bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team
Authors: Rajpura Asim , Boutros Ihab , Khan Tahir , Khan Sohail Ali 
Published: August 2016

AbstractIntroduction:Four weeks after the earthquake in Kashmir, Pakistan, multi-disciplinary surgical teams were organized within the United Kingdom to help treat disaster victims who had been transferred to Rawalpindi. The work of these teams between 05-17 November 2005 is reviewed, and experiences and lessons learned are presented.Methods:Two self-sufficient teams consisting of orthopedic, plastic surgical, anesthetic, and theatre staff were deployed consecutively over a two-week period. A trauma unit was set up in a donated ward within a private ophthalmological hospital in Rawalpindi.Results:Seventy-eight patients with a mean age of 23 years were treated: more than half (40) were <16 years of age. Fifty-two patients only had lower limb injuries, 18 upper limb injuries, and eight combined lower and upper limb. The most common types of injuries were: (1) tibial fractures (n = 24), with the majority being open grade 3B injuries (n = 22); (2) femoral fractures (n = 11); and (3) forearm fractures (n = 9). Almost half (n = 34) of the fractures were open injuries requiring soft tissue cover.Over 12 days, 293 operations were performed (average 24.4 per day). A total of 202 examinations under anesthesia, washouts, and debridements were performed. The majority of wounds required multiple washouts prior to definitive procedures. Thirty-four definitive orthopedic procedures (fixations) and 57 definitive plastic procedures were performed. Definitive orthopedic procedures included 15 circular frame fixations of long bones, nine of which required acute shortening and five open reduction and internal fixation of long bones. Definitive plastic procedures included 21 skin grafts, four amputations, 11 revisions of amputations, 20 regional flaps, and one free flap.Conclusions:A joint ortho-plastic approach was key to the treatment of the spectrum of injuries encountered. Only four patients required fresh amputations. Twenty patients may have required amputation without the use of ring fixators and soft tissue reconstruction. Having self-sufficient teams along with their own equipment and supplies also was mandatory in order not to put further demand on already scarce resources. However, mobilizing such teams logistically was difficult, and therefore, an organization consisting of willing volunteers for future efforts has been established.
The 2007 San Diego Wildfire Impact on the Emergency Department of the University of California, San Diego Hospital System
Authors: Schranz Craig I. , Castillo Edward M. , Vilke Gary M. 
Published: August 2016

AbstractIntroduction:In October 2007, San Diego County experienced a severe firestorm resulting in the burning of more than 368,000 acres, the destruction of more than 1,700 homes, and the evacuation of more than 500,000 people.Hypothesis:The goal of this study was to assess the impact of the 2007 San Diego Wildfires, and the acute change in air quality that followed, on the patient volume and types of complaints in the emergency department.Method:A retrospective review was performed of a database of all patients presenting to the Emergency Departments of University of California, San Diego (UCSD) hospitals for a six-day period both before (14–19 October 2007) and after (21–26 October 2007) the start of the 2007 firestorm. Charts were abstracted for data, including demographics, chief complaints, past medical history, fire-related injuries and disposition status. As a measure of pollution, levels of 2.5 micron Particulate Matter (PM 2.5) also were calculated from data provided by the San Diego Air Pollution Control District.Results:Emergency department volume decreased by 5.8% for the period following the fire. A rapid rise in PM2.5 levels coincided with the onset of the fires. The admission rate was higher in the period following the fires (19.8% vs. 15.2%) from the baseline period. Additionally, the Left Without Being Seen (LWBS) rate doubled to 4.6% from 2.3%. There was a statistically significant increase in patients presenting with a chief complaint of shortness of breath (6.5% vs. 4.2% p = 0.028) and smoke exposure (1.1% vs. 0% p = 0.001) following the fires. Patients with significant cardiac or pulmonary histories were no more likely to present to the emergency department during the fires.Conclusions:Despite the decreased volume, the admission and LWBS rate did increase following the onset of the firestorm. The cause of this increase is unclear. Despite a sudden decline in air quality, patients with significant cardiac and pulmonary morbidity did not vary their emergency department utilization rate. Based on the experience at UCSD, it appears that significant wildfires like that seen in 2007, only may marginally affect emergency department operations, and may not require significant changes to normal staffing levels.
Community Assessment for Public Health Emergency Response following Hurricane Ike—Texas, 25-30 September 2008
Authors: Zane David F. , Bayleyegn Tesfaye M. , Haywood Tracy L. , Wiltz-Beckham Dana , Guidry Harlan “Mark” , Sanchez Carlos , Wolkin Amy F. 
Published: August 2016

AbstractIntroduction:On 13 September 2008, Hurricane Ike made landfall near Galveston, Texas, resulting in an estimated 74 deaths statewide and extensive damage in many counties. The Texas Department of State Health Services, US Public Health Service, and the Centers for Disease Control and Prevention conducted assessments beginning 12 days following hurricane landfall to identify the public health needs of three affected communities. The results of the assessment are presented, and an example of a type of public health epidemiological response to a disaster due to a natural hazard is provided.Methods:A one-page questionnaire that focused on household public health characteristics was developed. Using a two-stage cluster sampling methodology, 30 census blocks were selected randomly in three communities (Galveston, Liberty, and Manvel, Texas). Seven households were selected randomly from each block to interview.Results:The assessments were conducted on 25, 26, and 30 September 2008. At the time of the interview, 45% percent of the households in Galveston had no electricity, and 26% had no regular garbage collection. Forty-six percent reported feeling that their residence was unsafe to inhabit due to mold, roof, and/or structural damage, and lack of electricity. Sixteen percent of households reported at least one member of the household had an injury since the hurricane. In Liberty, only 7% of the household members interviewed had no access to food, 4% had no working toilet, 2% had no running water, and 2% had no electricity. In Manvel, only 5% of the households did not have access to food, 3% had no running water, 2% had no regular garbage collection, and 3% had no electricity.Conclusions:Post-Ike household-level surveys conducted identified the immediate needs and associated risks of the affected communities. Despite the response efforts, a high proportion of households in Galveston still were reportedly lacking electricity and regular garbage pickup 17 days post-storm. The proportion of households with self-reported injury in Galveston suggested the need to enhance public education on how to prevent injuries during hurricane cleanup. Galveston public health officials used the assessment to educate local emergency and elected officials of the health hazards related to lack of basic utilities and medical care in the community. This resulted in the provision of an extensive public health outreach education program throughout the island. The Liberty and Manvel assessment findings suggest that most households in both communities were receiving the basic utilities and that the residents felt “safe”. The assessments reassured local health officials that there were no substantial acute public health needs and provided objective information that services were being restored.
Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community
Authors: Zeitz Kathryn , Grantham Hugh , Elliot Robert , Zeitz Chris 
Published: August 2016

AbstractIntroduction:Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.Methods:A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.Results:A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.Conclusions:This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.
Ability of First-Year Paramedic Students to Identify ST-Segment Elevation Myocardial Injury on 12-Lead Electrocardiogram: A Pilot Study
Authors: Levis Joel T. , Koskovich Mary 
Published: August 2016

AbstractIntroduction:The purpose of this study was to evaluate the ability of first-year paramedic students to identify ST-segment elevation myocardial injury (STEMI) on 12-lead electrocardiograms (ECGs) following a three-hour presentation by a board-certified emergency medicine physician experienced in ECG interpretation.Methods:Thirty-three first-year paramedic students with minimal to no experience in evaluating 12-lead ECGs were administered a pretest with 20 12-lead ECGs and were asked to evaluate each for: (1) presence of STEMI (STEMI identification); (2) if STEMI presents, ECG leads demonstrating ST-elevation (LEAD identification); and (3) if STEMI present, the anatomic distribution of the STEMI (ANATOMY identification). The students were randomized into two groups. Group 1 (16 students; control group) received a handout describing the evaluation of ECGs for STEMI, while Group 2 (17 students; experimental group) received the handout plus a threehour presentation on the evaluation of ECGs for STEMI. Following randomization, distribution of the STEMI handout and ECG STEMI presentation, a posttest with 20 new ECGs was administered to all participants. The pretest and posttest mean scores were compared between the two groups to determine if attendance at the presentation improved the paramedic students' abilities to evaluate and identify STEMI ECGs. Following the STEMI posttest, students in Group 1 were provided with the STEMI lecture. Students were retested with 20 new ECGs five months following the initial study to examine retention of the information taught.Results:The mean pre-test scores for the two groups (Group 1 vs Group 2, respectively) in STEMI identification (74.4 vs 75.6%; p = 0.79), lead identification (50.0 vs. 51.2%; p = 0.8) and anatomy identification (49.4 vs 51.8%; p = 0.60) were similar in all three categories. Post-test scores between Group 1 and Group 2 demonstrated statistically significant differences in STEMI identification (85.6 vs 92.4%; p <0.02), lead identification (73.4 vs 85.2%; p <0.02), and anatomy identification (65.9 vs 87.1%; p <0.01), with Group 2 demonstrating higher mean scores relative to Group 1 in all three categories. Comparison of mean initial pre-test and five-month retest scores for all students demonstrated statistically significant differences in STEMI identification (75.0 vs 87.4%; p <0.0001), lead identification (50.6 vs 82.2%; p <0.0001), and anatomy identification (50.6 vs 76.6%; p <0.0001).Conclusions:The ability of first-year paramedic students to accurately detect STEMI on prehospital 12-lead ECGs is enhanced by a structured ECG STEMI presentation provided by an emergency medicine physician, and these students maintained excellent retention of STEMI ECG skills over a five-month period.
Response of Thai Hospitals to the Tsunami Disaster
Authors: Leiba Adi , Ashkenasi Issac , Nakash Guy , Pelts Rami , Schwartz Dagan , Goldberg Avishay , Levi Brig. Gen. Yeheskel , Bar-Dayan Yaron 
Published: August 2016

AbstractThe disaster caused by the Tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters.The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients.Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims.Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed.Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system.
Acute Cyanide Poisoning in Prehospital Care: New Challenges, New Tools for Intervention
Authors: Guidotti Tee 
Published: August 2016

AbstractEffective management of cyanide poisoning from chemical terrorism, inhalation of fire smoke, and other causes constitutes a critical challenge for the pre-hospital care provider. The ability to meet the challenge of managing cyanide poisoning in the prehospital setting may be enhanced by the availability of the cyanide antidote hydroxocobalamin, currently under development for potential introduction in the United States. This paper discusses the causes, recognition, and management of acute cyanide poisoning in the prehospital setting with emphasis on the emerging profile of hydroxocobalamin, an antidote that may have a risk:benefit ratio suitable for empiric, out-of-hospital treatment of the range of causes of cyanide poisoning. If introduced in the US, hydroxocobalamin may enhance the role of the US prehospital responder in providing emergency care in a cyanide incident.
Health Aspects of Disaster Preparedness and Response Panel Session 1: Water-related Hazards
Authors:   Southeast Asia Regional Office/World Health Organization
Published: August 2016

AbstractThis Panel Session consisted of three country reports (Bagladesh, Bhutan, and Myanmar) and the common issues identified during the Panel discussions relative to water-related hazards and events in the Southeast Asia Region. The primary event discussed regardless of the hazards encountered was flooding. The merits of the responses generated in Bangladesh before, during, and following the 2004 floods provide evidence of what can be accomplished in community and national levels of preparedness.Many key issues arose in the discussions: (1) command and control systems and SOPs; (2) ready resources; (3) public information and education and human resource development; (4) community-level preparedness; (5) accessibility to health care; (6) increased focus on disease prevention and control; (7) management of dead bodies; (8) need for a legal framework; (9) funding and the management of funds; and (10) relationships with themedia.
Health Aspects of Disaster Preparedness and Response Panel Session 3: Industrial Accidents, Conflicts, and Other Emergencies
Authors:   Southeast Asia Regional Office/World Health Organization
Published: August 2016

AbstractThis Panel Session consisted of three country reports (Democratic People's Republic of Korea; Sri Lanka; and Timor-Leste) and the common issues identified during the Panel discussions relative to industrial accidents and conflicts in the Southeast Asia Region. Important issues identified included the needs for: (1) use of medical technology; (2) stockpiling of essential supplies; (3) human resource development; (4) surveillance systems for disease detection; (5) coordination; and (6) emergency funding.
Prioritizing Care During the Acute Phase: The Prominent Role of Basic Psychosocial Life Support
Authors: Rooze Magda , Netten Josee , de Ruyter Ariëlle , de Vries Maaike , Helsloot Ira , de Soir Erik , Selwood Philip , Schenk Henk , Hustinx Paul , Olinder Henrik 
Published: August 2016

AbstractThe issue of basic psychosocial life support during and after disasters is important. People who are affected by disasters can experience severe distress and may need psychosocial support. However, there still are many questions about service design and effectiveness of psychosocial support.During the process of the Targeted Agenda Program, “Prioritizing Care during the Acute Phase: The Prominent Role of Basic Psychosocial Life Support”, a team of experts reached consensus on some important issues concerning psychosocial first aid, civil participation, and risk communication.The experts come from many different backgrounds, which supports the notion that psychosocial care deserves special attention within disaster relief programs involving all disciplines and all responsibilities.
The Public Health Dimension of Disasters—Health Outcome Assessment of Disasters
Authors: van den Berg Bellis , Grievink Linda , Gutschmidt Kersten , Lang Thierry , Palmer Stephen , Ruijten Marc , Stumpel Rene , Yzermans Joris 
Published: August 2016

AbstractA broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters.During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment?A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters.The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policy-makers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors.Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population.It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disasters.
Is There One Optimal Medical Treatment and Evacuation Chain for All Situations: “Scoop-and-Run” or “Stay-and-Play”
Authors: Hoejenbos Maarten J.J. , McManus John , Hodgetts Timothy 
Published: August 2016

AbstractIn 2006, the Ministry of Defense of the Netherlands initiated a targeted agenda program for the World Congress on Disaster and Emergency Medicine in Amsterdam in 2007 (15WCDEM). The issue to be discussed was if there is one “golden” treatment and evacuation system that is applicable for different military and civilian situations. And, if there is not such a system, which parameters are important to construct the most optimal system for each different situation. This issue is related to the applicability and evidence base of the standards of the North Atlantic Treaty Organization.A group of experts started a website discussion on the issue during December 2006. During the 15WCDEM, several other participants were active in the discussion.Using the different experiences and the outcome of the discussions, it was concluded that there is not one “golden” medical emergency system, there are no “golden” timelines, and no “golden” skills. A medical system should be flexible and be able to adjust on each specific, local situation. First responder and non-medical people with medical skills (first responders) are essential in the front line of the emergency medical systems. More research is needed on the medical techniques and skills that are most effective early in the treatment and evacuation systems. Lessons learned from the military system are relevant for the civilian emergency medical services and vice-versa. The World Association for Disaster and Emergency Medicine can be an important platform to share and exchange information between these two systems.The target of the platform should be to obtain a generic picture of the important elements in prehospital emergency medical care.