bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injuries Among Afghan Refugees: Review of Evidence
Authors: Nasir Khurram , Hyder Adnan A. , Shahbaz C. M. 
Published: August 2016

AbstractBackground:Injuries are a public health problem in developing countries resulting in major financial and productivity losses. Injuries in vulnerable populations, such as refugees, make an even greater impact on loss of life. Afghan refugees in Pakistan continue to form one of the world's largest refugee populations. This study systemically reviews the literature to estimate the magnitude and prevalence of intentional and unintentional injuries in Afghan refugees, and explores the implications of the findings for refugee healthcare policy and development of potential interventions specifically for Afghan refugees.Methods:Electronic databases of MEDLINE, POPLINE, Refworld, and Winspirs were searched. In addition, a web search was conducted and specific organizational websites were reviewed. The search in developing countries was limited to studies in English or with an English abstract for the years 1966–2001.Results:The literature review identified patients with reported war injuries who presented to hospitals. Injuries to extremities (45%) were more frequent than injuries to the head or neck (36%, p <0.001), and thorax/abdomen (14%, p <0.001) regions. A majority of the injuries were caused by explosives, which included landmines (32.5%), fragmentations, such as shrapnel (33%), and firearms (27%). The mean incidence of mortality in these studies was 11%.Conclusions:Despite such an extensive search, limited information was found pertinent to injuries in Afghan refugees residing in refugee camps. This dearth of literature on the prevalence of injuries, risk factors, and outcomes among this vulnerable group is a research and policy gap for public health. Specific quantitive and qualitative studies in this field are required to shape refugee healthcare policies and develop intervention programs.
The Development of Conceptual Models for Mass-Gathering Health
Authors: Arbon Paul 
Published: August 2016

AbstractMass gatherings are an increasingly common feature of modern society. However, descriptive papers that focus on a single event or event type, dominate the literature, and, while these contribute to our understanding of the patient care required at such events, they do not provide an adequate analysis of the health effects of the mass-gathering phenomenon itself. This paper argues for the development of conceptual models and a research template for mass-gathering research. The development of theory and conceptual models would promote a better understanding of the health effects of mass gatherings. Two preliminary conceptual models are presented as a means to encourage further debate about the dominant influences on the health of people where crowds gather and to promote less superficial forms of analysis of the research data.These conceptual models are based on the idea that mass-gathering health can be understood as an inter-relationship between three domains: (1) the biomedical; (2) the environmental; and (3) the psychosocial. Key features influence the rate of injury and illness and characterize each domain. These key features are more or less well-understood and combine to produce an effect—the patient presentation rate, and a response—the health plan. A new element, the latent potential for injury and illness, is introduced as a mechanism for describing a biomedical precursor state important in assessing health risk during mass gatherings.
Building the Tower of Babel: Cross-border Urgent Medical Assistance in Belgium, Germany and the Netherlands
Authors: Post G. B. 
Published: August 2016

AbstractThe border area between Germany, Belgium, and the Netherlands includes a substantial number of cooperative forms in the urgent medical assistance sector. Collaboration usually takes place in densely populated areas with cities or villages situated on or in proximity to the border. In some regions, definitive borders are not apparent to the extent that inhabitants often times are unaware of their existence. The border may pass directly through a builtup area with intense cross-border activity due to population residency, place of work, shopping, and recreational pursuits.To obtain a deeper insight into cross-border Urgent Medical Assistance (UMA), the Ministry of the Interior and Kingdom Relations (IKR) and the Ministry for Health, Welfare, and Sports (HWS) in the Netherlands commissioned research into cross-border UMA impediments and solutions at administrative, judicial, and operational level. The following central questions were presented for research: what opportunities and impediments are presented in the area of cross-border, urgent medical assistance at administrative, legal, operational, and equipment employable level, and which solutions may be submitted to tackle existing impediments?Two techniques were employed to answer the research questions. First, relevant documents were studied from extensive file and literature searches. File and literature search findings subsequently were tested in practice through interviews with relevant experts.Dutch ambulance services provide support to both their Belgian and German counterparts and vice versa. In the instance of cross-border ambulance deployment, relevant assistance services are subject to due observance of various legislations and regulations. Such regulations may restrict effective and efficient deployment of personnel and equipment at critical moments, because regulation discrepancies may arise over ambulance personnel's authorities, ambulance content, and deployment sequence. Discrepencies also may exist in the area of financial compensation concerning ambulance deployment and hospital admission. Gaining knowledge on their disparate systems and the opportunity to utilize the medical provisions of a neighboring country potentially in closer proximity to those in the victim's own country serves the best interests of the patient. Survival chances of a traumatized patient increase with the expedited arrival of medical assistance and increased speed of transportation to an appropriate hospital.
Testing Emergency Medical Personnel Response to Patients with Suspected Infectious Disease
Authors: Klein Kelly R. , Atas Jenny G. , Collins Jerry 
Published: August 2016

AbstractObjectives:In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan.Methods:Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital “lock-down”; and (3) breach of drill protocol.Results:None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's bio-agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their “infected” patients, only two (29%) followed their notification protocol and contacted the local health department.Conclusion:This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.
Cost-Effectiveness and Benefit of Alternatives to Improve Training for Prehospital Trauma Care in Mexico
Authors: Arreola-Risa Carlos , Mock Charles , Herrera-Escamilla Alejandro J. , Contreras Ismael , Vargas Jorge 
Published: August 2016

AbstractIntroduction:In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the costeffectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.Methods:In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US]$150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of $400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site.Results:The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site.Conclusions:This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.
Demystifying Bioterrorism: Misinformation and Misperceptions
Authors: Noji Eric , Goodwin Tress , Hopmeier Michael 
Published: August 2016

AbstractThe true threat of bioterrorism remains mysterious and elusive to the common citizen. It principally has become the dominion of a few “experts”, many of whom have limited apparent expertise, who have failed to effectively communicate the risks and realities to society, and have instead created an air of uncertainty surrounding the topic. Unlike the great classic deceptions of modern life (e.g., “the check is in the mail”), the misinformation and misperceptions associated with bioterrorism can be dangerous and are not merely humorous. Indeed, it is possible to grasp the facts as well as fallacies associated with bioterrorism, and, as a result, demystify this nightmare scenario and prepare for the “unthinkable”.
Predictors of Emotional Adjustment following Traumatic Injury: Personal, Social, and Material Resources
Authors: Cordova Matthew J. , Walser Robyn , Neff Janet , Ruzek Josef I. 
Published: August 2016

AbstractIntroduction:The identification of factors influencing emotional adjustment after injury may elucidate the design of assessment and treatment procedures in emergency medicine settings and suggest targets for early intervention to prevent the later development of psychological impairment. Personal, social, and material resources may be influential factors and require further evaluation.Hypotheses:Greater experiential avoidance, social constraints on discussing the trauma experience, and loss of material resources would be associated with more of the symptoms of posttraumatic stress and depression following traumatic injury.Methods:Participants (n = 47) at a mean of 7.4 months post-injury, completed a telephone interview assessment, including evaluation of sociodemographic characteristics, conservation of resources, social constraints, acceptance and commitment, and symptoms of post-traumatic stress disorder (PTSD) and depression. Hypotheses were tested using multivariate regression analyses.Results:Only greater social constraints were uniquely predictive of greater PTSD symptomatology. Higher levels of experiential avoidance, social constraints, and loss of material resources all were associated with greater levels of depression.Conclusion:Assessment of personal coping style, receptivity of social network, and loss of potential material resources following traumatic injury may facilitate identification of individuals at-risk for poorer post-injury adaptation. Psychosocial interventions targeting such individuals may be promising.
The Incident Command System in Disasters: Evaluation Methods for a Hospital-based Exercise
Authors: Thomas Tamara L. , Hsu Edbert B. , Kim Hong K. , Colli Sara , Arana Guillermo , Green Gary B. 
Published: August 2016

AbstractObjectives:No universally accepted methods for objective evaluation of the function of the Incident Command System (ICS) in disaster exercises currently exist. An ICS evaluation method for disaster simulations was derived and piloted.Methods:A comprehensive variable list for ICS function was created and four distinct ICS evaluation methods (quantitative and qualitative) were derived and piloted prospectively during an exercise. Delay times for key provider-victim interactions were recorded through a system of data collection using participant and observer-based instruments. Two different post exercise surveys (commanders, other participants) were used to assess knowledge and perceptions of assigned roles, organization, and communications. Direct observation by trained observers and a structured debriefing session also were employed.Results:A total of 45 volunteers participated in the exercise that included 20 mock victims. First, mean, and last victim delay times (from exercise initiation) were 2.1, 4.0, and 9.3 minutes (min) until triage, and 5.2, 11.9, and 22.0 min for scene evacuation, respectively. First, mean, and last victim delay times to definitive treatment were 6.0, 14.5, and 25.0 min. Mean time to triage (and range) for scene Zones I (nearest entrance), II (intermediate) and III (ground zero) were 2.9 (2.0–4.0), 4.1 (3.0–5.0) and 5.2 (3.0–9.0) min, respectively. The lowest acuity level (Green) victims had the shortest mean times for triage (3.5 min), evacuation (4.0 min), and treatment (10.0 min) while the highest acuity level (Red) victims had the longest mean times for all measures; patterns consistent with independent rather than ICS-directed rescuer activities. Specific ICS problem areas were identified.Conclusions:A structured, objective, quantitative evaluation of ICS function can identify deficiencies that can become the focus for subsequent improvement efforts.
Successful Development and Implementation of a Tactical Emergency Medical Technician Training Program for United States Federal Agents
Authors: Ciccone Teriggi J. , Anderson Phillip D. , Gann Chon A.D. , Riley J. Michael , Maxwell Michael , Hopkins Robert , Ciottone Gregory 
Published: August 2016

AbstractIntroduction:The emerging need for tactical operations in law enforcement often places personnel involved at risk. Tactical operations often are carried out in environments in which access to emergency care is limited. With the war against terrorism expanding, special operations involving United States federal agents are occurring worldwide. Currently, there are very few tactical medicine curricula training traditional emergency medical services (EMS) providers to operate in these high-risk missions. Trainees in existing programs must have previous EMS experience, and are selected from a wide range of backgrounds. The goal of this study is to examine a Special Agent Emergency Medical Technician (SAEMT) training curriculum developed specifically for federal special agents with prior experience in tactical operations, but without previous medical training.Methods:An analysis of the SAEMT Program given to federal agents of the Drug Enforcement Administration (DEA) in Quantico, Virginia between July 2000 and April 2002 was performed. The SAEMT curriculum provided enrolled agents 181.5 hours of training in tactical emergency topics, including medical mission planning, logistics, operations, evacuation, and weapons training. In addition, SAEMT concurrently provides emergency medical technician (EMT) training. All of the participants were DEA agents with no previous medical training. Upon completion of the course, all participants took the National Registry of EMT-Basic examination. Measured endpoints included course completion rate and performance on certifying examinations.Results:Ninety-five agents were enrolled and successfully completed the SAEMT course between July 2000 and April 2002. Of the agents enrolled, 84 (88%) passed the National Registry of EMTs-Basic examination within two attempts.Conclusion:The SAEMT Program provides basic emergency medical training to federal special agents with no previous medical experience. The design of this program provides a useful template to meet the expanding demand for tactical emergency medical personnel.
Triage Decisions of United Kingdom Police Firearms Officers Using a Multiple-Casualty Scenario Paper Exercise
Authors: Kilner Tim , Hall F. John 
Published: August 2016

AbstractIntroduction:British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.Methods:Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.Results:The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.Conclusion:It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.
Symptom-Based, Algorithmic Approach for Handling the Initial Encounter with Victims of a Potential Terrorist Attack
Authors: Subbarao Italo , Johnson Christopher , Bond William F. , Schwid Howard A. , Wasser Thomas E. , Deye Greg A. , Burkhart Keith K. 
Published: August 2016

AbstractObjectives:This study intended to create symptom-based triage algorithms for the initial encounter with terror-attack victims. The goals of the triage algorithms include: (1) early recognition; (2) avoiding contamination; (3) early use of antidotes; (4) appropriate handling of unstable, contaminated victims; and (5) provisions of force protection. The algorithms also address industrial accidents and emerging infections, which have similar clinical presentations and risks for contamination as weapons of mass destruction (WMD).Methods:The algorithms were developed using references from military and civilian sources. They were tested and adjusted using a series of theoretical patients from a CD-ROM chemical, biological, radiological/nuclear, and explosive victim simulator. Then, the algorithms were placed into a card format and sent to experts in relevant fields for academic review.Results:Six inter-connected algorithms were created, described, and presented in figure form. The “attack” algorithm, for example, begins by differentiating between overt and covert attack victims (A covert attack is defined by epidemiological criteria adapted from the Centers for Disease Control and Prevention (CDC) recommendations). The attack algorithm then categorizes patients either as stable or unstable. Unstable patients flow to the “Dirty Resuscitation” algorithm, whereas, stable patients flow to the “Chemical Agent” and “Biological Agent” algorithms. The two remaining algorithms include the “Suicide Bomb/Blast/Explosion” and the “Radiation Dispersal Device” algorithms, which are inter-connected through the overt pathway in the “Attack” algorithm.Conclusion:A civilian, symptom-based, algorithmic approach to the initial encounter with victims of terrorist attacks, industrial accidents, or emerging infections was created. Future studies will address the usability of the algorithms with theoretical cases and utility in prospective, announced and unannounced, field drills. Additionally, future studies will assess the effectiveness of teaching modalities used to reinforce the algorithmic approach.