bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A163) Hospital Evacuation Plan
Authors: Khorram- Manesh A. , Nero C. , Ortenwall P. 
Published: May 2011

IntroductionHospitals, as one major cornerstone of contingency planning, are often expected to be fully functional during a major incident. However, the continuous streamlining of todays healthcare system with a constrained economy, lean production principles and increasing complexity together with changing levels of the threats may result in an evacuation, should hospitals themselves be the targets for a disastrous action.ObjectiveThe aims of this study were 1) to evaluate an appropriate risk and vulnerability analysis model as a basis for hospital evacuation plan, 2) to identify hazards triggering an evacuation 3) to evaluate the response needed in an evacuation situation and 4) to clarify the impact of such an evacuation plan on the ordinary emergency medical plan.Material and MethodsA systematic online literature search based on the following keywords; evacuation/closure, hospitals/medical facilities, and disaster/hazards; alone or with planning, and also a risk and vulnerability analysis as a case study at the hospital in Lidkoping, Sweden, were conducted.ResultsOur findings indicate that hospitals are vulnerable to different risks such as technological dysfunctions, climate changes and terror actions, which can result in an evacuation of patients. In such a situation, well functional transport organization and availability of temporary facilities along with good communication are necessities to assure patient safety. Such functional abilities may be assessed by planning, education and continuous training.Discussion and ConclusionThere is a need for an elaborated evacuation planning for hospitals. Such plan should continuously be drilled based on a risk and vulnerability analysis and be integrated in the ordinary medical emergency plan. Simulations of different scenarios are one way to determine risks and identify proper actions before a major incident or disaster strikes.
(A166) Disaster Risk Reduction - Extreme Heat Preparedness
Authors: Smyth V.A. 
Published: May 2011

BackgroundSouth Australia is often referred to as the driest state in the driest continent on earth and the community expects summers to be hot. However since 2007 South Australia has experienced several periods of extreme heat which have challenged and required the emergency services including health to consider a new preparedness approach. Any extreme weather condition can cause disruption to the community and the effects of such events as extreme heat are not always immediately obvious. However these effects can silently cause death and an increase to the health burden of the community.DiscussionIn South Australia the term ‘Extreme Heat’ as opposed to ‘Heatwave’ has been quite deliberately chosen as this describes more accurately an unusual climatic situation characterised by higher temperatures and greater length of time than normally expected. A number of studies have been undertaken to consider the impact on the health of the South Australian community and its health services and specfic action plans and communication strategies have been developed to respond to extreme heat and encourage an increasing level of community resilience. This paper will describe recent events, some of the research undertaken and the preparedness, planning and response strategies implemented to reduce and manage the risk.ConclusionThe response strategies introduced in South Australia have been recognised for their excellence and in 2010 SA Health was the recipient of several awards at both state and national level for this work.
(A167) Patient Tracking In Disaster Drills
Authors: Hilmi L.M. , Heerboth A. , Anthony D. , Tedeschi C. , Balsari S. 
Published: May 2011

IntroductionDisaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.MethodsOver eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.ResultsThere was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.ConclusionsOur group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
(A152) Is There a Need to Reconsider the Policy of Evacuating All Casualties from Remote Mass Casualty Incident (MCI) to the Closest Hospital? Lessons Learned from a Rural MCI
Authors: Adini B. , Cohen R. , Glassberg E. , Azaria B. , Simon D. , Peleg K. 
Published: May 2011

BackgroundInappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.ObjectiveThe aim of this study was to review the consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.MethodsHospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.Results31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.DiscussionOver and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.ConclusionsIn MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
(A175) Traffic Injury Severity Prediction by Algorithm of Automatic Crash Notification System
Authors: Wang S.J. , Choi H.Y. 
Published: May 2011

IntroductionSince 2009 automatic crash notification system(ACNS) using event data recorder(EDR) and mobile communication have been developed for early detection of traffic accident and prediction of physical injury of victims for increase of survival rate via early medical treatment. For adequate prediction of injury, authors developed the guideline and algorithm from parameters related to accident and medical situation. Methods: Expert survey was done about the adequate parameters related to accident and medical situation. Medical record of traffic accident admission was analyzed in a trauma center of a university hospital in Seoul, Korea. Additionally epidemiology of traffic accident death in a region was done. Afterwards data of medical record was linked to data of traffic accident insurance companies.ResultsThe important parameters for prediction of physical injury of victims were as follows: Intercept, deltav, belt, age, intrus, sex, multiple, roll, ejection, narrow, height, weight, steering defect, track loc.ConclusionsPrediction of physical injury severity of victims on traffic accident spot and immediate transfer of related information to adequate medical institution by automatic mobile communication can help the traffic accident victims and upgrade the trauma care system of traffic accident.
(A178) Evaluating the Feasibility of Verbal Analogue Scale among Emergency Care Providers in Assessment and Management of Acute Pain in Trauma Victims
Authors: Adhikari G. , Bhoi S. , Chauhan S. , Sinha T.P. , Gautam P. 
Published: May 2011

BackgroundAcute pain assessment and management in trauma victims is often overlooked in emergency department (ED). Visual analogue scale is the preferred scale for assessment and management of pain however, its role in a busy ED is limited. The objective of this study was to evaluate the feasibility of verbal and visual analogue scale among emergency care providers.MethodsEmergency caregivers were instructed to use both pain scales wherever feasible for assessment, management, and monitoring of pain in 100 non-consecutive alert patients. A separate, pre-tested survey questionnaire addressing the feasibility of each pain scales was surveyed among emergency care providers (emergency physicians, nursing staff). A Likert scale (1 to 5) was assessed for cooperativeness, availability of time for assessment, the format, the peak period feasibility, the monitoring ease and the amount of work load. Binary scale (yes and no) was used to measure the overall utility in assessment and management of pain.ResultsOut of 100 patients enrolled, the verbal analogue score was used in all patients and visual analogue score was used in 30 patients. The average Likert scale score for verbal analogue score questionnaire was 1.7 and the average Likert scale score for visual analogue score questionnaire was 3.9. On the overall utility both scales were found to be useful in all patients.ConclusionsBoth the scales were found to be useful in overall assessment and management of pain. However, there was a favorable trend towards using verbal analogue scale among emergency care providers.
(A181) Process Improvement in Disaster Relief: Implementation of a Fast Track in a Haitian Tent Hospital
Authors: Bloem C. , Gore R. , Arquilla B. , Naik T. , Schechter J. 
Published: May 2011

Study ObjectiveTo determine if instituting an Emergency Department (ED) fast-track area would increase efficiency in patient flow, improve utilization of limited resources, and identify critical versus non-critical patients during disaster relief in Port au Prince, Haiti.MethodsA survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center on a disaster relief mission following the 2010 earthquake. The following variables were obtained to assess ED effectiveness: number of patients, acuity level, chief complaints, critical interventions, waiting times, length of stay, specialty service coverage and physical plant space. Additionally, existing practitioners were surveyed regarding existing ED practices. ED operation flow maps were created.ResultsThe assessment revealed a large volume of low-acuity patients mixed with high-acuity patients without identification of acuity level, time of arrival, or designated area for treatment. Although literature reports routine use of START triage, this was not being implemented in this setting. Results of implementing a fast track area included: (1) Improved identification of patients needing immediate treatment. (2) Increased flow of low acuity patients in designated fast track areas. (3) Improved triage protocols maximized appropriate use of resources, and expedited subspecialty consultation.ConclusionBy instituting well-accepted, validated patient flow systems and reinforcing communication regarding resources available and the use of geographic space, better management of incoming emergency patients was achieved.
(A184) Survey of Knowledge, Attitudes and Risk Perceptions (KAP) of Healthcare Personnel, in the Event of an Outbreak of H1N1 Influenza, in Limited Resource Environment
Authors: Aditya K. , Gadgil A. , Joseph J. , Roy N. 
Published: May 2011

IntroductionLittle is known about the risk perceptions and attitudes of healthcare personnel, in the event of an epidemic of H1N1 influenza. It is acknowledged that perception of risks, as opposed to actual risks, alters behaviour. Indian data on KAP is needed as the scenario of working in limited resource environment, can have a different risk perception and attitudes amongst the healthcare workers. This will help in chalking out a ‘model response planning’ The study is designed to investigate the Knowledge and attitudes amongst healthcare workers in Mumbai, India during H1N1 pandemic of 2008–2009.MethodsQuestionnaire based interviews were given to healthcare workers, selected by their place of work, level of education and income group. This is based on the priori hypothesis that KAP differs amongst these groups. Surveys were distributed randomly to 20% employees from each of the above categories. Also healthcare officials, making policy decisions and guidelines, and the patients approaching these healthcare centres for treatment were interviewed for their perceptions of adequacy of the response measures. The questions designed included assessment of demographic characteristics, individual's knowledge about swine flu, perceived adequacy of training, perception of preparedness to tackle the epidemic situation and perception of risk to them and their families during epidemic conditions. The responses were graded as ‘adequate or inadequate knowledge’, perceived ‘high or low risk’ and ‘tendency to apathy’. Results were analysed using statistical software (SPSS17).ConclusionUnderstanding the concerns and responses of healthcare personnel to a major infectious disease outbreak is critical to maintaining response capacity.
(A194) “Displaced Voices”: Are those Displaced by War Satisfied with the Provision and Quality of Health Care they Received?
Authors: Wickramage K. , Surentrikumaran R. 
Published: May 2011

Research into how war-displaced communities value or prioritize aid response is limited. A clearer conceptualization of what affected populations seek from the international humanitarian response to their needs would be valuable in planning for emergencies.AimExploring internally displaced person's (IDP) experiences and perceptions of the humanitarian response, with a focus on health risks, resources, and health services received during their displacement.MethodA mixed-method approach using both quantitative and qualitative methods was used. This study assessed the perceptions of IDPs on provision of health and other services using an interviewer-administered-questionnaire (survey) using a sample frame that included the entire displaced population of 150,000 IDPs living in 97 camps. Findings from the survey were synthesized with the key themes that emerged through the qualitative methodology. In-depth interviews were conducted with health cluster actors. An innovative child-to-child (CTC) based research methodology was used to ascertain the insights and perceptions of displaced children and adolescents.ResultsThe survey revealed community satisfaction with health care services immediately after displacement (within IDP camps) improved considerably from 63% to 80% (6 months after the acute phase). Significant gains also were registered for shelter (54.2% to 81.4%), and sanitation (47.4% to 62%). Satisfaction of services rendered by primary healthcare workers also were high; 81.7% for public health midwife (who provided maternal and child health care), and 76.8% for public health inspectors (who provided environmental health and disease control). However, CTC workshops revealed inequalities in access to food based on ‘caste’ and occupation. Protection issues relating to violence from community and militant groups were reported.ConclusionsDespite IDP satisfaction with healthcare services, there were gaps in food security and violence/protection activities. Recognizing of the role/impact community health volunteers play in health care is an important factor in enhancing primary health care services in IDP camps.
(A198) Bringing H1N1 Vaccinations to Vulnerable Populations
Authors: Bollinger P. , Baird S. , Giard D. , Higginson G. 
Published: May 2011

BackgroundPopulations that participated in this project represented > 46% of the total H1N1 patients hospitalized and 34% of deaths in the state of Oregon.MethodsA committee was convened by the Oregon Health Authority to increase access to vulnerable populations. The committee determined the project must be supported by: (1) a local advocacy group; (2) a local Health Department; and (3) an emergency medical services (EMS) provider agency to provide immunization. This project involved outreach to a vulnerable population that may not be able to utilize mass vaccination clinics and may have limited access to medical services. Outreach was accomplished using three models: (1) volunteers delivering meals; (2) mailings to those receiving in-home meals; and (3) a community organization that conducted a flu clinic frequented by people with disabilities. Three models were developed for receiving calls and scheduling appointments. All projects followed the same procedure for vaccine administration.ResultsSeventy home-bound individuals met the criteria for vaccination. Post-survey results indicated: 55.2% lived alone and were homebound. Over 70% had previously received their vaccinations from their healthcare provider and 38.9% were not previously vaccinated due to vaccine availability. Fifty-eight individuals were vaccinated. Partner organizations were surveyed after their efforts were completed. Findings indicated that relationships between the EMS agencies and providers were greatly enhanced.ConclusionsOutreach using nontraditional partners was an effective method to reach a vulnerable population. The project demonstrated that qualified vaccinators can be mobilized quickly. However, because this resource-intensive effort is more costly than providing mass vaccination, similar projects should only be utilized when less costly means are not effective, or when the risk level of the vulnerable population being served warrants it.
(A209) Developing Medical Facility Preparedness for Radiological Hazmat Emergencies: Applying Surge Science
Authors: Lim H.C.S. , Cheong A. , Cai Y.L. 
Published: May 2011

IntroductionSingapore is considered a prime target for transnational terrorism. Perpetrators may select an explosive radiation dispersal device or “dirty bomb” as their weapon of choice. Additional risks of a local radiological emergency may arise from mishaps involving visiting marine nuclear-powered vessels. Strategies and methods used to enhance preparedness to respond to radiological mass-casualty incidents (MCIs) will be described.MethodsA core group comprising hospital emergency managers and radiology and emergency department staff spearheaded preparedness efforts. The Ministry of Health Guiding Document on managing radiological MCIs provides the principles and operational concepts to anchor the development of local protocols. Discussion sessions, site visits, drills, and exercises are conducted to improve organization performance. Expert opinion and feedback from various stakeholders and partners help shaped the overall plan.ResultsPreparedness activities focused on improving surge response capability through broad categories include: 1. Staff—Radiation response teams were developed and assigned roles and responsibilities. Training and education programs were created for different staff positions, e.g., on correct usage of electronic personal dosimeters and acute radiation syndrome. 2. Stuff—Material resources such as antidotes, and expendables like floor covering were procured and stored. 3. System—These areas include: (a) activation procedures; (b) communication plans; (c) safety measures; (d) casualty transfer protocols; and (e) handling radiologically contaminated waste and materials. 4. Space—Potential care areas, such as radiation isolation rooms were designated. An algorithm was devised to guide casualty management.ConclusionsFacility preparedness for radiological MCIs requires multidisciplinary involvement and the creation of trusting partnerships. More research is needed to identify the metrics to measure success objectively and aid protocol revisions.
(A213) Review of the Mass Casualty Incident after a Bomb Explosion in a Crowded Restaurant
Authors: Shettar S.S. , Kelkar K.V. , Jamkar A.V. , Gawali Y.V. , Kapil V. , Sasser S. , Hunt R. , Basavaraju S. , Galwankar S. 
Published: May 2011

Terror struck Pune on 13 Feb. 2010 as a powerful bomb ripped apart a popular restaurant, killing nine people and injuring more than 45. A retrospective analysis of the injury patterns was done.Materials and MethodsThe CDC template, viz. “Bomb Surveillance Form” was used for the data collection, that was analyzed by SPSS version 15 software.ResultsOf the 50 survivors transferred to the four nearby hospitals, 11 (22%) of them had severe life threatening injuries, with 19 patients (38%) having primary blast injuries, Secondary type of injury was seen in, and 22% had tertiary injuries. Orthopedic (24%) and burn injuries (36%) were prominent. The mortality rate was 16%.DiscussionThe occurrence of MCI in an unexpected scenario overwhelms the medical resources and challenges the emergency medical facilities. Analysis of the injuries revealed that fatal outcome was related to presence of shock, severe lung, bowel injury, presence of more than four types of injury and greater than 50% burns.StrengthsHighlights the importance of being able to recognize the blast injury patterns and their management.LimitationsInability to compare with other blast injuries due to several missing data.ConclusionBlast injury sustained in a small, enclosed space is one of the most serious and complicated forms of multiple trauma. Hospitals and civic authorities must be prepared to counter this menace of modem times. Not everything that is faced can be changed, but nothing can be changed until it is faced.