disaster Management Centre (DMC) and the Institute of Forensic Medicine and Toxicology (IFMT) in collaboration with the College of Forensic Pathologists of Sri Lanka. A working group representing forensic and legal experts, military, police, fire brigade department, and disaster management were involved in drafting these guidelines. Further guidelines for the effective conduct of mass burials following mass disasters were also prepared and published in 2007.Discussion:Despite all these efforts the efficacy of managing dead in recent mass disasters is still far from satisfactory.
Mass Gatherings and Youth Peer Volunteerism
Authors: Lund Adam , Lund Nadia , Scott Ron , Yu Quinn , Chui Stephen , Turris Sheila 
Published: May 2019

Introduction:Music and sporting events are mass gatherings with unique risks related to participation. “All-ages” events, which include participants below the age of majority (18 in many jurisdictions), have been observed to have an over-representation of patient presentations in the youth category. Peer helpers may lower the barrier to seeking on-site care. Youth (peer-aged) volunteerism provides opportunities for exposure to new environments, skills, and mentorship. Medical volunteerism may promote personal satisfaction through prosocial behavior (i.e., helping others), community engagement and immersion into a potential health professions career path.Methods:We conducted an observational pilot feasibility study with feedback forms and semi-structured interviews. The pilot program paired youth with parents/guardians/responsible adults as health care volunteers at special events.Results:Youth/adult dyads volunteered for a variety of events in Canada during the 2018 event season. All participants in the “Juniors Program” completed at least a Standard First Aid course, including orientation to personal safety and confidentiality. Each pair worked in one of two areas: first aid or Festival Health (the harm reduction space at music events) providing peer-to-peer and “all-ages” support. Post-event feedback from the dyads revealed many positive experiences and universally called for more opportunities.Discussion:A strong volunteer base is an asset to any community. In this pilot study, the volunteer experiences were supervised by a team of credentialed health care professionals. The authors report on qualitative feedback in themes based on patient perspective, volunteer perspective, team perspective, and event management perspective. More research is needed to measure the outcomes of the Junior’s Program. More Investigation is needed to determine not only the long-term benefits of participation on event medical teams, but also to identify factors that shape a positive experience for youth, their parents, and the event participants that they support.
Misericord Injuries: Ancient and Modern
Authors: Mori Alfredo 
Published: May 2019

Introduction:The Misericord, or stabbing pike, was a frequently used battlefield implement in medieval times. The misericord was used by battlefield clerics to relieve the suffering of irreparably wounded soldiers. Its cultural parallels include the Roman gladius, the Japanese wakazashi, and the eponymous Liston knife used in pre-Victorian era surgery in England.Methods:This demonstration will analyze modern misericord injuries in the light of the current epidemic of long knife (or zombie knife) attacks in London and the domestic terrorist threat in Australia.Discussion:A review of this weapon is pertinent to the projected low-technology, low-impact, and deep-penetrating wounds expected in urban terrorism in Australia and other cities globally. The talk will emphasize field discussion, demonstration, and disarming techniques against modern misericord-type weapons.
A Mixed-Methods Analysis of the Spatial and Temporal Relationship Between Boko Haram Activity and Lassa Fever Incidence in Nigeria 2017-2018
Authors: Concilio Joan , Macgregor-Skinner Gavin , Tswabki Benjamin Suleiman , Lengerich Eugene 
Published: May 2019

Introduction:Two major public health issues facing Nigeria in 2017 and 2018 were the terrorist activity by the Boko Haram Islamist group and an unprecedented outbreak of Lassa fever.Aim:To determine if Boko Haram activity was temporally or spatially related to the incidence of Lassa fever in Nigeria and if so, to identify potential concurrent causes and mitigation measures.Methods:The study was a mixed-methods design. First, we conducted a secondary analysis of the Armed Conflict Location and Event Data (ACLED) Project for all known Boko Haram activity and of the weekly Nigeria Centre for Disease Control reports for suspected Lassa fever cases. Data were analyzed for January 2017 through June 2018. The ACLED data were spatially overlaid with suspected Lassa cases for each of Nigeria’s 36 states. Secondly, we conducted interviews with six aid workers in Nigeria regarding Boko Haram activities and Lassa fever cases.Results:In the study period, 596 Boko Haram activities occurred in 13 states (36.1%): 416 in 2017 and 180 between January and June of 2018. During the same period, 3,137 suspected Lassa cases were reported from 21 states (58.3%): 1,022 in 2017 and 2,115 in January through June 2018. Only one state, Sokoto, was unaffected by either issue. Aid workers reported a positive relationship between Boko Haram activity and increased negative health outcomes.Discussion:The investigation found little geographic overlap in Nigeria between Boko Haram activity and the 2018 Lassa fever outbreak, suggesting independence of these two issues. However, unmeasured factors, such as public fear and mistrust of governmental activities, may affect both issues. It is also critical to note that widespread co-occurrence (97.2% of 36 states) of these two issues presents significant public health, medical, and security challenges for Nigeria, calling for overarching solutions such as governmental stability and economic stimulus.
Mortality at Music Festivals
Authors: Jones Tracie 
Published: May 2019

Introduction:Fatalities at music festivals are seldom reported in the academic literature, making it difficult to understand the full scope of the issue. This gap in our knowledge makes it challenging to develop strategies that might reduce the mortality burden. It is hypothesized that the number of fatalities is rising. Building on earlier research, two further years of data on mortality at music festivals was analyzed.Methods:Synthesis of grey/academic literature.Results:The grey literature for 2016-2017 documented a total of 201 deaths, including both traumatic (105; 52%) and non-traumatic (96; 48%) causes. Deaths resulted from acts of terror (n = 60), trampling (n = 13), motor-vehicle-related (n = 10), thermal injury (n = 6), shootings (n = 5), falls (n = 4), structural collapses (n = 3), miscellaneous trauma (n = 2), and assaults (n = 2). Non-traumatic deaths included overdoses/poisonings (n = 41), miscellaneous causes (n = 36), unknown/not reported (n = 18), and natural causes (n = 1). The majority of non-trauma-related deaths were related to overdose (44%). No academic literature documented fatalities that occurred while attending a music festival during 2016 or 2017.Discussion:Reports of fatalities at music festivals are increasingly common. However, the data for this manuscript were drawn primarily from media reports, a data source that is problematic. Currently no rigorous reporting system for fatalities exists. In the context of safety planning for mass gatherings, a standardized method of reporting fatalities would inform future planning and safety measures for festival attendees. The hypothesis that mortality rate reporting increased was substantiated. However, the proliferation of music festivals, the increase in attendance at these events, and the overall increase in internet usage may have influenced this outcome.
Nurse Leadership in a Small Hospital in the Less Developed Country: Is It Needs or Circumstances?
Authors: Benin-Goren Odeda , Baratz Yossi , Diallo Fatoumata Binta 
Published: May 2019

Introduction:Clinic Communal de Miniera is a small hospital located in the poor Dixinn district in Guinea Conakry. The hospital functions with seven general physicians, three surgeons, one gynecologist, one dentist, and fifteen nurses. The facility provides small admitting wards for medical, gynecologist (mostly maternity), and pediatric patients. The average number of patients per day is about forty, including acute and ambulatory patients. Although there is a medical director, the daily work is run by the Head Nurse (HN) who is specialized (on spot) as an Emergency Nurse. Management of all emergency patients is based on her experience, personality and the reality of the organization.Results:The circumstances emphasized the gaps between the managerial needs and existent reality, and raised the HN role to a team leader. The work will present the situation in the hospital as a case study related to “non-conventional” management due to a “deferent” situation and will highlight questions related to capabilities and risk factors.
PARABORN: A Training Program for “Outdoor” Activities by Pregnant Urgent Patients for Paramedics
Authors: Jordan Vaclav 
Published: May 2019

Introduction:Spontaneous delivery is a completely physiological phenomenon. Occupational obstetric care in a hospital environment focuses on supporting the mother, the smooth progression of the baby, and the treatment of the newborn child. Occupational activities play a rather supportive and assisting role. The obstetrician and the midwife are ready to respond immediately in the hospital environment to any complications or sudden emergencies. During a birth outside of the hospital environment, there are a number of influences that can cause complications in an unprepared environment without professional assistance, endangering the condition of both the child and the woman.Methods:The educational concept of PARABORN focuses on situations outside the hospital environment. It is generalized and adaptable to varying geographic, economic, and cultural-political conditions of the target providers, particularly to rescue and paramedic teams. Educational concepts are specialized, interactive courses. The course includes a theoretical and practical block. In the theoretical part, the participants acquire knowledge of urgent obstetric conditions in an out-of-hospital environment including an overweight birth, bleeding, premature delivery, or a complicated delivery (non-standard position, umbilical cord prolapse, etc.). In the practical block, participants acquire the skills of acute interventions as well as methods of communication in these emergency situations. Practical training takes the form of case studies and can be tailored to the real geographic and cultural conditions in which the intervention units operate such as remote terrain, conflicts zones, etc.Discussion:The knowledge of the cultural and political environment is a necessary prerequisite for managing the urgent situation. Paramedics, as first responders, should have adequate training to manage maternity situations in an out-of-hospital environment where a hospital environment is not available or accessible either by choice or circumstance.
Pediatric Outpatient/Urgent-Care Emergency and Disaster Planning
Authors: Frogel Michael , Foltin George , Cooper Arthur 
Published: May 2019

Introduction:Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.Aim:After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.Methods:The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.Results:Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.Discussion:An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.
Planning for the Use of Imaging in Mass Casualty Incidents
Authors: Starkey Deborah , Elliott Denise 
Published: May 2019

Introduction:A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.Aim:To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.Methods:An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.Results:Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.Discussion:While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.
Practicing What You Preach
Authors: Raviiolo Mario , Jaffe Eli , Herbst Raphael 
Published: May 2019

Introduction:During a mass casualty incident (MCI) seminar in Rome, Italy a survey was used to gauge the self-efficacy and confidence of the participants in managing an MCI. Following the course, a follow-up presentation was held by the Torino EMS Medical Director to evaluate and debrief the Torino Railway incident that occurred one day prior. Students partook in a seminar on MCI management, as well as a debriefing of the Turin Railway accident in which they evaluated the skills used by teams on the scene to manage the incident.Methods:Medical students partook in a seminar to learn to manage an MCI scene, as well as a debriefing of the Turin Railway accident. Following both seminars, the students were given a survey to assess their sense of self-confidence in managing such a situation.Results:The mean level of self-efficacy prior to the MCI training (M=3.43, SD+0.42) increased after the training (M=3.71, SD+0.37) and remained at the same higher level (M=3.71, SD+0.51) after the medical students were exposed to the details of the Turin train accident. The overall difference between the mean self-efficacy scores in the three time frames was not found to be significant. The mean level of confidence in managing MCIs prior to the training (M=2.83; SD+0.89) increased after the training (M=3.56; SD+0.53) and remained higher following the presentation of the Turin train accident, despite a slight decrease (M=3.52, SD+0.63).Discussion:The participants’ surveys showed an increase in their self-efficacy and confidence following the course and follow-up presentation. It is our professional recommendation that real-life events be used in such seminars to increase self-efficacy and confidence. The topic will continue to be evaluated further.
The Problems on Your Desk: A Research Study to Define and Describe Paramedic Practice in Canada
Authors: Bowles Ron 
Published: May 2019

Introduction:Paramedicine is a rapidly evolving profession, growing from its initial role of providing emergency care and transportation of the sick and injured into a broad discipline providing a wide range of care in multiple practice settings, yet the field is relatively unexplored. Much of the research in the field centers on patient care, often from the perspective of emergency medicine. A growing body of literature describing the discipline itself is largely descriptive.Aim:This interactive presentation describes and contributes to an applied research project that will define and describe Canadian paramedic practice. The research will develop frameworks, common taxonomy and designs, and evidence to support development of a national Canadian Paramedic Information System.Methods:This two-year mixed methods study is gathering data from a literature review, stakeholder workshops, and key informant interviews. The project will develop “user cases” that explore the issues and challenges facing Canadian paramedic stakeholders and identify the information and data required to address those issues.Results:The presentation will present initial findings that describe core concepts, data/knowledge structures, and models that are foundational to understanding and informing current and emerging paramedic practice. It will explore this data in relation to operational needs of practitioners, operations, communities, and stakeholders to inform decision-making, guiding policy and direction, and advancing the profession. Lastly, it will develop explanatory principles, models, and relationships in a conceptual framework that describes paramedic practice.Discussion:The study will develop models and core data sets that guide research and support policy development at local and national levels, and inform operational and strategic decision-making. The presentation will provide an overview of the research and findings to date. Participants will engage in activities that explore the user-cases and selected findings, applying the results of the study through the lens of their own backgrounds and operational contexts.