bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A22) Promoting Emergency Preparedness of Local Municipalities for Disasters – Lessons Learned
Authors: Ringel R. , Laor D. , Ohana A. , Adini B. 
Published: May 2011

BackgroundInvolvement of local municipalities in promoting emergency preparedness has been recognized as a key factor to build a resilient community. As part of the efforts to build and maintain knowledge and capabilities, the Israeli Ministry of Health initiated a series of conferences aimed at capacity building of city councils to provide services to the population following disasters.Methods6 conferences have been planned for the years 2010-2011 in which 250 senior administrative employees from all municipalities, responsible for the health status in their communities are expected to participate. Each conference covers a variety of emergency scenarios, including biological events, regional hostilities and management of massive Acute Stress Reactions among the civilian population. Pre-post tests based on Multiple Choice Questions are conducted before and following each conference to identify impact of the training program.ResultsFindings from the pre-post tests conducted up to date showed a significant increase in all elements included in the training program. The average knowledge scores of the pre-post tests were 33% and 79% respectively. The highest increases in level of knowledge were found in regard to deployment of community centers for light casualties in chemical warfare scenarios (48% and 100% respectively) and concerning population that requires evacuation during emergencies (68% to 100% respectively). Overall levels of knowledge regarding community treatment centers in biological events were relatively low both before and after the training (16% and 44% respectively).DiscussionTraining local municipalities' personnel is crucial in order to promote emergency preparedness. Raising knowledge regarding response to newly emerging threats (such as deployment of exposure centers in biological events) was found to be more complex in comparison to well-recognized hazards (such as deployment of community treatment centers in chemical warfare). There is a need to conduct follow-up studies to determine the retention of knowledge over time.
(A27) Traumatic Wound Management by Bystanders – Myths
Authors: Raju V. 
Published: May 2011

ObjectiveTo receive trauma victims from site of incidence to the emergency department without mauling with adjuvant by first aid managers.MaterialPoor dressing techniques practiced for first aid in industrial, domestic, traffic, calamity, etc. inflicted wounds. Dressing with copious amounts of cotton on traumatized parts that are open or exposed. Wrong wrapping, storage, transport of amputated parts for attempt of salvage / reimplantation.MethodsAssessment of increased rate in sepsis and rise in rate of risk of complications or loss of traumatized body part or even life in cases of trauma in which primary / incident manager with poor awareness / skills, shortage of first aid material.DiscussionNeed of training of general public on skills of first aid. Maintaining First Aid Kits for Emergencies as per stipulation and need based.ObservationImproved results in management of trauma that were properly attended to from time of incidence to casualty.ResultsImproved ratio of post traumatic sequel like sepsis, delayed amputations, revisions, graft rejections, co morbidities, expenditure, etc.
(A31) Integrating Health Volunteers into Community-Based Disaster Risk Reduction
Authors: Keim M. 
Published: May 2011

BackgroundDisaster risk reduction (DRR) has emerged as a core element of sustainable development. (UN/ISDR 2002). Reducing risk requires long-term engagement (O'Brien 2006), and the actual work of DRR is largely a task for local communities. (Schipper 2006). DRR shares some tenets with preventive medicine (Sidel 1992). As in preventive medicine, risk reduction calls for a basic attitude shift in the minds of many who traditionally get sick first and seek treatment later. The challenge for DRR, as applied to health, is to broaden the focus of disaster management from that of tertiary prevention, (response and recovery) to also emphasize primary and secondary prevention, (prevention, preparedness and mitigation).DiscussionThe role of the health sector spans across the spectrum of DRR to include prevention, mitigation and preparedness activities. DRR, as applied to health, is intended to prevent and/or reduce the negative health consequences of disaster hazards. This is accomplished by two means: hazard avoidance and vulnerability reduction. Health and medical volunteers at the community level can play an important role in reducing human vulnerability to disasters by: (1) reducing susceptibility – “healthy people” (2) reducing exposure to disaster hazards – “healthy homes; (Srinivasan et al. 2003); and (3) increasing resilience – “healthy communities”. Volunteers help to reduce exposures to disaster hazards through participation in population protection measures such as shelter-in-place, evacuation and mass care. They work to reduce susceptibility by participating in health care, health promotion, and immunization programs. Finally, volunteers may build resilience by way of their participation in community-level preparedness, response and recovery efforts. (Keim 2008)
(A69) Epidemiological Study of Trauma in Pregnancy: An Emergency Department-Based Study of a Level-1 Trauma Center
Authors: Sharma G. , Bhoi S. , Gautam P. , Adhikari G. , Sinha D.T. , Manral P. , Rodha M. 
Published: May 2011

BackgroundTrauma during pregnancy poses a challenge in assessment and management due to its unique anatomical and physiological changes. Trauma is the leading non-obstetrical cause of death. There is paucity of epidemiological data in this subgroup in India. An emergency department (ED)-based epidemiological study was conducted.MethodsFemale trauma victims of reproductive age with both positive and negative urinary pregnancy tests (UPTs) were selected retrospectively. Documentation was done by the nursing staff from the ED case records. Mode, mechanism, severity, site of injury, and ED disposal time were noted, compiled, and analyzed.ResultsOf 64 patients, 32 patients were UPT-positive and 32 were UPT-negative. The mean age was 26 (range 18–36) years. A total of 75% of UPT-positive and 59.3% of UPT-negative cases had assault due to domestic violence. As per START triage protocol, 84.3% of UPT-positive and 59.3% patients in UPT negative were triaged as yellow. Blunt trauma to the abdomen was the most common mechanism and site of injury in all patients. FAST and ultrasonic evaluation of the fetus was performed for all UPT-positive patients. The average ED disposal time was 2 hours 62 minutes in UPT-positive and 1.9 hours in UPT-negative.ConclusionsLimited data suggest domestic violence as leading cause of trauma in pregnancy. A large, epidemiological study is required to validate this.
(A72) Efficacy of Parental Opioid Analgesics versus Non-Opioid Analgesic in Acute Pain Management of Trauma Victims in the Emergency Department
Authors: Adhikari G. , Bhoi S. , Gautam P. , Sinha T.P. , Rodha M. , Kurrey L. , Bhasin A. 
Published: May 2011

BackgroundThe pyramid of pain management involves sequential drug escalation but its role is limited in an emergency department (ED). The efficacy of parental opioid analgesics versus non-opioid analgesic in acute pain management of trauma victims in the ED was evaluated to formulate protocol.MethodsAll alert patients with a baseline visual analogue scale score (≥ 7) was randomly assigned either parental non-opioid (Group A) or opioid analgesics (Group B). The emergency care providers noted the VAS in either group at 15 minutes, 30 minutes, and 60 minutes, and at the time of discharge from the ED. If the patient's VAS score did not reduce by 50% at 30 minutes, repeat parental analgesics was given. The oral analgesics prescribed at the time of discharge were documented. Ethical clearance was taken. Data was compiled and analyzed.ResultsOf 106 patients, 99 were analyzed. The mean age in Group A was 33.2 ± 13.2 years and 32.5 ± 18 years in Group B. The male:female ratio in Group A was 1.5:1 and 7:1 in Group B. The average baseline VAS score in Group A was 7.5, and that of Group B was 8.96. The average VAS at 15, 30, and 60 minutes and at discharge in Group A was 5.4, 5.34, 4.3, and 3.5 and it was 6.1, 6, 5.1, and 4.4. Repeat parental dose of analgesics were required in 95/99 (95%) patients in Group A and 5% that of Group B. The most common prescription at discharge from ED was non-opioid analgesics.ConclusionsAcute pain relief was comparable in both groups. Non-opioid analgesics may be preferred over opioid in VAS score ± 7 in a busy emergency department for early disposition.
(A74) Reducing the Potential for Tourniquet Associated Reperfusion Injury
Authors: Van Der Velde J. , Iohom G. , Serfontein L. 
Published: May 2011

BackgroundTourniquets have reappeared in the management of massive hemorrhage and as a tool to ameliorate the effects of reperfusion injury from limb entrapment or suspension trauma, while the patient is rescued to a safer environment. Strategies to minimize subsequent reperfusion injury were investigated in this prospective, randomized study.MethodsIn the safety of an operating theater, sixteen fit and healthy patients scheduled for repair of bimalleolar ankle fractures were randomized into two groups. In the standard release group (R, n1 = 6), the tourniquet was fully deflated at the end of surgery. In the staggered release group (SR, n2 = 10), the tourniquet was fully deflated for 30 seconds and subsequently re-inflated to 300mmHg. The procedure was repeated twice at three-minute intervals prior to full removal. Hemodynamic and blood biochemistry measurements were obtained from an indwelling arterial catheter immediately prior to initial tourniquet deflation and thereafter at 1, 4, 7 and 15 minutes.ResultsSerum Ca2 + concentrations were less in group R at 4 (1.027 ± 0.5 vs. 1.084 ± 0.07mmol/l, p = 0.046) and 7 minutes (1.045 ± 0.04 vs. 1.110 + /- 0.06mmol/l, p = 0.013). Serum lactate concentration was greater in group R compared to group SR at 1 (1.75 ± 0.19 vs. 1.33 ± 0.31mmol/l, p = 0.005) and 4 minutes (1.98 ± 0.23 vs. 1.48 ± 0.39mmol/l, p = 0.007), respectively. End-tidal CO2 was less in group SR compared to group R at 1 (4.82 ± 0.45 vs. 5.68 ± 0.26kPa, p = 0.0004) and 4 minutes (5.01 ± 0.59 vs. 5.68 ± 0.35kPa, p = 0.01), respectively. At 15 minutes, less hypotension and bradycardia was noted in group SR.ConclusionsA staggered tourniquet release was associated with greater hemodynamic stability and reduced the rate of acute systemic metabolic changes associated with limb reperfusion. Re-application of a tourniquet seemed to halt further reperfusion, providing a window period for patient evaluation and management.
(A77) Should Response Times continue to be used for Performance Measurement and Targets?
Authors: Turner J. 
Published: May 2011

PurposeResponse time performance for emergency calls has been used as an indicator of ambulance service quality in England since 1974. It was revised in 1996 with targets set of eight minutes for life-threatening (category A) and 19 minutes for urgent (category B) calls. Internationally, response time has been used as the benchmark for emergency medical services (EMS) performance. The evidence to support use of response times as a quality measure has been examined.MethodsA rapid review was used to assess the evidence base for the eight minute response time target. Also, a descriptive observational study of the clinical characteristics of category B calls was performed using two months patient report form data from one English ambulance service.ResultsFive papers were identified that have examined the relationship between response time and mortality for 911/999 emergency call populations. Four papers were from the USA, and in all cases no survival benefit was found for response times > 5 minutes even after adjustment for variables including age, sex and illness severity. This finding was replicated in one UK study. The descriptive study examined call characteristics for 26,882 category B calls. Half of the patients received no intervention other than basic vital signs measurement and 75% had assessment only. Twenty-five percent required some clinical intervention with the majority only requiring oxygen. Less than 5% received significant intervention such as drugs, intravenous cannula, or airway management.ConclusionsWith the exception of cardiac arrest there is consistent evidence that response time has no impact on mortality for EMS calls. Alternative indicators of quality of care should be developed that allow less focus on time targets and more effort on innovation and development of services which could better meet the needs of the majority of patients who do not have a life-threatening problem.
(A81) Curing Overcrowding and Boosting Patient Flow in a High Volume, Low Capacity Emergency Department
Authors: Arnold J. , Ferguson I.G. , Montefusco A. , Nguyen C. 
Published: May 2011

BackgroundOvercrowding afflicts emergency departments (ED) worldwide. The CDC has reported that EDs in the metropolitan US provide 1 bed per 1800 patient visits per year on average.ObjectiveWe sought to improve patient flow in our 24-bed ED at Santa Clara Valley Medical Center, a large tertiary public hospital in San Jose, California.MethodsWe applied a bundle of interventions based on Lean principles aimed at improving overcrowding in our department step-wise from October 2006 to December 2010, ranging from rapid medical evaluation to physician on arrival. We measured patient volume, left without being seen (LWBS) rates, time to provider (minutes), and time to discharge (minutes) as monthly averages. We secondarily measured CMS core measure performance for pneumonia and STEMI care and patient satisfaction scores.ResultsOur emergency patient volume doubled from an average of 192 to 412 per day (peak). Our LWBS rate decreased from 16.0 to 1.4%. Our time to provider decreased from 86 to 32 minutes. Our time to discharge decreased from 210 to 145 minutes. Core measure performance improved to 100% for all five ED-related metrics. The percentage of patients who ranked their care as excellent increased from 30% to 45%.ConclusionThe bundle of interventions based on Lean principles applied in our ED appears to have enabled us to significantly improve multiple operational outcomes, despite a doubling of our patient volume in our low capacity ED. Posting a physician on arrival, as the first healthcare worker that a patient meets when they enter the ED, may have had the greatest impact on operational performance.
(A85) Analysis of Health Risk Perception and Behavior Changes during Elevated Temperatures for an Urban Chinese Population
Authors: Chan E.Y.Y. , Kim J.H. , Lee P.P.Y. , Lin C.L.Y. 
Published: May 2011

BackgroundLimited research has been conducted to understand the relationship between heat wave warnings with public awareness and behavioral changes in the Asian population. The Hong Kong Observatory introduced the “very hot weather warning” in 2000 to alert the public of heatstroke and sunburn in Hong Kong. However, the population's behavioral responses to these weather alerts is unclear. Moreover, the relationship between perceived health risks and behavioral changes has not been examined. The goal of this study is to examine the health risk perceptions and behavioral changes following public heat wave warnings in Hong Kong.MethodsA cross-sectional, population-based, telephone survey, using the last-birthday method was conducted within two weeks following a heat wave warning in 2009. A heat warning and a health study instrument, based on Intergovernmental Panel on Climate Change (IPCC) guidelines and related literature was developed and validated. Descriptive and multivariate logistic regression analyses were conducted.ResultsThe questionnaire was completed by 1,123 individuals whose socio-demographic characteristics were comparable to 2009 Hong Kong population census data. Of respondents, 83.6% were aware of the heat wave weather warning. Multivariate logistic regression of socio-demographic factors indicated that being female, those in middle age groups, and those with higher educational attainment was significantly associated with heat wave warning awareness. Among those aware of the public warning, the majority were unconcerned about potential adverse health effects, < 40% were aware of the community heat-related preparedness plans, and < 50% changed their behavior to mitigate the potential adverse health impacts of hot weather.ConclusionThis is the first study to examine climate change and health behavioral responses in an urban Chinese population. Future research direction should further investigate correlations between awareness and health protective actions, as well as the drivers for health behavioral changes that mitigate the impact of climate change.
(A86) Emergency Department Patient Presentations during the 2009 Heatwave in Adelaide
Authors: Mayner L. , Arbon P. 
Published: May 2011

BackgroundRecordings of heatwaves date back to the early 1900s and usually are associated with high mortality. In Australia, heatwaves have been the major cause of natural hazard-related deaths. Heatwaves usually do not carry the global media coverage associated with other disasters, and frequently, are referred to as silent disasters. The main impact of heatwaves is on health and human life.ObjectivesPreliminary results are presented for the 2009 heatwave, investigating the emergency department patient presentations from three public hospitals in Adelaide, a city in the central southern area of Australia.MethodsDemographic and syndromic data were obtained from emergency department records. Ethics permission was obtained prior to data collection. Heatwave conditions occurred from 26 January–07 February 2009. Two non-heatwave periods were day-matched approximately two weeks before and after the heatwave. Data were analyzed by age groups, gender, and ICD codes for chronic conditions.ResultsThe two largest groups of people presenting were between 15 and 64 years of age and > 75 years of age during the heatwave and non-heatwave periods. During the heatwave period, both groups had significant increases in patient presentation related to renal problems (ICD 10: N000-N3999) and dehydration and hyperthermia (ICD10: E86, T67). The latter syndrome was far more accentuated during the heatwave, with emergency department patient presentations rising from 2 (non heatwave) to 62 presentations for the 15 and 64 years cohort and from 4 (non heatwave) to 91 for the > 75 years cohort. Cardiovascular- and respiratory-related presentations showed slight increases during the heatwave, while mental health had high presentations for the 15–64 year cohort throughout heatwave and non heatwave periods.ConclusionsBoth young and older people were affected by heatwave, and precautionary warning should be used throughout the community to alert people of the dangers underlying extreme heat conditions.
(A80) Second Thoughts about the Health System and Dilemmas in Wide Disasters, Using Haiti as a Case Study
Authors: Peleg K. 
Published: May 2011

In the Indonesian earthquake a total 21 USAR teams comprising upward of 688 rescue personnel and 67 dogs. The cost of which was estimated at tens of millions of dollars did not succeed in extricating any trappers. In Haiti, there were around 350000 casualties and 250000 dead. In this disaster 43 international USAR missions comprising over 1700 rescuers were deployed. These teams succeeded in rescuing approximately 134 trapped people, an average of about 3 trapped people per mission. During this period one field hospital treated a total of 1,111 people, 737 of these patients were hospitalized, 243 surgical procedures were carried out, of which at least 200 were life-saving procedures. In addition many other life-saving procedures that were not directly related to the injuries inflicted as a result of the earthquake were also carried out. Without the resources of the field hospital it is very possible that most of the trappers would not have survived. It mean; One field hospital (personal: 120 people) was able to save more people than 43 USAR teams, all of the highly dedicated and professional, who worked day and night to extricate people trapped.ngs. It seems that there is no need to carry out a complex economic analysis in order to determine the cost benefits and understand the significance of providing field hospitals and clinics as soon as possible after the occurrence of a disaster stemming from an earthquake. A consensus/brainstorming conference is needed.The aimTo formulate a logical and balanced approach to configuring and dispatching rescue and medical missions. The major goal of the conference would be to establish the guidelines for rescue missions that will result in the rescue of the maximum number of people, and to provide guidelines for the provision humanitarian aid in parallel to the rescue missions.
(A99) Remote Access and Extrication, the Haiti Experience
Authors: Paladino L. , Lucchesi M. 
Published: May 2011

IntroductionThe January 12 2010 7.0 magnitude earthquake's epicenter hit just 10 miles west of Port-au-Prince and its 2 million inhabitants at 4:53 pm. Estimates of dead 222,517 at the time of writing, with thousands missing and hundreds of thousands living in tent cities. Haiti is the poorest country in the Western Hemisphere with approximately 80% of the population living under the poverty line. There is a lack of seismic risk perception and planning at the national level. As a result in many areas there are no, or poorly followed, road, highway or bridge building codes.NeedAlthough assistance arrived to major ports and cities from all corners of the globe, access from rural and remote areas to centralized hospitals remained difficult. Our group, a mobile medical team able to negotiate difficult terrain by foot with vehicle support in close proximity, deployed to these remote areas. EMS systems were poor in rural areas prior to the earthquake and now are nonexistent, in areas where no access to phones or even addresses (tent cities) to respond to. We found many injured without access to transportation even a month after the earthquake. No family or friends had access to vehicles to transport them. Many knew help was available, but did not know where or how to access. They waited in situ for help not knowing if it was coming. Limb threatening injuries were left to get necrotic and infected, no doubt adding to the morbidity and mortality. Our groups identified patients requiring transport and arranged for drivers, many times using paid locals from cities.Call for future actionImplementation of a disaster plan for International NGOs to provide organized EMS transport for remote victims without access. Coordination with local community leaders and OCHA to identify areas in need of this service.