bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A102) Training Agricultural Emergency Responders
Authors: Cowen P.L. 
Published: May 2011

Training Agricultural Emergency Responders by Paula L. Cowen, D.V.M., Director, Professional Development Staff, Veterinary Services, Animal Plant Health Inspection Service, United States Department of AgricultureBackground Emergency Response is a critical component of our Animal Agriculture infrastructure. The ability to deploy trained personnel to handle any kind of emergency is key to quickly containing any disaster and mitigating the effects. This training is provided by a number of federal agencies, universities as well as at the state and local level. Body Several training strategies are employed by a number of different entities. Training is available on-line, in the classroom, with wet labs using live animals, through exercises and case studies. An overview of training and education of Agricultural Emergency Response personnel across the United States will be covered with a more in depth look at the training provided by the Animal Plant Health Inspection Service.ConclusionThe Professional Development Staff provides technical training in disease identification and control, emergency response, import/export, and other topics as needed. Protecting and promoting American Animal Agriculture is our core mission. Veterinary Services provides leadership at the intersection of Animal and Public Health concerns.
(A105) A Core Curriculum for Nurses in Disaster Preparedness and Response
Authors: Chang L. , Briggs S.M. 
Published: May 2011

BackgroundNurses play an essential role in disaster response. All health care responders, including nurses, must have knowledge of the key principles of disaster medicine. The International Trauma and Disaster Institute (ITDI) at Massachusetts General Hospital has developed a core curriculum for Mass Casualty Incident (MCI) management. The curriculum provides all members of the multidisciplinary disaster team with the fundamentals of the MCI response. The proposed concurrent session will report on understanding of the fundamental knowledge in disaster medicine and preparedness for nurses in local and international disaster responses.Discussion and ObservationsDisasters follow no rules. Traditionally, medical providers have held the erroneous belief that all disasters are different, especially those involving terrorism. In reality, all disasters, regardless of etiology, have similar medical and public health consequences. A consistent medical approach to disasters, based on an understanding of their common features and the response they require, is becoming the accepted practice throughout the world. This strategy, called the MCI response, has the primary objective of reducing the mortality/morbidity caused by the disaster. The Advanced Disaster Medical Response (ADMR) Course, available in eight languages, including Chinese, is designed to train nurses in the ABC's of basic medical and public health disaster care. The delivery of optimal care in a disaster relies on a common understanding of each health professional's role and common mastery of defined essentials of disaster response such as the Incident Command System, field triage, decontamination, care of specific injuries, environmental considerations, psychological response to disasters, and care of the dead and their families. Understanding key principles and training in medical disaster response will guide nurses in disaster preparedness and response to future disasters.
(A107) Victimbase: Disaster Victim Descriptions for Simulation, Training and Research
Authors: Debacker M. , Boosman M. , Van Norel W.J. , Tryan J.L. 
Published: May 2011

IntroductionA 2006 survey showed that 27% of training institutions used computer-based training in disaster medicine and an additional 23% indicated that they will use it in the near feature(1). Victim descriptions are an important element of simulation exercises. Currently, the victim data utilized in computerized simulation exercises cannot be used in an interchangeable way.MethodsThe European Master in Disaster Medicine (EMDM) Academy, recognizing the need for access to reliable disaster victim data, initiated the Victim Base project in order to improve the availability and quality of disaster victim profiles for use in simulation, training and research. A standardized victim template was developed through a review of primary and secondary survey requirements with consultation from an international consortium of training experts in disaster medical management during two workshops.ResultsThe victim template is composed of a description of the victim profile, a set of clinical conditions and triggers (time and interventions) to move from one clinical state to another. The parameters of a casualty condition are organized in sub-templates and arranged in the way the victim would most likely be assessed. Victim profiles can be delivered in different output formats on request of the users.ConclusionIn order to evaluate the effectiveness or outcome of disaster response exercises or test operational plans, victim data must be robust, reliable and of high quality. Moreover, the data must be interchangeable in order to make comparisons between different response systems, regions or countries. VictimBase as an online library of disaster victims will contribute to achieve these objectives. 1. Delooz H, Debacker M, Moens G, Johannik K. and the ISEE Partnership. European survey on training objectives in disaster medicine. Eur J Emerg Med 2007;14:25-31.
(A108) Hospital Disaster Planning: The Structured Approach
Authors: Khalifa G.E.A. 
Published: May 2011

BackgroundDisasters and incidents with hundreds, thousands, or tens of thousands of casualties are not generally addressed in hospital disaster plans. Nevertheless, they may occur, and recent disasters around the globe suggest that it would be prudent for hospitals to improve their preparedness for a mass casualty incident. Disaster, large or small, natural or man-made can strike in many ways and can put the hospital services in danger. Hospitals, because of their emergency services and 24 hour a day operation, will be seen by the public as a vital resource for diagnosis, treatment, and follow up for both physical and psychological care.ObjectivesDevelop a hospital-based disaster and emergency preparedness plan. Consider how a disaster may pose various challenges to hospital disaster response. Formulate a disaster plan for different medical facility response. Assess the need for further changes in existing plans.MethodsThe author uses literature review and his own experience to develop step-by-step logistic approach to hospital disaster planning. The author presents a model for hospital disaster preparedness that produces a living document that contains guidelines for review, testing, education, training and update. The model provides the method to develop the base plan, functional annexes and hazard specific annexes.
(A112) Development of Model Medical Care Protocols for Alternate Care Sites during Pandemics and Public Health Emergencies
Authors: Markenson D. , Reilly M. 
Published: May 2011

IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites which can serve as areas for primary screening and triage or short-term medical treatment, can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Maintaining consistent standards of care in these settings is essential to a uniform approach to the medical management of a public health emergency.MethodsSubject matter experts in emergency and disaster medicine, public health, pediatrics, and various other medical specialties were convened at regular intervals over an 18-month period. Through a consensus-based process this working group created a universal standard of care along with model clinical protocols to manage patients in an out-of-hospital setting using medical and non-medical personnel.ResultsThese protocols were designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting for a limited period of time and then return to their homes for convalescence. Of particular importance are that these protocols applicable to all public health emergencies and do not rely on the active presence of physicians at the alternate care site to render care.ConclusionThe development of consistent standards of care and the ability to care for patients in an out-of-hospital setting during a pandemic or public health emergency is essential to preserve the sustained operation of acute care hospitals and the entire healthcare system. Diverting patients to a community- based alternate care site or encouraging the early discharge of patients to these locations can assist in managing the large numbers of casualties anticipated during a pandemic or public health crisis.
(A115) Disaster Preparedness and Learning Habits of the German Security and Rescue Forces: A Survey
Authors: Fischer P. , Christian J. , Wafaisade A. , Kees T. , Kabir K. , Müller M. , Rohner M. , Müller S. 
Published: May 2011

ObjectiveDeveloping an e-learning platform addressing security and rescue forces to eradicate the lack of disaster preparedness underscored by diverse studies. In order to reach this aim the performance of a needs analysis is essential.MethodsThe audience of security and rescue forces was clustered in (emergency) physicians, fire-fighters, policemen, Paramedics and members of the Federal Agency for Technical Relief (THW). For each cluster a questionnaire was developed and corrected by specialists in disaster care. The questions were about previous knowledge, habits of studying; further training habits and internet requirements.ResultsThe questioner was posted online during 4 months and was filled in by 1142 persons (141 physicians, 194 fire-fighters, 108 policeman, 444 rescue workers and 255 members of the THW). The biggest lacks in previous knowledge were shown in reacting on CBRN-incidents. 64, 1% thought they were not able to act correctly in case of chemical contamination. The most important learning tools were books, lectures, seminars and the principle of learning by doing. The reasons for using an e-learning platform were saving time, high quality of the tutorials (77% thought it important), quicker reach of information, multimedia formats of the taught facts and links to further information. 55, 2% were slightly unsatisfied with the actual pool of further trainings. The most frequently used sources of information were the internet (78, 8% use it frequently) and colleagues.ConclusionsThe survey shows that lacks in disaster preparedness in Germany definitively exist but it also reflects that most of the security and rescue forces are motivated to do further trainings and use therefore new technologies. But they require a high quality of teaching and a reasonable use of them. There is a need for using innovative Methods, and user-friendly web-based instruction and information modules to address all security and rescue forces in Germany.
(A137) Prediction of Short-Term Functional Outcomes of Older People in the Emergency Department
Authors: Kumar P. , Dey A.B. 
Published: May 2011

BackgroundAdvancing age and co-morbid illness result in loss of the ability to perform activities for daily living (ADLs), and are important determinants of loss of independence and autonomy among older persons. Acute illness reduces the functional status of previously healthy older persons.The aim of the current study was to determine the change in ADLs due to acute destabilization in old age one month following discharge.MethodsOlder subjects admitted to the General Medical Wards from the emergency services of the All India Institute of Medical Sciences were included between August and February 2008. The Barthel index of ADL was assessed in a longitudinal design at the time of admission and one month post discharge. The values of the indices were compared using paired samples t-test.ResultsOf 108 subjects who presented to Emergency Geriatric Services at the hospital, 11 were excluded due to incomplete records, inability to trace on follow-up, incorrect telephone numbers, or had since died. Advancing age did not show a significant correlation with pre-morbid ADL score (r = −0.040; p = 0.749) or post-morbidity ADL score (r = −0.65; p = 0.636). A 45% decline in ADL score was noted one month following discharge after acute illness in older subjects (pre-ADL = 15.85; post-ADL = 8.78).ConclusionsOlder subjects are at a higher risk of poor functional outcome because they are less likely to recover function lost before admission and more likely to develop new functional deficits during hospitalization and after discharge.
(A138) Duration of Emergency Department Stay and Injury Profile of Homeless Patients in a Level-1 Trauma Center
Authors: Chauhan S. , Bhoi S. , Sinha D.T. , Rodha M. , Alexender L. , Kuamr R. 
Published: May 2011

Background and ObjectiveImmediate resuscitation and early disposition to definitive care improves outcomes. Homeless patients are neglected in emergency department (ED). The duration of ED stay and profile of injury of homeless patients at a Level-1 Trauma center were measured.MethodsThe study was performed from October 2008 to September 2009. Homeless patients were defined as patients who had no attendant and did not have any shelter. Duration of ED stay was noted from the ED arrival time to entry time at the definitive care (intensive care unit/ward). Clinical and demographic details were recorded. Subjects who had: (1) an attendant; (2) were discharged from the ED; or (3) expired in the ED were excluded.ResultsForty-one homeless patients were admitted. The mode of injury was road traffic crash in 73.2%; assault in 7.3%; fall from height in 7.3%; and in 12.2%, the mode of injury unknown. The average Injury Severity Score (ISS) was 6.76, with a maximum of 34 and minimum of 1. A total of 24 subjects (59%) had a Glasgow Coma Scale (GCS) score of ≤ 8 (severe head injury), 10 patients (24%) had GCS score 9–12 (moderate head injury), and seven subjects (17%) had GCS score 13–15 (minor head injury). Breath alcohol test was positive in 13%. The average duration of ED stay was 35 (3–173) hours in the homeless group and 12 (0.5–18) hours for patients with an attendant. Twenty-one subjects were admitted to neurosurgery (51.2%) with an average ED stay of 22.4 hours, five to surgery (12.20%) with average ED stay of 56.6 hours, and 15 to orthopedics (36.6%) with average ED stay of 45.3 hours.ConclusionsThe emergency department stay of homeless patients was 35 hours. Orthopedic trauma subjects had a prolonged disposal time. This addresses serious patient safety concerns and immediate remedial measures.
(A143) European Project SICMA (Simulation of Crisis Management Activities) for Medical Management of Maxi Emergency Trauma Patients
Authors: Magalini S. , Di Mugno M. , De Gaetano A. , La Posta G. , Sermoneta D. , Gui D. 
Published: May 2011

IntroductionModern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.MethodsThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.ResultsSICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel expertise, to ambulance and helicopter transportation depending on traffic and weather conditions. The system also simulates rescue doctrines (i.e. “Casualty Clearing Station” or “Scoop and run”), transportation priorities according to color codes, doctrines for assignment of new casualty to neighboring hospitals, hospital resources and involvement, final clinical outcome of individual casualties. Patient health status and physiological reserve of single casualty is based on the ABCD ATLS system, considering with a simple algorithm both level of damage and rate of worsening in time.ConclusionUtilizing this simulation system, managers who predispose organizational and logistic procedures may modify the main elements in order to identify the optimal resource allocation and the best procedures to save the most human lives.
(A144) Health Status Casualty Model for Simulation of Crisis Management Activities (EU SICMA Project)
Authors: Di Mugno M. , Magalini S. , De Gaetano A. , La Posta G. , Sermoneta D. , Gui D. 
Published: May 2011

IntroductionThe European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. The first step toward chain procedure modelling in the management of major emergencies is the representation of a traumatized patient whose health status can be followed in time during simulation. Since management of the trauma patient follows criteria of stabilization of main physiological functions, a trauma patient model was developed based on fundamental pathophysiological functions independently of specific lesion characterization. Methods: Each patient's health status was modelled according to 5 parameters (ATLS): A(airway), B(breathing), C(circulatory), D(disability), E(Exposure). Patient samples are extracted from a 10.000.000 patient database, generated by considering real anatomical lesions compatible with type and severity of considered scenarios (explosion, building collapse, fire, gunfight). Simulated lesion characteristics were then converted to pathophysiological parameters. Each physiological compensation parameter was represented by: (1) baseline value expressed as percentage of altered function; (2) function reduction rate over time, obtained by a mathematical approximation of clinical worsening. From level of function, rate of worsening and function-specific death thresholds, estimated time-to-death according to sustained damage is computed.ResultsThis model allows simulation of evolution of patient health status both in absence of medical care, but also under therapy, in terms of immediate increment of each single parameter (“temporary” treatment), and of reduction or zeroing of parameter dec14rement rate (“definitive” treatment).ConclusionThis model, based on evaluation of physiological parameters, presents an advantage over the consideration of single lesions, because simulating logical procedures that guide treatment choice in real situations can provide a more accurate assessment of casualities for those actors assigned to management of major emergencies.
(A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department
Authors: Ong M.E. , Sultana P. , Fook-Chong S. , Annitha A. , Ang S.H. , Tiah L. , Yong K.L. 
Published: May 2011

ObjectiveTo compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.MethodsThis is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.ResultsA total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).ConclusionA resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.
(A159) Core Competencies for Emergency Preparedness Education for Health Profession Schools
Authors: Markenson D. , Reilly M. 
Published: May 2011

BackgroundThe possibility of natural disasters and public health emergencies coupled with the possibility of terrorism clearly support the need to incorporate emergency preparedness and response material into the curricula for every health professional school in the nation.DiscussionTo date, the focus has been on the education of the existing healthcare workforce. Students' needs differ from those of practitioners in that there is a fundamental difference between educational competencies and occupational competencies. It is also important to recognize that to assure proper preparedness there must be a clear connection between departments of public health and all other healthcare entities. To this end we included public health students in the creation of competencies and have shown that non-clinical practitioners can, and indeed must, be included in this process.ObservationsWe describe a process and present a list of emergency preparedness core competencies for health care professions and their applicability to Medical, Dental, Nursing and Public Health students. While we have designed this set of competencies using these disciplines, they may be easily adapted to other healthcare disciplines. The only variations would be in the assignment of proficiency levels and the decision of whether or not clinical competencies are appropriate. The core competencies have been divided into the following four categories which represent broad subject areas and the separation of the competencies related to direct patient care:
–Emergency Management Principles–Terrorism and Public Health Emergency Preparedness–Public Health Surveillance and Response–Patient Care for Disasters, Terrorism and Public Heath Emergencies.