bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A313) Role of Physiatrists in Post Disaster Scenarios - Lessons Learned from Pakistan, China and Haiti Earthquakes
Authors: Rathore F.A. , O'connell C. , Li J. 
Published: May 2011

IntroductionPhysical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.MethodologyAuthors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.ResultsIn these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.ConclusionPhysiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.
(P1-2) Incidence and Pre-Hospital Care of Acute Coronary Syndrome in Emergency Department Banja Luka
Authors: Banjac N. , Maravic-oplakan G. , Kovacevic B. , Jelovac L. , Mihajlovic D. , Burgic-radmanovic M. , Kovacevic D. 
Published: May 2011

IntroductionThe acute coronary syndrome is a leading cause of heart death among adults. The treatment of such patients begins during the first contact with the doctor who is in most cases neither an internist or cardiologist, but an emergency medicine specialist or general practitioner working in the emergency department. For that reason it is of great importance to educate doctors who will be able to establish a fast and precise diagnosis, start therapy and organize quick transport to the nearest catheterization room or coronary unit.ObjectiveThe primary objective was to measure frequency of patient's visits to the Emergency Department because of an acute coronary syndrome. The Secondary objective was to examine the choice of treatment in pre-hospital conditions.MethodologyThrough the statistical retrospective analysis we collected the data from the Emergency Department protocols for the period between June 1, 2008 and December 31, 2008.ResultsIn 14,986 patients during the six-month period, 343 of them had acute coronary syndrome. Men were more affected ((59.5%) than women (40.5%). Most cases belonged to the age group from 65 to 80 years (39.6%) and prevalence after 50 years shows abrupt growth. According to the diagnoses, most patients had unstable pectoral angina (42%) and then followed stenocardia (31%) and AIM (27%). Other therapy included NTG (22%), antihypertensives (21%), acetyl-salicylic acid (20%), analgesics (13%), antiarrhythmics (4%). Fifty-seven percent of the patients had complications. STEMI was diagnosed in 69% of patients, and most often the anterior wall was involved (35%).ConclusionThe diagnosis of acute coronary syndrome was established in 343 patients based on the clinical image, electrocardiographic changes and level of cardiospecific enzymes (troponin T).
(P1-13) Initial Experience with Mobile Computed Tomography in the Neurosurgery Intensive Care Unit in a Level-1 Trauma Center in India
Authors: Chauhan S. , Agarwal D. 
Published: May 2011

BackgroundNeurosurgical patients require frequent Computed Tomographies (CTs) of the head, usually at short notice. A mobile CT may prove to be invaluable for these patients.ObjectivesTo review the usefulness of mobile CT in intensive care unit (ICU).MethodsThis review was carried out over a 14 month period (18 July 2009 till 31 August 2010). Administrative and clinical data were reviewed and analyzed. For the first 6 months, only the number of CT's done was available. However, data were collected prospectively starting 01 Jan 2010 to include variables such as Glasgow Coma Scale (GSC) ventilator status and pressor support at the time of CT scan. The average time to do a CT was 150 minutes (range 60–240 minutes). The mean number of people required for shifting the patient was 4(range 3–6). For, mobile CT the average time to do a CT was 27.4 minutes (range 7.8–47 minutes) and mean for manpower was 3 (range 3–4).ObservationsThe mobile CT was installed and became functional in the neurosurgery ICU on 18 July 2009. A total of 1,752 head CTs were performed during the study period, with an average of 4.8 CTs daily. Detailed prospective data were available (since 01 January 2010) on 1,023 patients. Of these patients, 75.9% (n = 776) were on ventilator, 72.3% (n = 740) were on sedation, and 5.6% (n = 57) were on pressor support at the time of CT. The mean GCS at the time of CT was 8.1 (range 3–15).ConclusionsMobile CT was found to be easy to use, with fast scanning time and excellent image quality. It proves to be beneficial for nurses as it requires less time, energy and manpower. The mobile CT is strongly recommended for any high volume neurosurgery department in the country.
(P1-18) Experience of IMSS Medical Equipment in Rescue Efforts in Haiti
Authors: LorÍa-castellanos J. , Cruz-vega F. , Gomez-zarate E. 
Published: May 2011

Has been a tradition of the Mexican Social Security Institute (IMSS) have a great spirit of solidarity with any type of disaster. That is why the early hours of the earthquake in Haiti was appointed to a group of specialists trained in emergency care who participated in the first acts of rescue and stabilization of multiple victims. The first group of six specialists arrived Port au Prince on January 15 fieldwork being allocated in coordination with the rest of the Mexican aid mission in the sector 8 of the city, preferably at the University of Saint Gerard. Among the actions taken by this group were:
•Application of 300 doses of immunization.•Tracking and signaling a radius of 3 km in search of survivors and bodies.•Working in conjunction with the group of Topos, the Federal Police and the Navy in the initial care, resuscitation and transfer of 9 people rescued from the rubble.•More than 60 dressings and sutures.•Monitoring and maintenance of health of mission personnel.The second group, consisting of specialists in trauma, reconstructive surgery, anesthesiology, surgical and intensive care nurses, was part of a Field Hospital was established in conjunction with the United States at the place called “Killi Point”, involving a network trauma care in which our doctors surgically intervened the hospital ship “Comfort”. Were to a large number of cases of traumatic amputation, children and adults burned, fractures, crushing limbs and carrying large infections for obvious reasons IMSS staff recognizes the professionalism and capacity of the entire Mexican mission of humanitarian aid to Haiti and the opportunity offered to us to help a sister nation, we reiterate that we are engaged, if required again to respond with the same promptly and sense of humanity shown so far.
(P1-40) Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital
Authors: Plani F. 
Published: May 2011

Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital F. Plani1, E Degiannis, P Lingham No disaster training had ever been carried out at the CHBH, the biggest hospital in the world with over 2900 beds and over 5000 staff members. The 2010 Disaster Plan required that all clinical staff undergo the appropriate training. Basic Interprofessional Training for Trauma Disasters 411 staff members attended a half day course during May/June 2010, presented and sponsored by CHBH Trauma Directorate consultants. The aims of the course were to disseminate the trauma disaster plan in interdisciplinary and interprofessional fashion, clarify hospital triage, familiarize staff with Trauma Unit equipment, and practice resuscitations in mass casualty incidents. The course started with presentations on CHBH Disaster Plans and Protocols and Principles of Triage and Standard of Care in Disasters. This was followed by 3 multiple patient scenarios with rotating groups, over a whole hospital floor with: 1) 50 mixed patients outside the hospital; 2) 10 serious patients in the ER; 3) 10 patients deteriorating later in a ward or ICU. Next were individual patient resuscitations, Primary, Secondary, Tertiary Survey and “hand-over”, patient resuscitations in a disaster, using the contents from “Disaster Bags” and questionnaires to assess confidence and suitable treatment areas (Red, Yellow, Green, OT) for allocation in a disaster. The course was wrapped up by a familiarization visit to ED and the colour coded areas.ResultsFinal questionnaires demonstrated that all participants were a lot more confident in the triage of patients and the initial resuscitation using the implements found in the resuscitation room and the “Disaster Bags”. The course has been adopted as part of staff orientation at all professional levels from 2011 onwards, and is in the process to be extended to secondary level hospitals in Gauteng, RSA.
(P1-43) Standardized Full-Scale Exercises using Indicators Related to Patient Outcome: A Method to Increase Knowledge Coping with Aircrafts Incidents
Authors: Rådestad M.E.A. , Nilsson H. , Rüter A. , Castren M. , Svensson L. , Gryth D. 
Published: May 2011

IntroductionDisaster medicine is a young discipline and there is a need for the development of methods for evaluation and research. This includes full-scale disaster exercises that are quite costly. Within each organization these exercises are seldom conducted. If there was a standardized concept on how to conduct as well as evaluate these exercises, this could lead to better knowledge and cost effectiveness. The aim of this study was to increase awareness of the possibility to develop and conduct full-scale exercises in different settings using performance indicators combined with indicators related to patient outcome serving as a basis for comparison and evaluation process.MethodsTwo full-scale exercises in different organizations were studied. Identical panorama with the same number and type of casualties was used. Sets of performance indicators combined with indicators for unfavorable patient outcome, according to the Emergo Train System®, were recorded as well as all transportation times and the patient distribution to selected hospitals. Qualified observers scored the results on predetermined locations; on the scene, hospital and strategic command and control.ResultsThe lowest scored performance indicators were “first report to dispatch”, “second report from scene” and “first patient evacuated”. Due to insufficient response and evacuation times of victims to the receiving hospitals the unfavourable patient outcome, regarding preventable deaths and preventable complications were 28% (n = 18) and 41% (n = 17), respectively.ConclusionsStandardized full-scale exercises where the same type of results is recorded can be conducted. This combination of performance indicators and Emergo Train System® leads to probabilities of development and better command and control response. Future use of the same concept may demonstrate important results that will lead to new and better knowledge that can be applied during real incidents.
(P1-45) Harvard Humanitarian Initiative (HHI) and Federal University of Paraiba (UFP) Joint Emergency Medicine and Disaster Preparedness Training Center A Model for Academic and Clinical Exchange of Expertise
Authors: Morris S.C. 
Published: May 2011

IntroductionEvolving health systems frequently seek guidance with emergency medicine related topics. This has lead to countless international collaboration between organizations attempting to meet this need.BackgroundParaiba, a state of 3.6 million, ranks near the bottom in Brazil for per capita income. The medical establishment has private, public and military systems without emergency medicine training and no disaster plans. HHI and Harvard International Emergency Medicine Fellowship are academic research and service oriented organizations with an emergency medicine and disaster preparedness focus. In 2009 a request for technical assistance was made to HHI from Paraiba, concerning disaster preparedness, clinical emergency medicine and pre-hospital training.MethodsExchange of correspondence surrounding needs and expectations of the partner organizations was conducted until the August 2010. During August a series of meetings was conducted among the civilian, military and federal representatives and a collaborating body was formed under the guidance of UFP consisting of SAMU (prehospital care), the medical school and the five main hospitals of the city. In September HHI staff conducted a series of meetings and assessments in Paraiba. Plan Evaluation, educational and programmatic steps were decided on to be conducted over the several year project. Space and resources for the training center at the UFP was allocated. Establishment of 8–12 teaching modules for practicing physicians and nurses, built and taught by local staff with HHI support will be implemented and become a requirement to work in emergency areas. An assessment of disaster risks and emergency metrics will be conducted concomitantly. Exchange of staff between Brazil and USA will occur throughout the project.ConclusionNo standard model of collaboration exists regarding international emergency medicine and disaster planning but ours demonstrates that exchange of information can evolve to match the abilities and expectations of both parties.
(P1-51) Learning from a Cohort of Emergency Technicians & Doctors in Patient Assessment - A Survey in Secondary Hospital, Ningbo Area, China
Authors: Wang X.W. , Xu J. , Zhou W. 
Published: May 2011

BackgroundPatient assessment (PA) is one of the key points to Emergency Technicians and Doctors (ETD) in Emergency cases. Objective of this study is to investigate the general level of PA skill in ETD in a secondary hospital Ningbo and how ETD practice in different scenarios during PA process.MethodsA retrospective study was carried out by using a questionnaire .33 ETD which includes 3 Emergency Technicians and 30 Emergency Doctors (Male: Female = 2:1) were taken into the study. Thus the analysis of position dependent PA skill variation is difficult to carry out. Mean age of the subject was 28.2 years. Average working experience was 3.91 years.Analysis12% ETD did not carryout scene size-up before approaching victims.The same proportion (12%) of ETD didn't call Police /Fire Agency in risk situations. 1/3 doctors insisted in entering the dangerous spot. Almost 30% doctors ignored bystanders safety when assessing patients.10% doctors did not collect patient history during transferring. Only 30% of the doctors practice complete physical examination, others (70%) were inclined to assess main parts. 84% of the ETD would not carry cervical collar when approaching the injured. During assessment, 69.9% ETD neglected patient's medical tag. 94.1% ETD accepted Emergency Training with only once or twice a year.ConclusionAwareness on safety of scene and self protection is weak in ETD in PA. Less doctors examine patient completely. Most of ETD does not look for medical tag which is considered an important element in PA although it is not prevailed yet in Ningbo. No significant differences are perceived upon the gender of the worker. Systematic education programs and ongoing trainings with identified shortcomings in patient assessment skill of ETD in Secondary hospitals in Nigbo area are highly recommended.
(P1-59) Atom Course in Japan
Authors: Nagata T. , Hashizume M. , Lefore A. 
Published: May 2011

IntroductionTrauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.MethodsThe ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.ResultsParticipants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value < 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value < 0.001), with all groups reaching statistical significance.DiscussionThis course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.
(P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study
Authors: Hsu C. 
Published: May 2011

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper managementof difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.
(P1-66) Operating a Field Hospital after the Earthquake at Haiti - The Israeli Experience
Authors: Bader T. , Kreiss Y. 
Published: May 2011

IntroductionOn January 12th 2010 an earthquake of 7.0 magnitude struck Haiti. The region suffered an estimated 230,000 fatalities with approximately 250,000 injured and more than one million people who lost their houses. The government of Israel dispatched a military task force consisting of 230 people. 121 of them were medical personnel from the IDF Medical Corps. The force's primary mission was to establish a field hospital in Haiti and to give medical support to as many people as possible. We left Israel about 50 hours after the Earthquake and the field hospital started operating at Porte-Au-Prince 89 hours after the earthquake.Materials and MethodsDuring our 10 days of operating, 1111 patients were treated at our hospital. 363 of them were pediatric patients (younger than 18 years). 272 pediatric patients were treated by the pediatric division, 79 (29%) were hospitalized and 57 (21%) required surgery.ResultsThere were 16 deliveries, 5 Neonates, 244 Operations and 17 Intra-hospital deaths. We noticed a change of pattern of the hospital activity, regarding the cause of the admission after the sixth day. On the ninth day most of the patients who came to our hospital were due to a non-traumatic cause. At the pediatric department, the common treatments included wound debridement and dressing, I.V. rehydration and antibiotic treatment, and a neonatal unit, the sole one in the inflicted area. Operations when needed were done by the orthopedic team and the pediatric surgeon.ConclusionsOperating a field hospital for a population inflicted by natural disaster is a complex mission and since pediatric care has its own unique, challenging characteristics, operating a pediatric division in such a field hospital is a continuous challenge, which includes preparedness in uncertainty and the necessity to have dynamic treatment strategy according to the unique circumstances.
(P1-67) Collaboration of Military and Civil EMS during Russian Georgian War 2008
Authors: Chikhradze K. , Kereselidze T. , Zhorzholiani T. , Oshkhereli D. , Utiashvili Z. , Jibladze C. , Canava G. , Tevzadze N. 
Published: May 2011

IntroductionDuring 2008 Russian Federation realized major aggression against its direct neighbor, the sovereign republic of Georgia. It was Russia's attempt to crown its long time aggressive politics by force, using military forces. EMS physicians from Tbilisi went to the Gori district on August 8 at first light, 14 brigades were sent. At noontime of August 8, their number was increased up to 40. 6 brigades of disaster medicine experts joined them as well.ResultsDestination site for the beginning was the village Tkviavi, where a military field hospital was assembled and a Military Hospital in Gori. Later 6 brigades were withdrawn towards the village Avnevi. During fighting, wounded victims were evacuated from the battlefield, where initial triage was done. Evacuated victims were brought to the military hospital where the medical triage, emergency medical care and transportation to Gori military hospital or to Tbilisi hospitals was done. A portion of the wounded was directly taken to Gori military hospital and later to different civil hospitals in Tbilisi. Corpses were transported to Gori morgue as well. On August 9, the emergency care brigades and field hospital left Tkviavi and moved to the village Karaleti, then to Gori. On August 12, the occupied territory was totally evacuated by civil and military medical personnel. Although withdrawal of wounded was done on following days. Up to 2232 military and civil persons were assisted by EMS brigades during war period (8–12 August), from them 721 patients were transported among which 120 were severely injured.ConclusionClose collaboration between military and civil EMS gave the system opportunity to work in an organized manner. On the battlefield prepared military rescuers were active taking out wounded victims to the field or front-line hospitals from which civil emergency care brigades transported them to Tbilisi hospitals. Only 3 fatalities occurred during transportation.