bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Model for Admitting Pediatric Trauma Casualties in the Emergency Department
Authors: Madar Raya Tachlizky , Adini Bruria , Greenberg David , Goldberg Avishay 
Published: May 2019

Introduction:Pediatric trauma is one of the leading causes of child mortality and morbidity and is a major challenge for healthcare systems worldwide. Treatment of pediatric trauma requires special attention according to the unique needs of children, especially in children affected by severe trauma who require life-saving treatments. It is essential to examine the preparedness of Emergency Departments (EDs) for admitting and treating pediatric casualties.Aim:To develop a model for admitting and treating pediatric trauma casualties in EDs.Methods:Seventeen health professionals were interviewed using a semi-structured qualitative tool. A quantitative questionnaire was distributed among general and pediatric EDs’ medical and nursing staff. Following the qualitative and quantitative findings, another round of interviews was performed to identify constraints, to construct a “Current Reality Tree,” and develop a model for admission and management of pediatric casualties in EDs. The model was validated by the National Council for Trauma and Emergency Medicine.Results:Lack of uniformity was found regarding age limit and levels of injury of pediatric patients. Most study participants believe that severe pediatric casualties should be concentrated in designated medical centers and that minor and major pediatric casualties should be treated in pediatric rather that general EDs. Pediatric emergency medicine specialists are preferred as case managers for pediatric casualties. Significant diversity in pediatric-care training was found. Based on qualitative and quantitative findings, a model for the optimal admitting and managing of pediatric casualties was designed.Discussion:To provide the best care for pediatric casualties and regulate its key aspects, clear statutory guidelines should be formulated at national and local levels. The model developed in this study considers EDs’ medical teams and policy leaders’ perceptions, and hence its significant contribution. Implementation of the findings and their integration in pediatric trauma care in EDs can significantly improve pediatric emergency medical services.
Lessons Learned from an Obstetrics/Newborn/Neonatal Intensive Care Full-Scale Exercise
Authors: Cooper Arthur , Frogel Michael , Foltin George 
Published: May 2019

Introduction:Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the New York City Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.Aim:On April 26, 2018, the NYCPDC conducted a first full-scale exercise with the New York Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the obstetrics, newborn, and neonatal units at Staten Island University Hospital North. The goal of the exercise was to evaluate current obstetrics/newborn/neonatal plans and assess the hospital’s ability to evacuate patients.Methods:The exercise planning process included a review of existing obstetrics/newborn/neonatal plans, four group planning meetings, specific area meetings, and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility’s existing evacuation plans during an emergency.Results:The exercise assessed the following: communication, emergency operation plans, evacuation, patient tracking, supplies, and staffing. Internal and external evaluators rated exercise performance on a scale of 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot wash session, and after-action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.Discussion:Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, and equipment needed for vertical evacuations in addition to providing staging and alternate care sites with sufficient patient care and electrical power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.
Pharmacists Transcend Disaster Health "Silos"
Authors: Watson Kaitlyn E. , Singleton Judith A. , Tippett Vivienne , Nissen Lisa M. 
Published: May 2019

Introduction:Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.Aim:To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.Methods:Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.Results:The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.Discussion:Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.
The Verdict is In: Pharmacists Do Have a Role in Disasters and It is Not Just Logistics
Authors: Watson Kaitlyn E. , Singleton Judith A. , Tippett Vivienne , Nissen Lisa M. 
Published: May 2019

Introduction:The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.Aim:To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.Methods:There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).Results:Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.Discussion:This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.
Health Sector Preparedness During the Eid-al-Fitr Homecoming Across Indonesia in 2017
Authors: Ariani Madelina , Achmad Yurianto , Kamarruzzaman Kamarruzzaman , Agustina Ina , Donna Bella , Wartatmo Hendro 
Published: May 2019

Introduction:Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.Aim:To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.Methods:The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.Results:The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.Discussion:The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.
Recent Unprecedented Wildfires in British Columbia, Canada: Progression of a Grassroots Disaster Psychosocial Program
Authors: LeBlanc Jeanne , Kaplan Julie 
Published: May 2019

Introduction:Psychosocial needs related to disaster are increasingly identified as a significant concern for both communities and responders. In response to the needs of travelers suddenly unable to leave Vancouver immediately after 9/11 in the United States, a network for the provision of volunteer mental health response at the time of a disaster was developed through the Provincial government within British Columbia (BC). Starting from less than 20 individuals primarily located within the Vancouver area, Disaster Psychosocial Services (DPS) now encompasses a network of over approximately 200 providers throughout the Province.Aim:To showcase a successfully functioning DPS program modeled after a volunteer-based mental health network, the evolution undergone, its present operational framework, and future goals.Methods:In response to the observed need for trained psychosocial intervention, we developed a framework for recruitment, education, deployment, and support of a volunteer network of mental health professional and paraprofessional providers.Results:This approach has been found to be effective, significantly increasing our volunteer base and opportunities for deployment.Discussion:This presentation will detail the grassroots development of BC’s DPS Program as well as the current model in practice. It will provide an overview of how BC’s DPS network of providers was stimulated and managed; issues related to volunteer management, including the selection of volunteers; methods of specialized training; and deployment. Multiple settings in which DPS is now utilized with increasing regularity will be described, including Emergency Operations Centers, Reception Centers, and Town Hall Meetings. Lastly, there will be a focus on the lessons learned, as well as future goals highlighting a focus on culturally-sensitive support, specifically with respect to British Columbia’s indigenous populations for building community resiliency and knowledge across the province.
Responding to Disasters: More Than Economic and Infrastructure Interventions
Authors: Crompton David 
Published: May 2019

Introduction:Natural disasters confront individuals, communities, and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters, it is pertinent to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community.Aim:The presentation will highlight the effectiveness of interventions post-disaster, and continued adverse outcomes five years post-event.Methods:An evaluation of literature related to the psychosocial impact of natural disasters, treatment efficacy, and government strategies to confront the social and psychological impact of natural disasters for the period 1983 – 2016 was undertaken.Results:Epidemiological studies following natural disasters, despite the use of differing psychological measures, demonstrate significant psychological morbidity – anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%), and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy capability.Discussion:The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social, and economic consequences of these events have resulted in the development and implementation of government policies to confirm the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions, with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance of developing strategies to ensure effectively evaluated psychosocial interventions are available across at-risk communities.
Tragedy Meets GME: The Impact of the October 1st Mass Casualty Incident on Academic Attending and Resident Physicians
Authors: Roozendaal Suzanne , Guldner Gregory , Abou-Zaid Hoda , Siegal Jason , Berkeley Ross , Davey Dylan , Allswede Michael 
Published: May 2019

Introduction:On October 1, 2017, a gunman fired on a festival in Las Vegas, Nevada, killing 58 people and wounding over 500. Multiple casualties were received at two nearby hospitals that sponsor residency programs: Sunrise Hospital and Medical Center and University Medical Center.Aim:To evaluate the impact of the most lethal mass-shooting event in US history on graduate medical education (GME) at the involved hospitals.Methods:Anonymized surveys were sent to 210 physicians at SMC and 110 physicians at UMC. Surveys incorporated 4 validated instruments: The Post Traumatic Growth Inventory (PTGI), The Impact of Events Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), and The Team Cohesion Factor (TCF).Results:Sixty-six physicians completed the surveys (38 attendings; 17 residents). 10% of physicians scored in the likely posttraumatic stress disorder (PTSD) range and 15% found themselves avoiding or struggling with managing similar patients, though overall survey response rate was low. The majority of physicians did not believe the event impacted their specific GME activities. No attending physician rated the event as negative in terms of global impact on GME, and 34% rated it as positive. However, 12 of 17 residents rated the event as a hurdle in its GME impact. A regression model predicting the IES-R score demonstrated a trend that those with higher pre-event stress and lower social support reported more adverse impact (p<0.06).Discussion:We believe our study is the first to examine the impact of mass casualty traumatic events on graduate medical education. Attendings and residents differ in their global perception of the impact, with attendings viewing it as a positive event and residents as a challenge. Pre-event level of stress and perceived social support predicted the impact of the event and may partially explain these results if residents and attendings vary on these parameters.
From Science to Policy and Practice: A Critical Assessment of Knowledge Management Before, During, and After Environmental Public Health Disasters
Authors: Généreux Mélissa , Lafontaine Marc , Eykelbosh Angela 
Published: May 2019

Introduction:Canada, like many countries, increasingly faces environmental public health (EPH) disasters. Such disasters often require both short- and long-term responses, necessitate evacuation and relocation, cause major environmental impacts, and generate the need for specific knowledge and expertise (chemistry, epidemiology, risk assessment, mental health, etc.).Aim:Given the importance of evidence-based, risk-informed decision making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster risk management in several Canadian and other jurisdictions.Methods:In-depth interviews were conducted with 23 leaders in disaster risk management from Canada, United States, United Kingdom, and Australia, and were complemented by other methods (i.e. participant observation, information gathered from participation in scientific events, and document review). Three criteria were explored: governance, knowledge creation and translation, and related needs and barriers. An interview guide was developed based on a standardized toolkit from the World Health Organization. Data were analyzed through a four-step content analysis.Results:Six cross-cutting themes emerged from the analysis. These themes are identified as critical factors in successful disaster knowledge management: 1) blending the best of traditional and modern approaches, 2) fostering community engagement; 3) cultivating relationships, 4) investing in preparedness and recovery, 5) putting knowledge into practice, and 6) ensuring sufficient human and financial resources. A wide range of promising knowledge-to-action strategies was also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources.Discussion:There is no single roadmap to incorporate EPH knowledge and expertise into disaster risk management. Our findings suggest that beyond structures and plans, it is necessary to cultivate relationships and share responsibility for ensuring the safety, health, and wellbeing of affected communities while respecting the local culture, capacity, and autonomy. Any such considerations should be incorporated into disaster risk management planning.
Preparing for Mass Casualties: Improving Staff Preparedness and Hospital Operations through Multidisciplinary Simulation Training in Disaster Management
Authors: Watkins Nathan , Johnston Amy NB , McNamee Peter , Muter Naomi , Huang Cindy , ling Li Yuet , Samsuddin Amanda , Sweeny Amy 
Published: May 2019

Introduction:World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.Aim:This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.Methods:Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.Results:Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.Discussion:Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.