bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A109) Systematic Literature Review on Pediatric Sleep Disturbance Management Post-Disaster: Implications of Post-Disaster Pediatric Clinical Management in Developing Countries
Authors: Chan E.Y.Y. , Koo S.D. 
Published: May 2011

IntroductionSleep disturbances are common symptoms during the immediate and long-term aftermath of exposure of traumatic events. While stress affects sleep in all age groups, due to differences in physiological, psychological, and socio-behavorial risk factors, the clinical management of pediatric patients with sleep disturbances post-disaster might be different. This study aims to systematically review scientific literature on the clinical management of pediatric sleep disturbances post-disaster and its clinical implication in developing countries. Methods: A keyword-based, systematic review was conducted for scientific publication in academic and disaster literature databases (Medline, PUBMED, Academic Search Premier, Google Scholar, ELDIS, PsycINFO, PILOTS and RELIEFWEB) until October 2010. Abstracts of all the hits were inspected to remove non-relevant articles, and all relevant articles were reviewed and scored by two reviewers to determine relevancy before being included in the final study database. Quality, relevance, and applicability of the reported literature were examined critically with the EBM level of evidence and EPPHPPQ (2003) assessment tool.Results and DiscussionThe literature disproportionally emphasized the clinical effects and psychological impacts of traumatic events on pediatric patients, and most reported studies were reported as a subset within PTSD study literature. Management of younger children, gender differences, clinical effectiveness of cross-disciplinary management modalities, and experiences in middle- and low-income countries were extremely limited. While principles of sleep hygiene and clinical guidelines for management of adult sleep disturbance are available, the application of clinical effectiveness and appropriateness of these guidelines in pediatric population must be examined further.Conclusion and ImplicationsCurrently, there is limited literature on the acute management of pediatric sleep disturbances post-disaster in developing countries. Evidence-based studies are needed to identify the appropriate clinical approaches to support the pediatric population with sleep disturbances post-disaster.
(A130) Advantages of Apparatus of External Fixation in Severe Injuries of Extremities in Children
Authors: Karabenyuk A. , Levitskiy A. 
Published: May 2011

PurposeTo study advantages of external fixation in severe injuries of extremities in children.Material and Method305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.ResultsSets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.ConclusionThe usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.
(A131) Surgical Help to Children in Disasters and Wars
Authors: Roshal L. 
Published: May 2011

PurposeTo describe results of experience in providing surgical aid to children in technological and natural disasters in various countries of the world: Haiti, Algeria, Armenia, Afganistan (three times), Georgia, Egypt, Russia, Indonesia (twice), Iran, Pakistan, India, Japan, Gaza strip, Chechnya, and Yugoslavia.Materials and MethodsThe Russian specialized team consisting of highly qualified pediatric specialists (traumatologists, neurosurgeons, plastic surgeons, specialists in wound treatment, anaesthesiologists-reanimatologists and others if necessary) work at local hospitals in the disaster zone. All of them work as volunteers. The most serious pediatric victims were concentrated in one or two regional hospitals. The volunteer specialists work on a twenty-four hour basis together with local doctors. Every day they examine patients, control wound bandaging, and perform surgeries. For long tubular bone fractures metalosteosynthesis is used. Modern techniques are used for Crush syndrome and for extended and purulent wounds (water-based ointments, early autoplasty). Currently, the main difficulty in many cases is primary treatment of extensive wounds with their complete closure and the many indications for amputations. Conservative and sparing techniques are not often used.ConclusionsPediatric victims in technologic and natural disasters must be helped by pediatric specialists. Our experience in the countries to which we have responded have revealed that there are not enough local specialists who can provide highly professional aid to children. There is no known coordinating structure in the world to efficiently organize specialized pediatric help to children in disasters and wars.
(A135) Preliminary Results of Post-Flooding Impacts on Rural Elderly in Hainan Province, China
Authors: Chan E.Y.Y. , Lin C.L.Y. , Lee P.P.Y. , Zheng I. , Cheung E.Y.L. , Lam S.C. 
Published: May 2011

BackgroundLimited information is available on the health outcomes of the rural older population in developing countries is affected by disasters. In October 2010, Hainan Province experienced severe flooding following heavy rains. Nearly four million people were affected and many had undergone resettlement. This study investigated the impacts of the flooding on people living in the disaster-affected rural communities. The findings were compared with baseline information collected in 2010 about health issues in rural villages in Hainan. Health outcome comparisons also were made between ethnic groups (Han versus Li).MethodsA two-stage cluster-sampling, cross-sectional post-disaster study was conducted. The entire Hainan Island was categorized into ranks of different severity in rainfall amount and associated damage in October (most severe, intermediate, least severe). The county with the most rainfall and the most severe ranking and the one with least rainfall and the least severe ranking were identified. In each county, one Han and one Li village were chosen by using a computer-generated random number, so four villages were sampled in total. More than 100 individuals ≥ 50 years of age were interviewed by face-to-face survey. Data on disaster-related injuries, socio-demographic information, non-communicable disease, lifestyle, and mental health were collected.ResultsFindings indicated the severity of impact was associated with self-reported health outcomes of older population. Gender and ethnic differences were found in reported health outcomes. Predictors of adverse post-disaster health outcomes in older populations in rural communities were identified.ConclusionsThe results demonstrated significant differences in the impacts of flooding in rural populations. Targeted services and interventions should be planned to address the disparity and meet the physical and mental health needs post-disaster.
(A140) An Analysis of National Survey on Disaster Drill by Emergency Medical Centers in Korea
Authors: Wang S.J. 
Published: May 2011

IntroductionDisaster drills have been performed officially for disaster medical preparedness by wide regional emergency medical centers in Korea. Government evaluates these disaster drills every year, but this evaluation is performed based on administrative aspect not disaster medical aspect. Also there are insufficient number of research on disaster drill not on disaster itself, especially national level. So these disaster medical drills were analyzed and reevaluated.MethodsDisaster drills performed by wide regional emergency medical centers in Korea were evaluated and analyzed from August 2006 to July 2008. Disaster drill planning, performance, kinds of disaster drill, contents of drill and resources of drill were collected and analyzed in medical aspect based on the disaster drill report and additional compensation of incomplete data by direct contact with the participating institutions. The appropriateness and evaluation results referred to the guideline of National Emergency Medical Center of Korea.ResultsAll the wild regional emergency medical centers had their own disaster drill planning and resource application planning for drills and real disasters. Most of disaster drill planning were appropriate, but disaster facility was the weakest point in the planning. Types of disasters in disaster drills were fire and structural collapse(44.4%), special disaster(13.7%), natural disaster(1.7%). Average duration of disaster drills were 6.12 hours and 1.26 days. Real field drill rate was 80.3%. Sixty five percent of drills were connected to multiple institutions or organizations other than hospitals. Number of participating persons from wide regional emergency medical centers were 21 on average.ConclusionsMedical situation on disaster drills is that there are various levels and kinds of disaster drills done by wide regional emergency medical centers, so the quality and quantity should be enforced in low level centers. It is recommended that international situation or database can be extracted based on this research.
(A141) Hospital Preparedness for a Large Scale Biological Drill
Authors: Benin-Goren O. , Miller E. , Dalla I. 
Published: May 2011

BackgroundDuring the past four years large scale biological exercises took place in several districts of the state of Israel. The drills included hospitals, Health Maintenance Organizations (HMOs), Emergency Medical Services (EMS), public health district offices and interface agencies such as Israel Defense Forces (IDF) Home Front Command (HFC).Discussion and ObservationsOn January 2010 a comprehensive biological exercise was conducted in Tel Aviv. Tel Aviv Sourasky Medical Center (TASMC) together with the agencies mentioned above practiced the hospital competing with Exceptional Biological Event. New elements, which had never been inspected before, were evaluated in this drill:
•Activating of a triage point at the hospital gate.•Opening a special registration point.•Staff protection from biological agents.•Activating a separate Emergency Department (ED) for bio- threat.•Detection and Containment ward.•Protected elevators and passageways•Interface agencies in and out the hospital.Designated physicians, nurses and paramedical team, that practiced other events in the past, needed to be trained and practiced in order to be ready for a biological event. Wards that usually did not participate in such drills, needed to take part in this particular drill, while the routine work continued. This paper presents the hospital preparation for the drill, the methodology of training and preparedness, as well as the outcome of the drill.
(A142) Simulated Evacuation of Three Critical Hospital Departments: A Comparison
Authors: Dhondt E.L. , Lauwaert D. , Hendrickx C. 
Published: May 2011

BackgroundAccording to the Belgian Hospital Disaster Planning Act, all hospitals are required to have written disaster plans and to routinely conduct annual disaster drills. In 2010, three neighboring hospitals organized independently from each other an evacuation exercise of a critical care department (CCD): two university hospitals of a Dialysis Center and a One-day Surgery Clinic respectively and the military hospital of a Burn Unit.AimTo compare these CCD's evacuation plans and drills and the overall hospital emergency incident response and command system.Methods and ResultsConducting an evacuation exercise in a CCD, moving vulnerable highly dependent people towards an alternative shelter site is challenging, causing an important burden to ongoing medical specialist care, working staff and critical infrastructure. In all three CCD, it was decided to conduct a simulated evacuation exercise following an internal fire, thereby deploying fashioned simulated patients and visitors but bringing into action the regular attending medical, nursing and logistic staff. In each hospital a multidisciplinary design team was launched, consisting of the hospitals disaster preparedness coordinator, the EMS-staff, external emergency incident management and operational engineering experts. The appointed objectives for evaluation were the knowledge of the regular evacuation drills, especially the clearance of an intensive care or an operating room; access to evacuation routes; visibility of safety guidelines; need of specific evacuation equipment for the movement of patients; mission and tasks of the hospital's first response team and the medical incident manager; communication and information flow and the establishment of the hospital's coordination committee.Conclusion1. Simulated hospital evacuation exercises increased the hospital emergency preparedness, awareness and response to disasters within the hospital, in particular in a CCD, otherwise difficult to assess. 2. All three CCD experienced the same challenges and identified similar flaws. 3. A hospital disaster exercise manual might be of valuable help.
(A154) A Comprehensive Thrombolysis Service for Patients with Acute Ischemic Stroke Administered Prehospital and in an Emergency Department in Northern Taiwan
Authors: Chen Y. , Chen C. , Chiang C. , Peng G. , Tzeng R. , Huang H. , Huang C. , Wu W. , Hsiung K. , Liu H. 
Published: May 2011

BackgroundGolden time of thrombolysis therapy in acute ischemic stroke is only three hours. Emergency medical services transport and hospital prenotification were not been strengthened in Taiwan.AimsIn order to elevate the medical quality of acute ischemic stroke, we developed a Quality Control Circle (QCC) focused on a comprehensive thrombolysis service for patients with acute ischemic stroke administered pre-hospital and in an emergency department.MethodsQCC activities contained early recognition of acute stroke by EMT, hospital prenotification, early emergency management, activate the stroke team, shorten the time to CT scan and report, and early thromobolytic therapy. There were three policy groups via quality method analysis which these methods aimed to improve the efficiency and quality of management process focused on acute ischemic stroke.ResultsGroup 1: After the implementation of QCC, the number of times of pre-hospital notification was six in Mar. 2010, achieve the expected standard. Group 2: Responses were received from 160 people for the pretest and 145 people for the posttest. In the pretest and posttest analysis, significant improvement in the attitudes of the physician group (p < 0.001) and general behavior (p < 0.001) were disclosed. The case-based educational module of acute stroke was better than the traditional oral lecture especially in the nursing group (p < 0.001). Group 3: The rate of administering thrombolytic therapy/total ischemic stroke increased from 3.1% to 10.5 % (from Mar to Apr, 2010) after running the organized service. These activities reached the goal of expected standard (5%). All above groups were set up into standardization. The thrombolytic rate in effect maintainence was still around 5% eight months later.ConclusionSetting up and running a organized thrombolysis service for patients with acute ischemic stroke prehospital and in the emergency department can be a good method to increase the rate of administration of thrombolytic therapy.
(A155) Acute Myocardial Infarction with Upper Gastrointestinal Bleeding
Authors: Tandon S. , Bordoloi P. , Kole T. 
Published: May 2011

ObjectiveTo report a rare case of Acute Myocardial Infarction (AMI) along with Upper Gastrointestinal bleeding (UGIB).Presentation and InterventionA 58 year old male with history of black coloured stools was admitted in ER for chest pain and coffee ground emesis. ECG showed an acute inferior wall MI. After doing the necessary interventions, patient was inserted with a nasogastric tube and started on medications in the Emergency for UGIB followed by immediate endoscopy. Endoscopy confirmed presence of multiple superficial Ulcers in the stomach along with Esophagitis.ConclusionWe support Esophagogastroduodenoscopy (EGD) prior to cardiac catheterisation in patients with AMI associated with overt Upper GI Bleed. This results in fewer complications as compared with direct catheterization
(A158) Preventing Disasters: Public Health Vulnerability Reduction as a Sustainable Adaptation to Climate Change
Authors: Keim M. 
Published: May 2011

BackgroundGlobal warming is predicted to increase the number and severity of extreme weather events. (IPCC 2007) But we can lessen the effects of these disasters. “Critically important will be factors that directly shape the health of populations such as education, health care, public health prevention and infrastructure.” (IPCC 2007) A comprehensive approach to disaster risk reduction (DRR) has been proposed for climate change adaptation. (Thomalla 2006) DRR is cost-effective. One dollar invested in DRR can save $2-10 in disaster response and recovery costs. (Mechler 2005) Disasters occur as a result of the combination of population exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity to reduce or cope with the potential negative consequences.DiscussionBy reducing human vulnerability to disasters, we can lessen—and at times even prevent—their impact. Vulnerability may be lessened by: 1) reducing human exposures to the hazard by a reduction of human vulnerability, 2) lessening human susceptibility to the hazard, and 3) building resilience to the impact of the hazard. (Keim 2008) Public health disasters are prevented when populations are protected from exposure to the hazard. Public awareness and education can be used to promote a “culture of prevention” and to encourage local prevention activities. Public health disasters may also be mitigated through both structural and social measures undertaken to limit a health hazard's adverse impact. (IPCC 2007) Community-level public health can play an important part in lessening human vulnerability to climate-related disasters through promotion of “healthy people, healthy homes and healthy, disaster resilience communities.” (Srinivasan 2003)
(A72a) Development of Emergency Medical System in High Speed Train and Station
Authors: Wang S.J. , Byun H.J. 
Published: May 2011

IntroductionHigh speed train is defined as train which can run at the speed of more than 200Km/h and Korean version of high speed train (Korean Train Express: KTX) runs at 300Km/h on average. Because of high speed, safety is the most important issue of high speed train, so the early detection of technical error and operational safety have been emphasized. But the research about emergency medical system for patients occurring in the high speed train and stations is insufficient. So author analyzed the project on development of emergency medical system for cardiac arrest in the high speed train and stations.MethodsThe project on development of emergency medical system for cardiac arrest in the high speed train and stations was analyzed retrospectively and the real situation was confirmed by interviewing the staffs and visiting the high speed train and stations. The education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was analyzed. Simulation was perfomred for adequate distribution and arrangement of AEDs (automatic external defibrillators) in the high speed train and stations.ResultsThe education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was performed to 1323 persons from October 2008 to June 2009. Total 51 AEDs were arranged in 6 stations and 87 AEDs were arranged in the high speed train. One AEDs were arranged for successive 6 passenger car in a train. Public education by repeated video playing in the high speed train was started.ConclusionsThe emergency medical system for cardiac arrest in the high speed train and stations was developed by training staffs and arranging AEDs initially. The next step will be developing the disaster medical system in the high speed train.
(A204) Importance of Emergency Response Program Organizations in Coping with the Increasing Risk of CBRN Events
Authors: Ranghieri M. , Guidotti M. , Rossodivita A. 
Published: May 2011

IntroductionOne of the most prevalent issues identified by Emergency Response Program Organizations (ERPOs), is the inability to care for an overwhelming number of contaminated patients within a civilian community. Even when emergency responders successfully decontaminate and triage large numbers of patients at the scene, it is unlikely that neighboring hospitals are prepared and equipped to receive such a large amount of patients and treat them within the boundaries of the existing healthcare system. Thus, planners must avoid any collapse of the healthcare system and may need to redistribute existing resources to enhance and facilitate patient outcome. As a response to this issue, ERPOs should develop an alternative healthcare facility: the Off-Site Triage, Treatment and Transportation Center (Off-Site Center). This Center is a temporary patient clearinghouse to be disassembled once the flow of new patients has diminished to the point that they can be handled by the existing healthcare systems.MethodsThe Off-Site Center is intended to care for patients who have been triaged as “Minimal” at the scene, those patients who are worried that they might have been exposed to contamination, and those who self-refer to the Center.ResultsPlanners, administrators, first responders, medical professionals, and public health and emergency management personnel must evaluate the Concept of Operation for the Off-Site Center in order to increase their level of preparedness and provide effective mass-casualty care.ConclusionsIn this report, some general guidelines will be provided for the efficient planning and management of an Off-Site Center. A practical example will be also illustrated: a case study in Bergamo during a May 2010 National Meeting of the Italian Association of Alps Infantry Troops.