bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children
Authors: Reilly M. 
Published: May 2011

IntroductionRecent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.MethodsA nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.ResultsVery few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.ConclusionsOut study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.
(A252) Impact of Protracted, Intrastate Conflict on Population Health in Manipur, India
Authors: Kaushik V. , Nair S. , Tanwar Y. , Sinha S. , Roy N. 
Published: May 2011

IntroductionManipur is a state in northeastern India and in civil war for > 45 years. Healthcare delivery and access is affected due to poor security, restricted accessibility, and the incapacity of this fragile state.MethodsThe burden of morbidity and mortality in the conflict area of Manipur was estimated using data sources (hospital attendance, hospital inpatient, and death registries, national family and health registries, and in-depth interviews of healthcare providers) and compared to national averages. These findings were co-related with violent events reported in the local newspaper.ResultsExcess mortality was observed in the 21–50 year age group, but not in females or the elderly. The major causes of deaths were non-communicable diseases, cerebrovascular accidents, and chronic pulmonary disease. Chronic conflict increased the burden of alcohol liver disease and of mental health diseases. Suicidal deaths were common in the mid-twenty age group and usually due to agricultural pesticide consumption. These deaths were higher in men, and suicide attempts were higher in women. The prevalence of intravenous drug users and of HIV was reported to be five times as higher than the national average. High rates of disappearances, mutilation, torture, kidnapping, and hostage-taking, spousal physical violence and attacks on healthcare facilities and medical personnel were events of concern. There were no reported events of suicide bombers.ConclusionsProtracted conflict dramatically changes the demographics and disease burden. Humanitarian space constantly is under threat of attack and the insecurity interferes with the provision of sustained preventive and curative services. Recommendations to be implemented would measures to continue treatment in the insecure environment through telephonic or online medical helplines, vaccination, and drug supplies during negotiated ceasefires or curfew times and protecting humanitarian spaces. However, militarization of healthcare may not be favorable solution.
(A273) Mass Gatherings and the Application of the New International Risk Management Standard ISO3100
Authors: Hills M.W. 
Published: May 2011

BackgroundEarly involvement by health services in the planning, preparation, operations and post-event analysis of mass gatherings provides one of the best opportunities to engage with other agencies and to develop a real sense of your agency's capabilities. The establishment of the new ISO Standards on Risk Management provide the best opportunity in a decade to structure this work in a manner that will develop true capacity to manage the multitude of risks health services face this century.DiscussionRather than ad hoc and sometimes conflicting approaches we now have the “lingua franca” on which to build our policy, capacity development, budgets and response. The evolution of risk management standards has seen the release of ISO 31000: 2009, Risk management - Principles and guidelines and ISO 31010: 2009, Risk management – Risk assessment techniques. Largely based on the earlier Australian Standard 4360 and work of the IEC these standards have the potential to embed critical aspects of the responsibilities of health agencies worldwide into a universal singular policy framework. Translating this into other areas of health agencies work includes communicable disease management and emergency management, in general, which will allow other agencies to understand the “health” perspective and vice versa.ConclusionsDrawing on personal experiences from mass gatherings since 1997, the author will demonstrate the utility of the ISO Standards as the framework for health emergency management including mass gatherings. Examples will include mass gatherings at the international level within the Asia- Pacific Region to the local level within Sydney, Australia from 1997 to 2010.
(A276) Young People at Mass Gathering Events: Data Collection Tools and Findings
Authors: Hutton A. 
Published: May 2011

BackgroundDuring the summer months in Australia, school leavers celebrate their end of school life at Schoolies festivals around the nation. These events are typically described as a mass gathering as they are an organised event taking place within a defined space, which is attended by a large number of people.Discussion and ObservationsTwo research projects were undertaken to understand the Schoolies phenomenon. The first project was to understand the event as a mass gathering. The second to determine what was important to stay safe and healthy at this event from a young person's perspective. To understand the Schoolies event as a mass gathering Arbons conceptual framework was used which considers the psychosocial, environmental and biomedical aspects of the event. This study found that the crowd mood of the Schoolies were expressive, social and participatory. The environment was bounded, ticketed and dry. The bio-medical data showed a high patient presentation rate when compared to the Australian average. However most of the presentations were minor. What was of concern to the researchers were the high level of risky drinking that took part a this event. The second study used postcards to understand what young people perceived to be important to their health and safety whilst at Schoolies. 3 lead questions were used, and 9 items placed underneath each question to be ranked by participants. Data collected showed that exposure to illicit drugs and violent behaviour where of concern to them. The results from these studies highlights the need to re focus the Schoolies event to be inclusive of strategies that not only support young people to party safely, such as dry zones, but to support young people to feel safe from exposure to drugs, and to violence (physical and sexual) that can occur for many reasons.
(A278) Providing Medical Coverage for an Unfamiliar Sport Event: Tent-Pegging and the 2nd Asian Beach Games
Authors: Al-Qusimy H.N. 
Published: May 2011

BackgroundThe addition of Tent-pegging to the 2nd Asian Beach games as one of its 14 Competition events was a welcomed step, especially to the equestrian community of the games' host country, Oman. An equestrian sport of ancient military origin with a long history in Asia, Tent-pegging It a fast-paced sport in which a lance or sword is used to pick pegs off the ground while riding a horse at full gallop. The sport is gaining popularity especially in a number of countries around the world, including Oman.Discussion and ObservationsThe hazards inherent in equestrian sports and specifically in Tent –pegging, furthermore, the mass gathering created by the equine presence, the participants, as well as the spectators, required a well planned medical coverage to safely conduct the games. Taking into account that Tent-pegging events normally receive limited medical support, the presentation will discuss the concepts and methods that are commonly followed by the host country on planning and implementing the medical care to sport events of Olympic standards, along with an illustration on how exclusively these concepts were applied to the Tent -pegging events during the 2nd Asian Beach Games. In addition, the presentation will elaborate on the challenges that were dealt with by the medical care providers, and the outcome following a 1st major sporting event of such a scale to be conducted by the host country, Oman. As more countries bid to host major sport events for their first time, suggestion for improving the methodology of providing medical coverage to a sport event will be discussed in the presentation.
(A279) Evidence-Based Decision-Making in Triage
Authors: Mirhaghi A. , Sajjadi M. , Golafshani A. 
Published: May 2011

Background and AimsDecision-making is the major component in triaging emergency department patients. Influencing factors on decision-making have been identified but it`s not clear how much of the decision is based upon scientific criteria. The objective of this study was to determine frequency of using reliable and valid guidelines by nurses in emergency departments.MethodsIt was a descriptive survey study. The questionnaire was composed of demographic data, evidence-based triage questions (15) and triage decision-making questions (10). The questionnaire reliability was 0.87 using the test-retest method. Content validity was considered based upon Canadian Triage and Acuity Scale.Results70 nurses from 10 emergency departments participated. 40 % of nurses` responses to evidence-based questions was correct. The percentage of inter-rater agreement between nurses was moderate (0.56) related to decision-making questions. No valid and reliable guideline was utilized in emergency departments.ConclusionNurses` decision-making was poorly based on evidence-based criteria. Low level of nurses` knowledge about triage may be derived from lack of official and specialized triage training courses. Academic triage courses establishment and development of national triage scale are recommended.
(A282) Comparison of Safety Index in Iranian Hospitals
Authors: Djalali A. , Massumi A. , Öhlen G. , Castren M. , Kurland L. 
Published: May 2011

IntroductionHospitals are highly complex facilities that play a key role in the medical response to disasters. However, they are susceptible to the impact of disasters with respect to their structural, non-structural and functional elements. Many hospitals have collapsed or been damaged and rendered nonfunctional as a consequence of disasters. The resilience of a hospital along with the capability of effective medical response to disasters is a key part of a community based disaster plan.ObjectiveThe objective of this study was to evaluate and compare hospitals in Iran with respect to safety.MethodsThis study was performed as a survey in four hospitals in Iran. The Hospital Safety Index package from WHO was used as an evaluation tool. The evaluation team consisted of: a PhD in structural engineering, an architect with a Master's degree, a specialist in electrical and mechanical maintenance, a medical doctor, a specialist in disaster management, and an expert in health care planning. The hospitals were evaluated in three elements; structural, non-structural, and organizational. The hospital safety calculator was used.ResultsThe most important hazard for these hospitals was earthquakes. The structural safety at three hospitals was inadequate or at risk; and consequently needs intervention in a near future. Also, the administrative and organizational element of these hospitals was inadequate or at risk. All hospitals need intervention in the near future due to non-structural safety being inadequate. The overall safety index at one hospital was A (functional); in two hospitals B (at risk); and in one hospital C (inadequate).ConclusionsThe Iranian hospitals which had been assessed were on the whole unsafe. Also, these hospitals do not have a disaster management plan. Implementing a comprehensive disaster plan, including mitigation and a preparedness plan, would most likely enhance the safety of these hospitals.
(A278) Preliminary Successes and Challenges in the Creation of an Emergency Medical Care Training Program in the Wake of the 2010 Earthquake
Authors: Sacks E. , Mastroianni M. , Hanselman K. , Cange V. 
Published: May 2011

BackgroundThe earthquake in January 2010 killed more than 250,000 Haitians and caused traumatic injury to tens of thousands of survivors. In the aftermath of the earthquake, Haitian civilians assisted in various medical roles. Many of the civilians requested training, and 8 months after the earthquake, a team of American clinicians, EMTs and health educators returned to Haiti to teach a course in basic lifesaving and emergency care.MethodsUsing a modified French-language EMS training curriculum, 60 community members with no previous medical experience were trained during an intense 2-month period. Trainings were held to teach basic lifesaving and stabilization skills. The Gwoup Ayisyen pou Ijans was formed and is preparing to take the French-language EMS exam. A follow-up study is being conducted to assess the capabilities of the students.DiscussionPreliminary challenges included securing safe places for training and teaching in both French and Kreyol. Successes were the willingness of trainers to volunteer time and equipment, and the high motivation of the students, despite the inability of the government to promise consistent work for an EMT force.
(A312) Evaluation of a Continuing Education Intervention to Improve Management of Mass-Casualty Incidents
Authors: Jaffe E. 
Published: May 2011

IntroductionEmergency medical services (EMS) personnel must continuously educate themselves on mass-casualty management. Emergency medical services personnel in Israel are provided with continuing education programs aimed at maintaining knowledge and skills to manage different types of mass-casualty incidents (MCIs). There are 11 Magen David Adom (MDA) regions that have different incidences and experience with MCIs.ObjectiveThe purpose of this study was to evaluate the effectiveness of an intervention for the management of conventional and mega MCIs.MethodsA 17-item, multiple choice question pre-test (n = 640) and post-test (n = 536) were administered after a brief continuing education intervention based on lectures and discussion in all 11 EMS regions. The MCI and mega MCI scores were combined to provide an overall MCI score. An independent t-test and ANOVA were used to examine for differences by age, seniority, role, and area of employment of EMS personnel. (p = 0.05)ResultsReliability of the pre- and post-tests was 0.70. The overall mean score and standard deviation for the pre- and post-test was 64.31% Â ± 14.2% and 75.0% Â ± 14.0%) respectively (p = 0.000). Distribution of scores on the pre- and post-tests were: 80%, 11.8% pre-test, 42.7% post-test. No significant differences were found in pre-/post-test scores by area. Older personnel (> 50 years of age), and those who had been working in EMS for longer periods were found to have significantly lower scores (p = 0.05). Overall scores of paramedics was significantly higher than driver/medics. (p = 0.05).ConclusionsBoth pre- and post-tests were reliable. Post-test scores improved significantly after the intervention. Age and seniority are factors that must be considered when developing continuing education interventions. Possibility should be given to implementing role specific continuing education interventions. Attrition of knowledge must be investigated.
(A313) Integrating Paramedics into the Health System — Israel as a Case Study
Authors: Wacht O. , Dopelt K. , Davidovitch N. , Schwartz D. , Goldberg A. 
Published: May 2011

BackgroundSince its development in the 1970s, the paramedic profession has tried to expend its traditional role of providing prehospital emergency care in ambulances into new fields of practice (e.g. community care). Paramedics in Israel are employed almost exclusively in the emergency medical services (EMS). Similar to other countries, the manpower shortage in the Israeli health system forced policy-makers to consider the expansion of traditional roles of various healthcare professions including paramedics.ObjectivesThis presentation seeks to: (1) map the current situation and challenges facing paramedics in Israel; (2) examine paramedics' professional status among policy-makers; and (3) examine the best way to integrate paramedics in the Israeli health-system.MethodsQualitative interviews were conducted with 20 senior policy-makers in the Israeli EMS system, Academia, Health Ministry, and military. A policy analysis of documents, laws, regulations, and public media was conducted.ResultsThe Ministry of Health in Israel did not play a significant role in the regulation of the profession. Nevertheless, according to the interviewees, paramedics have gained considerable professional recognition among policy-makers, healthcare professionals, and the general public. Following the medical manpower crisis that is evolving in Israel, and the trends that are common in many western countries of expanding the traditional roles of allied health professions, most policy-makers in Israel see the paramedic role evolving into new field of practice. According to policy-makers, legislators, and EMS officials, the major challenges that the paramedic profession faces deal with legislative and professional (mainly academization) issues.ConclusionsThe paramedic profession must adapt itself to the new medical environment. More research should be conducted to build a model, adapted for different local national context, to expand the traditional role of paramedics. This will influence training, research and policy-making regarding the paramedic profession, and will change the traditional professional medical borders.
(A331) Simulation of Mobile Hospital Team for Mass Gathering and Mass Casualty in Iraq: Korean Experience
Authors: Wang S.J. 
Published: May 2011

IntroductionFrom 2007, it is decided officially to provide and support mobile hospital team for Iraqi people to enhance access to quality healthcare not only for primary healthcare but also for religious mass gathering and mass casualty situation. Multiple special vehicles were donated to two provincial governments in Iraq and Iraqui experts were invited to Korea for mobile hospital team training including field simulation.MethodsThe simulation was based on computer aided initially, and table top simulation was done and real field drills were performed twice. This process was performed for 2 years to different teams from different province in Iraq. The arrangement of mobile hospital vehicles differed between the first and second year field simulation for finding more efficient arrangement. All the table top simulation and real field drills were recorded by writing and camcoders, after the simulations the video was analyzed and discussed with experts and participants.ResultsTable top simulation has highest number of right decisions in individual simulation situation. The second field drill has more right decisions than the first field drill. The second year field simulation has less duration of drill, highest number of right decisions, and was more comfortable to trainees.ConclusionsThe necessity of mobile hospital team is increasing especially in some region and situation, however, the effort is not enough to seek the appropriate preparedness and method of operation academically. Specific knowledge and guideline for mobile hospital will be necessary as well as the up-to-date facilities and technologies.
(A341) Disaster! What about Me?
Authors: Al-Qusimy H.N. 
Published: May 2011

BackgroundThere is one important aspect of hospital preparedness for disaster that has so far received minimum attention. It has been taken for granted that medical staff know best how to take care of themselves and are well prepared personally when there is a call for disaster. However, the reality is far from what is expected, and many staff tend to keep their personal needs as a second priority when it comes to patient care, especially during disasters and mass casualties. They may not show it, however, while attending to their duties and managing casualties of disasters.DiscussionMedical staff continue to have personal concern regarding their family, properties, personal safety and in some instances their own health as well. The medical staff are not the only one to blame, as other parties, including their employers are involved. This presentation will discuss causes and consequences of ill prepared medical staff personnel to disaster or Mass casualty, including a brief illustration of a mini survey that was conducted immediately following a hospital disaster drill. The presentation will also elaborate on developing staff personal response plans and kits that will contribute in reducing the burden of concern for their own family and them and indirectly may help increase their performance and productivity during disaster or mass casualty situations.