bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A145) Simulation for the Assessment and Optimization of Medical Disaster Management
Authors: Dhondt E.L. , Van utterbeek F. , Ullrich C. , Debacker M. 
Published: May 2011

BackgroundThe ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.ObjectiveThe aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.Methods and ResultsA system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.ConclusionsSimulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.
(A151) The Situation of Reporting Road Traffic Accidents Resulting In Injury and Death in a Suburban Roadway: A Cohort Study
Authors: Hatamabadi H. , Soori H. , Hadadi M. , Vafaii R. 
Published: May 2011

IntroductionThe prerequisite of improving the situation of traffic accidents and injury prevention is to set up a “Road Traffic Accident and Victim Information System (RTAVIS)” which does not exist in Iran. The objective of this study was to compare the three major sources information including police, emergency medical service and hospitals to show the necessity of integrated road traffic injury surveillance system.MethodThis prospective cohort study has been done by pursuing each road traffic accident (RTA) case within 30 days of its occurrence by a draft questionnaire and data pooling from participating sources during one year.ResultsIn this study, after aggregating/ pooling the data from all organizations, it was finally revealed that during one year 254 injury crashes happened in Tehran–Abali road (with 45 Kilometer distance) in which 434 people were injured or died. Out of these injury crashes, Police and Emergency Medical Services (EMS) stated to be unaware of 67 and 51 cases, respectively. In other words, Police, pre- hospital emergency service and hospital have reported 56.2% 82.9% and 76.4% of the entire number of injuries or deaths respectively.ConclusionNone of the information sources including police, EMS and health care facilities has complete information about injuries and deaths caused by traffic accidents. It seems that formulating and implementing a centralized and multidisciplinary data collection system of national traffic accidents with the collaboration of police, Ministry of health and medical education (EMS and medical centers), forensic medicine, and Iranian Red Crescent is necessary.
(A153) Does Prehospital Delay Change Trauma Outcomes in Mumbai?
Authors: Kumar V. , Suryawanshi P. , Dharap S.B. , Roy N. 
Published: May 2011

IntroductionPrehospital delay in trauma victims has been associated with worsened trauma outcomes, and forms the basis of emergency medical services (EMS). Survival rates of severely injured patients with life and limb threatening trauma were studied and corrlated with prehospital delays in Mumbai, India, where there is no central EMS system.MethodsFrom October 2010 to March 2011, a researcher collected Injury Severity Score and prehospital time delay data in all severely injured patients arriving at the Trauma Centre. The time of injury, and time and mode of transport to the Trauma Centre were recorded, along with the details of the injury and the physiological parameters upon admission. Information regarding time and place of the crash, arrival to a trauma care facility, injuries, and survival were noted.ResultsA taxicab was the most common mode of transport followed by a police van, private ambulances, and government ambulances. Patients reached the Trauma Centre more quickly when accompanied by relatives or police, and took longer if they were examined at peripheral centers, were unknown victims, or arrived by Government ambulances. Better outcomes were observed in patients with informal carers. The majority of the victims presented within three hours of trauma.ConclusionsPrehospital delay did not correlate well with poorer outcomes. Further research is needed to determine how many injured die on the way to the hospital in countries without a formal EMS system. Implementation of a high-cost, state-funded EMS system in a congested, resource-poor, urban setting must be balanced with the insufficient evidence about whether prehospital field interventions actually improve survival outcomes.
(A154) Overcrowding of Ambulances at the Scene of a Disaster: Pitfalls and Implications
Authors: Waseem H. , Shahbaz S. , Razzak J. 
Published: May 2011

IntroductionPakistan is a developing country with a basic prehospital system in some cities. The prehospital services are a mixture of government and private ambulances.There is no central regulatory body for them and no central command to control the influx and out flux of ambulances from the scene.ObjectiveIn this paper, five episodes of terrorist incidents in the country and will try to estimate the number of ambulances on the scene.MethodsRetrospective data was collected and triangulation was done by three sources: (1) ambulance records; (2) visual estimation; and (3) print media. An estimate of total ambulances was reached along with dead and injured. Furthermore medical transport capacity was calculated where possible.ResultsIn majority of the incidents, it was found that there was a huge influx of ambulances beyond the need. This further adds to the chaos and confusion already present on the scene of disaster.ConclusionsA Command and Control Center should be established to direct all ambulance control and movements.
(A179) A Survey of Rapid Sequence Intubation (RSI) Complications in Immam Hossein Medical Center Carried Out by Emergency Residents
Authors: Hatamabadi H. , Golkhatir I. , Amini A. , Alavi Moghadam M. 
Published: May 2011

IntroductionCritically ill patients in emergency department frequently require emergency airway management. This procedure in our ED is carried out by emergency medicine resident with rapid sequence intubation (RSI). This study investigates complications of tracheal intubation carried out in critically ill patients including: (1) hypoxemia and hypotension (2) aspiration and esophageal displacement (3) pneumothorax and right bronchus intubation.MethodsData were collected on consecutive intubations carried out by EM residents over a 29 months period. Between 195 patients only 100 patients had including criteria to enter this study. Also we compare the complications and success rate among three level of personnel carrying on the procedure.(first to third year of emergency medicine residency).Results109 consecutive intubations were carried on in 100 patients. Oral translaryngeal intubation was done in all patients. Three intubations required more than 2 attempts and hypoxia occurred in 34 cases. Aspiration was diagnosed by direct vision in 5 cases. Hypotension was found in 5 cases causing death in 3 of them during the intubation or in 30 minutes following the procedure. Esophageal displacement occurred in 10 of the attempts but all were recognized and reintubated. Success rate between three personnel levels are as follow: in first year residency 82% and in second year residency 94% and in third year residency is 100% (p = 0.014).There was not a statistically significant difference among these three groups considering the complications but the success rate should a difference between level 1 and 3 (p = 0.936). Multiple attempts did not increase the rate of complications. Mortality were dependent to hypotension (p = 0.019) and age (p = 0.001).ConclusionIn our study we did not find the results of RSI to be operator dependent as long as it was done by emergency residents. It is recommended to compare the results of RSI and non- RSI methods in a future.
(A215) Delayed Diagnosis of Injury in Survivors of the February 2009 Crash of Flight TK 1951
Authors: Postma I.L.E. , Winkelhagen J. , Bijlsma T. , Bloemers F. , Heetveld M. , Goslings J.C. 
Published: May 2011

IntroductionIn 2009, a Boeing 737 crashed near Amsterdam, traumatically injuring 126 people. In trauma patients, some injuries initially escape detection. The aim of this study is to evaluate the incidence of Delayed Diagnosis of Injury (DDI) and the effects of tertiary survey on the victims of a plane crash.MethodsData collected included documentations of DDI, tertiary surveys, Injury Severity Scale (ISS) score, Glasgow Coma Scale score, number and type of injuries, and emergency intervention. Clinically significant injuries were separated from non-clinically significant injuries. Comparison was made to a crash in the UK (1989), before advanced trauma life support became practiced widely.ResultsAll 126 victims were evaluated in a hospital emergency department; 66 were admitted with a total of 171 clinically significant injuries. Twelve clinically significant DDIs were found in eight patients (12%). In 65%, a tertiary survey was documented. The DDI incidences differed for several risk factors. Eighty-one survivors of the UK crash had a total of 332 injuries. Of those with > 5 injuries, 5% had a DDI, versus 8% of those with ≤ 5 injuries.ConclusionsThe DDI incidence in this study was 7% of the injuries in 12% of the population. A tertiary survey was documented in 65%; ideally this should be 100%. In this study, a high ISS score, head injury, > 5 injuries, and emergency intervention were associated with DDI. The DDI incidence in the current study was lower than in the UK crash.
(A228) Evaluation of the “Health Legal Preparedness” Model in the Context of Emergency Response in Israel
Authors: Cohen O. , Feder-Bubis P. , Bar-Dayan Y. 
Published: May 2011

BackgroundThe “Health Legal Preparedness Model” developed in the US aims to provide better health-related responses in times of emergency. It includes four components: (1) law; (2) competencies; (3) information; and (4) coordination.ObjectiveThe aim of this study is to examine the usefulness of the “Health Legal Preparedness Model” in the present state of affairs in the field of emergency preparedness in Israel.MethodsA qualitative study was conducted. In-depth interviews were performed with leading experts in the past or at present in the Israeli emergency health system.ResultsThe Israeli healthcare system already has elements of the model in place at various levels. The relative perceived importance of each of the four aspects of the model varied between the experts. Of the four components, law and coordination were perceived as a major system concern. Training of specialists in emergency legislation was controversial. In addition, differences were found in the experts' perceptions as of the optimal way to operate the health system during an emergency. Variability also was found in the perception of the private sector growth and in the importance of its incorporation into emergency response plans. The study found that the emergency preparedness system resembles military practices in its conduct. Nevertheless, there is willingness toward mutual emergency systems drills, including aspects of legal preparedness.ConclusionsThe model already is applied partially in the Israeli emergency healthcare system. Results indicate that the Health Legal Preparedness Model might be useful in identifying gaps in emergency response plans. It also crystallized gaps related to optimal operation during emergencies in the country. Therefore, it is important to reach agreement upon solutions that will incorporate a regulatory guideline in order to improve the function of the emergency healthcare system.
(A242) Evaluación De Emergencia Sobre Agua Y Saneamiento En Brote Epidémico De Cólera (Artibonite, Haití Octubre 2010)
Authors: Baena Izquierdo J. , García Pulido K. , Cabello Sanabria F. , Muñoz Martínez P. , Sevillano Borowski D. , Reyes Remedios J. 
Published: May 2011

IntroducciónEn la actuación de Cruz Roja Haitiana/ Cruz Roja Española en la emergencia de Artibonite (Haití), se evaluaron posibles puntos de intervención para el tratamiento de agua dentro de hospitales regionales convertidos en Centros de Tratamiento de Cólera (CTC) improvisados.ObjetivoEvaluar las capacidades de Agua y Saneamiento del Centro Hospitalario de L'Estere, así como su respuesta de emergencia ante el brote epidémico de cólera a finales de Octubre de 2010.MetodologíaTras la confirmación de los primeros casos de cólera en la zona de Artibonite, se desplazó a la zona un equipo especializado de delegados en Agua y Saneamiento de la Cruz Roja Haitiana/Española que realizaron una valoración y evaluación de emergencia en la región, identificando el Centro Hospitalario de L'Estere, donde una brigada médica cubana ya ofrecía atención médica a la población previo al brote epidémico de cólera. Las tareas de apoyo a dicho centro fueron principalmente de potabilización y distribución de agua de diversas fuentes (aljibe propio y río), mantenimiento de niveles altos de cloración del agua, fabricación de letrinas y drenajes, así como capacitación en promoción de la higiene a usuarios y familiares de pacientes del Centro Hospitalario de L'Esfere y comunidades cercanas al mismo.ResultadosDel 21 de Octubre de 2010 al 26 de Octubre de 2010 se valoraron un total de 1966 pacientes; (424 hombres, 374 mujeres, 229 menores de 15 años, 596 de 5 a 10 años y 370 menores de 5 años), de los cuales 798 fueron diagnosticados de cólera. El número total de fallecidos en este periodo fue de 16.ConclusionesUna evaluación y respuesta rápida de apoyo en Agua y Saneamiento a estructuras sanitarias regionales permite capacitar y mejorar la respuesta de los mismos ante enfermedades epidémicas como el cólera.Palabras clave: Cólera, potabilización, saneamiento.
(A243) Características De Estudios De Posgrado En El Area De La Salud
Authors: Ruiz R.B. , Ramírez G.P. , López F.S. 
Published: May 2011

ObjetivoDescribir las Características de estudios de posgrado en el área de la salud como preparativos para la realización de Planes en caso de Desastres y la asistencia de las principales patologías de Nuestro País.MétodoSe realizó un estudio descriptivo del seguimiento de 92 Diplomados en el área de la salud durante 8 años, realizados en el “Centro Nacional de Capacitación y Educación Ernesto Giovanni Porras”, con participantes médicos, enfermeras y paramédicos de más 75 % de estados de la República Mexicana.DesarrolloEl 12 de junio del 2002 se constituye una Asociación Civil sin fines de Lucro denominada “Desarrollo Educativo de Posgrado en el Área de la Salud e Investigación AC”, con el objetivo principal de Capacitar y Actualizar al Personal de la Salud en las principales causas de morbilidad y mortalidad, como una respuesta de mejorar la atención de estas patologías. Tres Universidades Avalan estos Diplomados.ResultadosEl diplomado con más participantes es el de Urgencias Médicoquirúrgicas (75%). La profesión más interesada corresponde a los médicos (95%), seguida por personal de Enfermería (4%), El tiempo destinado de capacitación corresponde a 250 hrs. mínimo por cada nivel. El financiamiento de los Diplomados es absorbido por el propio participante (98%), El Índice de deserción es del 20%, siendo la principal Causa por cuestiones económicas (85%) y en segundo lugar por cambio de adscripción o de jornada laboral. Lo más atractivo para el proceso de enseñanza aprendizaje corresponde a la práctica más que a la teoría (95%). La realización de estos planes mejora la capacidad funcional hospitalaria dentro del programa Hospital Seguro, y se evalúan y mejoran mediante la realización de simulacros.ConclusionesLos estudios de posgrado son elementos indispensables en la atención de las principales causas de morbimortalidad y en la realización de planes de Emergencia de un Hospital.
(A257) Enhancing Human Resources for Health in Crisis: Experience from the War-Affected Districts of Sri Lanka
Authors: Wickramage K. , Ranasinghe T. , Zwi A. 
Published: May 2011

AimsThis paper examines the coordination framework and interventions undertaken by the Sri Lankan health sector in providing essential health services to the displaced communities in the aftermath of the violent conflict in 2009. The narrative describes, in a chronological format, the strategies and actions undertaken by the health sector in response to a rapidly changing humanitarian crisis. The paper examines some of the key challenges faced by the health sector in the post-conflict recovery phases, the most pertinent being the human resources for health needs.MethodsA review of Ministry of Health departmental meeting minutes/circulars, inter-agency health coordination meeting reports, weekly surveillance reports, inter-agency/agency assessments, media files, and donor and health cluster member reports were compiled and then analyzed in order to construct a narrative on how the Health Sector responded to the humanitarian crisis (from acute emergency phase to the post-conflict recovery and resettlement phase). The authors also were integrally involved in the planning, development, implementation, and monitoring of a spectrum of health sector interventions during the humanitarian crisis from within Government and the United Nations system.RecommendationsA health systems strengthening approach, which places emphasis on human resources for health, can be effective in delivering high impact, sustained, high quality health care even in difficult and complex humanitarian emergencies such as civil war. The Sri Lankan experience has shown that harnessing effective human resource management stratergies in crisis also is vital for the post-conflict health system recovery phase that follows.The excuse that “the system may be too overwhelmed”; or health departments “too overstretched” to lead a coordinated effort can be mitigated with positive leadership and planning. The dividends of working in such an approach also ushers reconcilliation via a unified health workforce and promoting the idea of health as a bridge for peace.
(A260) Triage Decision-Making in Intoxication
Authors: Mirhaghi A. , Mohammadi G.R. , Asghari M. 
Published: May 2011

Background and AimsDecision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.MethodsCritical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.ResultsGeneral physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.DiscussionResources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
(A284) Improving Hospital Mass Casualty Preparedness through Ongoing Readiness Evaluation
Authors: Adini B. , Laor D. , Hornik-Luria T. , Goldberg A. , Schwartz D. , Aharonson-Daniel L. 
Published: May 2011

BackgroundIsraeli Hospitals are required to maintain a high level of emergency preparedness.ObjectivesTo investigate the effect of on-going use of an evaluation tool on acute-care hospitals' emergency preparedness for mass casualty events (MCE).MethodsEvaluation of emergency preparedness for MCE was carried out in all acute-care hospitals, based on an evaluation tool consisting of 306 objective and measurable parameters. Two cycles of evaluations were conducted in 2005 to 2009 and the scores were calculated to detect differences.ResultsA significant increase was found in the mean total scores of emergency preparedness between the two cycles of evaluations (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training and equipment, but the change was significant only in the training category. The relative increase was highest in hospitals that did not experience real MCE.DiscussionThis study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated measurable benchmarks. An ongoing assessment of the level of emergency preparedness motivates hospitals' management and staff to improve their capabilities and thus results in a more effective response mechanism for emergency scenarios.ConclusionsUtilization of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the evaluated areas. The expectation is that these benchmarks will allow for a better response to actual MCEs. The study further demonstrated that even hospitals without “real-life” experience can gear up using preset benchmarks and reach a high standard of mass casualty event preparedness.