bluuebunny/crossref_metadata_2025_split huggingface dataset:
(A13) Effective Proactive Outreach among Disaster Relief Workers (DRW) in an Emergency Mortuary (EM)
Authors: Dhondt E.L. , Heulot A. 
Published: May 2011

BackgroundFollowing the Buizingen train-crash disaster on February 15, 2010, nineteen dead bodies were evacuated to the morgue of the Military Hospital. According to the hospital's emergency incident management system, the reception plan for the deceased was activated and an EM organized. Aim: To determine the psychological impact of exposure to current death and to evaluate the effect of proactive outreach in DRW deployed in an EM.Methods and ResultsFor five consecutive days 62 hospital staff personnel were involved in the daily activities of an EM: disaster victim identification, autopsies, care for the dead, logistic support and reception and mental relief of the families. Besides a critical incident debriefing on day 5, a postal questionnaire survey of these 62 DRW was conducted, including the Davidson Trauma Scale (DTS) – detecting acute post-traumatic stress reactions/symptoms (ASR/S) – and the Symptom Checklist SCL 90 self-report inventory – measuring primary symptoms and global distress – administered 2, 4 and 7 months following the train-crash. Out of these, 35 (56%) initially responded (informed consent), followed by a return rate of 80% (28/35) and 68% (19/28) respectively. Six out of the 35 participants were identified suffering from acute psychological distress according to DTS and SCL 90 and subsequently followed up in the hospital's dedicated Military Centre for Crisis Psychology. In five of them, normalization of symptoms had occurred by the second inquiry and persisted. Ten months post-event, only 1 patient still needs psychological counseling, whereas 34 demonstrated psychological resilience.ConclusionPrevalence of chronification is low (1/35) compared to literature (5 to 10%). Timely detection of acute distress and proactive outreach may effectively counterbalance chronification in tertiary victims following a critical incident. Education and training should help hospital staff deal with ASR/S and improve coping. Hospitals should support professionals in the most disturbing situations.
(A16) Using Geographical Information Systems in Road Traffic Injury Research: A Case Study of New Mumbai, India
Authors: Srikanth A. , Guru B. 
Published: May 2011

IntroductionA multidisciplinary approach with Geographical information systems, Public health and Social science inputs was adopted to survey the fatal and non-fatal traffic crash events in the New Mumbai municipality region in Western India to identify the risky zones on the arterial highways.MethodsA Standardized questionnaire was used to collect event data about the time, date, day of the week, location, type of injury, and vehicle type involved in the accidents, from the police station records. The data for the time period of January 2009 to July 2010 was merged into ESRI's ArcGIS software as attribute data. All the crash sites were georeferenced into the base map (with the major road networks of the region) by using a GPS receiver.ResultsAnalysis was done for Hot spot identification along the major highways, number of accidents, number of fatalities and injured, case-fatality ratio and number of accidents with only financial loss. Further, the role of environmental, geographical, sociological and constructional factors was highlighted on the locations of the RTC. These roadway factors, weather, population density, road conditions, profile of the injured and healthcare access was studied. Majority of RTCs occurred during normal weather and road conditions, during daylight and on dry roads. All the analyses and interpretations were done within the ArcGIS software environment and classifying RTCs according to the attributes on the Geodatabase gave significant results.ConclusionSpatial analysis using GIS for Road Traffic Accidents to identify hot spots to identify high risk zones in the region enables policy makers to design injury prevention strategies for RTCs. In India, further GIS-based research is needed for planning access to emergency health care, to determine environmental-related causes, developing Injury registries and design population-based educational interventions in a developing country setting.
(A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India
Authors: Lodhia N.A. , Strehlow M. , Pirrotta E. , Swathi B.N.V. , Gimkala A. , Sistla S. , Rao R. , Mahadevan S. 
Published: May 2011

BackgroundNon-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.MethodsAll patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.ResultsA total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.ConclusionThis initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.
(A19) Establishing a Trauma Registry at the National Referral Hospital in Thimpu, Bhutan
Authors: Nelp T.B. , Manice N.F. , Morris S.C. 
Published: May 2011

BackgroundThe burden of traumatic injuries is increasing in Bhutan. Data from the Ministry of Health of Bhutan (MoH) indicates that the number of injuries has increased 37% from the years 2004 to 2008. Current data on demographics, cause, and outcome of injuries is not well documented, leaving the MoH with insufficient data to guide policy decisions. The MoH and the Bhutan Foundation have prioritized development of a national trauma registry in Bhutan, starting with a trauma registry at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH).ObjectiveTo design and implement a sustainable tool for the collection and storage of data describing trauma patients at JDWNRH.Design and MethodsThe trauma team defined trauma as any injury that requires an evaluation, intervention, or admission to the hospital. A paper based tool was designed by consensus to collect data on demographics, injury type, injury location, injury severity, treatments and outcomes. A hospital based system to processes the data into Microsoft Access was established and data collection began in September 2010. Monitoring is ongoing to ensure the reliability of data.DiscussionDuring a four month period, with a team of physicians, government officials and public health staff developed a model trauma registry. The registry emphasized simplicity in design and execution and will serve as a stepping stone for a nation-wide trauma registry. Data collected from JDWNRH will provide the MoH with a detailed set of injury data to help with policy and resource utilization decisions. Logistical and technical challenges of developing a trauma registry are similar across health systems and this data collection tool and the lessons learned could be adapted to fit other institutions or health systems worldwide.
(A37) Characteristics and Evaluation of China's Earthquake Disaster Management Systems
Authors: Svirchev L. , Li Y. , Yan L. , He C. , Ma B.L. 
Published: May 2011

BackgroundThis presentation summarizes our ongoing hybrid sociological-geological research into China's earthquake disaster management systems. Our methodology is a grounded research approach, based firstly on field observations related to the Wenchuan earthquake, including interviews with survivors and professionals responsible for disaster management; secondly on an extensive review of the English-language disaster management literature. China's earth scientists, frequently in collaboration with international scientists, have created a substantial English-language literature, but the social literature on disasters in China is scant. China's geographic variation is complex, with significant fault lines criss-crossing the nation.DiscussionApproximately half of the population lives in areas with a high risk of earthquakes. The two most-devastating of these since 1949 were the 1976 point-source Tangshan earthquake with mortality of 242,419, and the 2008 huge-area Wenchuan earthquake with mortality of 69,226. Our research has found that China's earthquake disaster management systems at the local, provincial, and national levels respond rapidly to earthquakes. National mobilization for rescue-relief after the Tangshan earthquake began within six hours, and within two hours for the Wenchuan earthquake. These systems are also characterized by reconstruction planning that functions in parallel to, and melds into, the relief effort streams. China's major infrastructure projects, such as hydro-electric power dams, are designed to resist extreme earthquake; however, rural mountain populations and the historic built-environment have low earthquake resistance, conditions which will endure for a long time.ConclusionsAs a result of the Wenchuan earthquake, China has undertaken ambitious three-dimensional monitoring and response programs. We recommend studies and action to reconnoiter, investigate, and prevent population exposure to geo-hazards, particularly in the Qinghai-Tibet Plateau. In summary, China excels at disaster response but has not yet entered a development era of preventing the population's exposure to earthquake hazards.
(A70) Traumatic Brain Injuries at a Rural Teaching Hospital: Pattern of Presentation and Documentation
Authors: Agrawal A. , Kakani A. , Baisakhiya N. , Galwankar S. , Dwivedi S. 
Published: May 2011

Background and ObjectivesAnalyses of causes and trends of traumatic brain injuries help to define public health policy priorities. There are not much TBI registries, thus making documentation of injuries inadequate and accessing these data problematic. This study is aimed at identifying the characteristics of TBI and determining the efficiency of documentation of patients' records in a tertiary hospital.Patients and MethodsBased on WHO guidelines “Standards for Surveillance of Neurotrauma” we designed a proforma to collect data on traumatic brain injuries. A prospective data collection was done from January to June 2010. Data was collected on a paper form and then entered into the self-developed TBI registry database. Descriptive analysis was performed.ResultsData for a total 414 patients were collected. Mean age was 33.00 years (SD ± 16.725, range 1–85 years), and 81% male. Most of the accidents took place on highways (57.2%), commonest being the road traffic accidents (55.1%), brought by relatives (74%). The mean duration for hospital stay was 5.42 days (SD ± 8.312 days, range 1-79 days). 10% patients required resuscitation at the time of admission. Details of Glasgow coma scale were available; details regarding CT scan findings were available for 300 patients. Good recovery was seen in 68.4% and the mortality was in 7.2%. Further details on vital parameters and investigations included in the study were also collected.ConclusionsTBI related research in many developing countries is in the developmental stages with relatively few published data. Although early analysis of a TBI data can lead to useful information, there is further need for the development of a user-friendly secure web-based database system to continuously maintain and analyze the registry.
(A73) Burden of Maxillofacial Trauma at Level Trauma 1 Centre
Authors: Sagar S. , Singhal M. , Kataria K. , Kumar S. , Gupta A. , Mishra B. 
Published: May 2011

BackgroundThere is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide.MethodA retrospective study of patients with maxillofacial fractures seen and treated at the Jai Parkash Narayan Apex Trauma Center, AIIMS, New Delhi, India between January 2007 to June 2010. Data extracted from the patients' records include aetiology, age, sex, types and sites of fractures, treatment modality and concomitant injuries.ResultsThere were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (56.8%) was the most common aetiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 years to 75 years (mean = 34.7) with a peak incidence in the 3rd decade with a male–female sex ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615(77%) and middle third 205(23%). With regards to mandibular fractures, the body (29.6%) was the commonest sites, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%) and Lefort III (3.3%). Majority of the patients were treated by Open reduction and internal fixation (70.6). Concomitant injuries were 10.8% with orthopaedic injuries accounting for the majority (63.9%). Head injury was associated with 16.3 % of cases.ConclusionMaxillofacial fractures are on the increase. We advocate the establishment of regionalized trauma centers with basic training available to all surgical residents for initial emergency room management.
(A78) EMS System Assessment & Gap Analysis
Authors: Skeen T. 
Published: May 2011

PurposeThe World Health Organization Model Trauma System Policy suggests that Governments should undertake systematic reviews of the de facto prehospital transport systems for severely ill and injured persons. These systems, be they formal or informal, should be designed to optimize local resources with emphasis on standards of training, equipment, infrastructure and communications so as to assure delivery of prompt, quality, and equitable prehospital care. Scope of Review and Assessment a System Assessment and Gap Analysis (SAGA) tool has been developed to measure 127 key components of a high performance emergency transport system within the realms of Clinical, Organizational and Logistical functionality. The evaluation compares the current status of the specific components with those commonly expected to be seen in a formal international accredited EMS organization.MethodologyThe tool utilizes a thorough investigative process sufficient to produce credible and practical data which can be used to form a “System Improvement Plan.” While the scope of the project can be seen as relatively broad, the assessment process allows for adaptation to a wide variety of EMS system models which bring specific focus to the greatest areas of improvement opportunity with practical applications and alignment with those resources which are available to a given governmental entity.PresentationThis abstract, (in both oral and poster presentation format), demonstrates a portional mock evaluation with focus on those components often overlooked by both evolving and mature formal system designs by the international EMS community. The SAGA approach is an invaluable tool for those responsible for integrating the functionality and needs of a broad range of stake holders into the overarching prehospital delivery system in building support for qualitative improvements.
(A82) Triage in the Prehospital Setting
Authors: Khorram- Manesh A. , Hedelin A. , Ortenwall P. 
Published: May 2011

IntroductionThe prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.AimThe aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.Method and MaterialOver 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.ResultsThere was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.Discussion and ConclusionsA mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
(A124a) Developing Pediatric Emergency Preparedness Performance Measures
Authors: Markenson D. , Reilly M. 
Published: May 2011

BackgroundThe most obvious deficiency in the current evaluation of disaster response is the lack of objective, quantifiable measures of performance. This frequently leads to assessments that are highly subjective depending on the evaluator, does not provide those who are planning with targets to achieve, and does not allow for measures that they have improved their preparedness. The goal of this research project is to offer recommendations for government agencies at the federal, regional, and local levels, public health departments, and health care institutions to aid in the development of pediatric emergency management performance measures.InterventionsThe goal was achieved through the application of traditional quality principles to the assessment of emergency management efforts and to the use of innovative analytic methodologies to develop comprehensive approaches to performance measurement in emergency management.Discussion and ObservationsWhen one discusses performance measures, it is important to remember that these are metrics we use to improve the quality of care. With regard to emergency management, performance measures are used to increase capacity and efficiency. A classic approach to health care performance measures is to discuss them with regard to the domains of structure, process, and outcome. Recently, in addition to these domains, volume has also become an important predictor of clinical outcomes. Although we believe that these domains can be applied to emergency management functions and the development of performance measures for disasters, there are some fundamental differences when compared with their use in development and categorization of traditional health care metrics which have been built in to our modification of these domains to emergency preparedness. This approach, quantitative methodology and consensus development process, when applied, will significantly advance pediatric preparedness. Ultimately, these pediatric specific measures must exist and be used to assess current levels of performance and guide resource allocation and targeted improvement efforts.
(A73) The Importance of Interagency Communications in the Tsunami Disaster Stricken Area in the 2011 East Japan Great Earthquake
Authors: Ogasawara M. , Ito K. , Saito K. 
Published: May 2011

IntroductionIn the 2011 East Japan Great Earthquake over 200 DMAT immediately headed to the disaster stricken area.ProgressLand lines and all mobile telephones had interrupted service. Radio communication could only be used at a short distance in one area. Satellite phones were the only means of communication, but since there were limited number of devices, power shortages. DMAT used a management browser called EMIS (Emergency Medical Information System) to exchange information and coordinate activity, but the internet itself did not work. Without communication equipment, the victims could not send or receive information and even DMAT had trouble understanding the situation. There was rumor of many victims in a wide range of isolated evacuation shelters that were left behind. The land was flooded, vehicles were carried away, the town was buried under debris and mud, and fires occurred one after another. The wounded and sick could not access hospitals immediately. Because of the blackout, the suspension of the water supply, and prospect of restoring heating were not in sight, an immediate confirmation of medical needs and triage of the sick and wounded were required. Therefore, as the disaster front headquarters, the fire department, police department, self-defense force, Japan Red Cross medical care relief squad, the city, the prefecture, and the public health center, many organizations in collaboration held meetings every day at 5:30 and 18:30 aiming to gather information and establish strong collaboration. Four teams from the Japan Red Cross medical care squad and 4 teams from the Ground Self-Defense force were dispatched in replacement of the insufficient DMAT to manage the disaster front. They restored roads and headed to isolated shelters and hospitals. With the cooperation of the Air Self-Defense Force, DMAT was sent by helicopter to an isolated peninsula.ResultWe use helicopters, ambulances, and Self-Defense Force vehicles to transport as many patients to hospitals in other regions, because there was no place to return home. In one of the isolated hospitals, they had to use candlelight in a room temperature below zero, they were unable to use the aspirator, and four patients were already deceased. The remaining 38 inpatients were transported out of the disaster area and preventable death could be prevented.ConsiderationBecause the local staff suffered damage from the earthquake, all organizations consisted of groups dispatched from other regions. With a communications network not functioning in the disaster stricken area, it is necessary to exchange information and share the best plans. Taking this into perspective, having two disaster relief measures meetings in one day was very effective.