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Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control.
Problem
An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance.
Methods
A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed.
Results
Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant.
Conclusion
Waterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.
CaseyML, NguyenDT, IdrissB, BennettS, DunnA, MartinS. Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone. Prehosp Disaster Med. 2015;30(6):625–627.
Prompt prehospital care is essential for improving outcomes of road crash victims; however, this service is sub-optimal in developing countries because Emergency Medical Services (EMS) are not readily available. Training of lay responders in first aid has been suggested as a means of filling this gap in settings with inadequate EMS. This study was conducted to determine the effect of first aid training on the first aid knowledge and skills of commercial drivers.
Methods
A before-and-after study was conducted among 128 commercial drivers (62 intervention and 66 controls) selected by multi-stage sampling. Drivers’ first aid knowledge and skills were assessed at baseline, immediate, and three months post-intervention. The intervention involved a 2-day training session in first aid. Repeated measures ANOVA was used to test for differences in respondents’ pre- and post-intervention scores over the three assessment points.
Results
Mean first aid knowledge scores for intervention drivers were 48.9% (SD=12.0), 57.8% (SD=11.2), and 59.2% (SD=9.0) at baseline, immediate, and three months post-intervention. Corresponding scores for the controls were 48.3% (SD=12.8), 39.2% (SD=15.3), and 46.8% (SD=15.3). Mean first aid skill scores for intervention drivers were 17.5% (SD=3.8), 80.7% (SD=8.3), and 72.3% (SD=16.8). Scores for control drivers were 16.5% (SD=4.5), 16.3% (SD=4.7), and 20.4% (SD=9.1), respectively. Repeated measures ANOVA showed significant differences in first aid knowledge and skills scores over the three phases. Independent t-test revealed significant differences in scores between the intervention and control groups post-intervention.
Conclusion
The training led to significant improvement in first aid knowledge and skills of intervention drivers. This confirms that lay responders can be trained in provision of first aid. The slight drop in skills scores, which occurred three months post-intervention, highlights the need for periodic refresher trainings to be conducted for the drivers in order to maintain the knowledge and skills acquired.
OlumideAO, AsuzuMC, KaleOO. Effect of First Aid Education on First Aid Knowledge and Skills of Commercial Drivers in South West Nigeria. Prehosp Disaster Med. 2015;30(6):579–585.
The challenges presented by traumatic injuries in low-resource communities are especially relevant in South Sudan. This study was conducted to assess whether a 3-day wilderness first aid (WFA) training course taught in South Sudan improved first aid knowledge. Stonehearth Open Learning Opportunities (SOLO) Schools designed the course to teach people with limited medical knowledge to use materials from their environment to provide life-saving care in the event of an emergency.
Methods
A pre-test/post-test study design was used to assess first aid knowledge of 46 community members in Kit, South Sudan, according to a protocol approved by the University of New England Institutional Review Board. The course and assessments were administered in English and translated in real-time to Acholi and Arabic, the two primary languages spoken in the Kit region. Descriptive statistics, t-test, ANOVA, and correlation analyses were conducted.
Results
Results included a statistically significant improvement in first aid knowledge after the 3-day training course: t(38)=3.94; P<.001. Although men started with more health care knowledge: (t(37)=2.79; P=.008), men and women demonstrated equal levels of knowledge upon course completion: t(37)=1.56; P=.88.
Conclusions
This research, which may be the first of its kind in South Sudan, provides evidence that a WFA training course in South Sudan is efficacious. These findings suggest that similar training opportunities could be used in other parts of the world to improve basic medical knowledge in communities with limited access to medical resources and varying levels of education and professional experiences.
KatonaLB, DouglasWS, LenaSR, RatnerKG, CrothersD, ZondervanRL, RadisCD. Wilderness First Aid Training as a Tool for Improving Basic Medical Knowledge in South Sudan. Prehosp Disaster Med. 2015;30(6):574–578.
The incidence and mortality of traumatic brain injury (TBI) has increased rapidly in the last decade in China. Appropriate ambulance service can reduce case-fatality rates of TBI significantly. This study aimed to explore the factors (age, gender, education level, clinical experience, professional title, organization, specialty before prehospital care, and training frequency) that could influence prehospital doctors’ knowledge level and practices in TBI management in China, Hubei Province.
Methods
A cross-sectional questionnaire survey was conducted in two cities in Hubei Province. The self-administered questionnaire consisted of demographic information and questions about prehospital TBI management. Independent samples t-test and one-way ANOVA were used to analyze group differences in the average scores in terms of demographic character. General linear regression was used to explore associated factors in prehospital TBI management.
Results
A total of 56 questionnaires were handed out and 52 (93%) were returned. Participants received the lowest scores in TBI treatment (0.64; SD=0.08) and the highest scores in TBI assessment (0.80; SD=0.14). According to the regression model, the education level was associated positively with the score of TBI identification (P=.019); participants who worked in the emergency department (ED; P=.011) or formerly practiced internal medicine (P=.009) tended to get lower scores in TBI assessment; participants’ scores in TBI treatment were associated positively with the training frequency (P=.011); and no statistically significant associated factor was found in the overall TBI management.
Conclusion
This study described the current situation of prehospital TBI management. The prehospital doctors’ knowledge level and practices in TBI management were quantified and the influential factors hidden underneath were explored. The results indicated that an appropriate continuing medical education (CME) program enables improvement of the quality of ambulance service in China.
KouK, HouXY, SunJD, ChuK. Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings. Prehosp Disaster Med. 2015;30(6):560–568.
Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict.
Problem
Injuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce.
Methods
In a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence.
Results
Seventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ2=46.8; P<.001).
Conclusion
People injured in traffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.
SchneiderM. War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries. Prehosp Disaster Med. 2015;30(6):618–620.
To describe the process adopted to identify, classify, and evaluate legacy of health care planning in the host city of Porto Alegre for the Football World Cup 2014.
Background
There is an emerging interest in the need to demonstrate a sustainable health legacy from mass gatherings investments. Leaving a public health legacy for future host cities and countries is now an important part of planning for these events.
Process
The Ministry of Sports initiated and coordinated the development of projects in the host cities to identify actions, projects, and constructions to be developed to prepare for the World Cup. In Porto Alegre, a common structure was developed by the coordinating team to instruct legacy identification, classification, and evaluation. This structure was based on international documentary analysis (including official reports, policy documents, and web-based resources) and direct communication with recognized experts in the field.
Findings and Interpretation
Sixteen total legacies were identified for health surveillance (5) and health services (11). They were classified according to the strategic area, organizations involved, dimension, typology, planned or unplanned, tangible or intangible, territorial coverage, and situation prior to the World Cup. Possible impacts were then assessed as positive, negative, and potentiating, and mitigating actions were indicated.
Conclusions
The project allowed the identification, classification, and development of health legacy, including risk analysis, surveillance, mitigation measures, and provision of emergency medical care. Although the project intended the development of indicators to measure the identified legacies, evaluation was not possible at the time of publication due to time.
WittRR, KotlharMK, MesquitaMO, LimaMADS, MarinSM, DayCB, BandeiraAG, HuttonA. Developing Legacy: Health Planning in the Host City of Porto Alegre for the 2014 Football World Cup. Prehosp Disaster Med. 2015;30(6):613–617.
The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region.
Methods
This cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility.
Results
Three MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals’ emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers.
Conclusions
Deficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.
De WulfA, AluisioAR, MuhlfelderD, BloemC. Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study. Prehosp Disaster Med. 2015;30(6):553–559.
Hospital nurses play a key role in the aftermath of the occurrence of disasters and need specific competencies to work in these situations. From a global perspective, few models exist that focus on disaster nursing.
Problem
This study aimed to identify hospital nurses’ competencies in disaster situations.
Method
A qualitative, descriptive, exploratory study was developed using focus groups as a method of data collection. Three meetings were held from June through September 2012 with nurses who worked at a hospital used as reference for disaster situations in the South of Brazil. Thematic analysis of collected data generated the competencies. For statement standardization, a format consistent with a verb, a noun, and a complement was adopted.
Results
The group validated 17 competencies, which were organized according to the phases of emergency management described by the World Health Organization (WHO) and classified in domain areas of management, health care, communication, and education.
Conclusions
The competencies identified in this study can contribute to the education and practice of nurses in the hospital ambience, strengthening its capacity to face disaster situations.
MarinSM, WittRR. Hospital Nurses’ Competencies in Disaster Situations: A Qualitative Study in the South of Brazil. Prehosp Disaster Med. 2015;30(6):548–552.
To assess General Dental Practitioners’ (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management.
Materials and Methods
This study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence.
Results
A total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000).
Conclusions
High willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.
ChhabraKG, RajeshG, ChhabraC, BinnalA, SharmaA, PachoriY. Disaster Management and General Dental Practitioners in India: An Overlooked Resource. Prehosp Disaster Med. 2015;30(6):569–573.
Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of insanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.
DwivediS, CariappaMP. Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013. Prehosp Disaster Med. 2015;30(6):621–624.
The ultimate goals of conducting disaster research are to obtain information to: (1) decrease risks that a hazard will produce a disaster; (2) decrease the mortality associated with disasters; (3) decrease the morbidity associated with disasters; and (4) enhance recovery of the affected community. And decrease the risks that a hazard will produce a disaster. Two principal, but inter-related, branches of disaster research are: (1) Epidemiological; and (2) Interventional. Epidemiological research explores the relationships and occurrences that comprise a disaster from a particular event. Interventional research involves evaluations of interventions, whether they are directed at relief, recovery, hazard mitigation, capacity building, or performance. In response to the need for the discipline of Disaster Health to build its science on data that are generalizeable and comparable, a Disaster Logic Model (DLM) and a set of five Frameworks have been developed to structure the information and research of the health aspects of disasters. These Frameworks consist of the: (1) Conceptual; (2) Temporal; (3) Societal; (4) Relief/Recovery; and (5) Risk-Reduction Frameworks. The Frameworks provide a standardized format for studying and comparing the epidemiology of disasters, and with the addition of the DLM, for evaluating the interventions (responses) provided prior to, during, and following a disaster, especially as they relate to the health status of the people affected by, or at-risk for, a disaster. Critical to all five Frameworks is the inclusion of standardized definitions of the terms. The Conceptual Framework describes the progression of a hazard that becomes an event, which causes structural damage, which, in turn, results in compromised, decreased, or losses of function(s) (functional damage) that, in turn, produce needs that lead to an emergency or a disaster. The Framework incorporates a cascade of risks that lead from the presence of a hazard to the development of a disaster. Risk is the likelihood that each of the steps leading from a hazard to a disaster will take place, as well as the probabilities of consequences of each of the elements in the Conceptual Framework. The Temporal Framework describes this chronological progression as phases in order of their appearance in time; some may occur concurrently. In order to study and compare the effects of an event on the complex amalgam that constitutes a community, the essential functions of a community have been deconstructed into 13 Societal Systems that comprise the Societal Framework. These diverse, but inter-related, Societal Systems interface with each other through a 14th System, Coordination and Control. The DLM can be used to identify the effects, costs, outcomes, and impacts of any intervention. Both the Relief/Recovery and Risk-Reduction Frameworks are based on the DLM. The Relief/Recovery Framework provides the structure necessary to systematically evaluate the processes involved in interventions provided during the Relief or Recovery phases of a disaster. The Risk-Reduction Framework details the processes involved in interventions aimed at mitigating the risk that a hazard will produce a destructive event, and/or in capacity building to augment the resilience of a community to the consequences of such an event.
BirnbaumML, DailyEK, O’RourkeAP, LorettiA. Research and Evaluations of the Health Aspects of Disasters, Part I: An Overview. Prehosp Disaster Med. 2015;30(5):512–522.
A Conceptual Framework upon which the study of disasters can be organized is essential for understanding the epidemiology of disasters, as well as the interventions/responses undertaken. Application of the structure provided by the Conceptual Framework should facilitate the development of the science of Disaster Health. This Framework is based on deconstructions of the commonly used Disaster Management Cycle. The Conceptual Framework incorporates the steps that occur as a hazard progresses to a disaster. It describes an event that results from the changes in the release of energy from a hazard that may cause Structural Damages that in turn, may result in Functional Damages (decreases in levels of function) that produce needs (goods and services required). These needs can be met by the goods and services that are available during normal, day-to-day operations of the community, or the resources that are contained within the community’s Response Capacity (ie, an Emergency), or by goods and services provided from outside of the affected area (outside response capacities). Whenever the Local Response Capacity is unable to meet the needs, and the Response Capacities from areas outside of the affected community are required, a disaster occurs. All responses, whether in the Relief or Recovery phases of a disaster, are interventions that use the goods, services, and resources contained in the Response Capacity (local or outside). Responses may be directed at preventing/mitigating further deterioration in levels of functions (damage control, deaths, injuries, diseases, morbidity, and secondary events) in the affected population and filling the gaps in available services created by Structural Damages (compromise in available goods, services, and/or resources; ie, Relief Responses), or may be directed toward returning the affected community and its components to the pre-event functional state (ie, Recovery Responses). Hazard Mitigation includes interventions designed to decrease the likelihood that a hazard will cause an event, and should an event occur, that the amount of energy released will be reduced. Capacity Building consists of all interventions undertaken before an event occurs in order to increase the resilience of the community to an event related to a hazard that exists in an area-at-risk. Resilience is the combination of the Absorbing, Buffering, and Response Capacities of a community-at-risk, and is enhanced through Capacity-Building efforts. A disaster constitutes a failure of resilience.
BirnbaumML, DailyEK, O’RourkeAP, LorettiA. Research and Evaluations of the Health Aspects of Disasters, Part II: The Disaster Health Conceptual Framework Revisited. Prehosp Disaster Med. 2015;30(5):523–538.
Despite landmine-risk education programs and extensive demining activities on the Western border of Iran, landmines and unexploded ordnance (UXOs) still cause civilian and child casualties three decades after the Iraq-Iran war (1980-1988). The objective of this study was to understand the epidemiological patterns and risk factors of injury in child casualties of landmines and UXOs in Western and Southwestern Iran.
Methods
Children who were 18 years old or younger at the time of study and who sustained injuries from landmines and UXOs were identified through a search at the Iranian National Veterans Registry. These children participated in a 5-day gathering. The information on socioeconomic status, health-related issues, quality of life, health care utilization, and clinical profiles concerning the landmine and UXO injuries were collected. The method of data collection consisted of three component surveys: health interview, social survey, and medical examinations. Social surveys and health interviews were conducted in a face-to-face method by utilizing a questionnaire consisting of 39 questions addressing household and individual components, including information on time and type of injuries, physical activity, mental health, and quality of life. A comprehensive team of physicians in different subspecialties evaluated and examined children to assess the current medical and psychiatric conditions and physical activity, and recommended and arranged further medical, rehabilitation, or surgical planning.
Results
Seventy-eight child casualties were identified and participated in the study. The mean age of the participants at the time of study was 16.11 years old (SD=2 years). The mean age of victims at the time of injury was 8.2 years (SD=3.12 years; ranged from 2 to 15 years old). Sixty-seven (85.9%) of the children were male. Provinces of Kurdistan and Kermanshah had the highest number of casualties, with a total number of 54 children (68.3%). Eighty percent of the injuries were caused by landmines, and UXO explosions were reported in 20% of the cases. Overall, 24 children (30%) had received some landmine-risk education before or after the events. Sixty percent of the explosions had happened in the morning between 9:00 am and 12:00 pm. Playing and grazing livestock were the most prevalent activities/reasons at the time of injury, which were reported in 77% of the subjects. Sixty-three percent of incidents had multiple casualties and in only 13 explosions were the children the only victims of the explosion. The most prevalent injuries were amputations in 41 subjects (52.56%), followed by hearing loss in 23 subjects (29.5%). Amputations were more common in upper extremities (62%) than in lower extremities (38%).
Conclusion
Landmines and UXOs comprise a significant safety hazard to the children living in the Western border of Iran decades after the Iraq-Iran War. The large number of injuries and lack of risk training among victims suggest that landmine cleanings and landmine-risk education should be age-specifically targeted and expanded substantially.
MousaviB, SoroushMR, MasoumiM, KhateriS, ModirianE, ShokoohiH, FatemiMJ, HemattiMA, SoroushM, Ghassemi-BroumandM, RassafianiM, AllamiM, NouriF, YavariA, GanjparvarZ, KamyabM, MirsadeghiSA, Epidemiological Study of Child Casualties of Landmines and Unexploded Ordnances: A National Study from Iran. Prehosp Disaster Med. 2015;30(5):472–477.
On October 29th, 2012, Hurricane Sandy caused a storm surge interrupting electricity with disruption to Manhattan’s (New York, USA) health care infrastructure. Beth Israel Medical Center (BIMC) was the only fully functioning major hospital in lower Manhattan during and after Hurricane Sandy. The impact on emergency department (ED) and hospital use by geriatric patients in lower Manhattan was studied.
Methods
The trends of ED visits and hospitalizations in the immediate post-Sandy phase (IPS) during the actual blackout (October 29 through November 4, 2012), and the extended post-Sandy phase (EPS), when neighboring hospitals were still incapacitated (November 5, 2012 through February 10, 2013), were analyzed with baseline. The analysis was broken down by age groups (18-64, 65-79, and 80+ years old) and included the reasons for ED visits and admissions.
Results
During the IPS, there was a significant increase in geriatric visits (from 11% to 16.5% in the 65-79 age group, and from 6.5% to 13% in the 80+ age group) as well as in hospitalizations (from 22.7% to 25.2% in the 65-79 age group, and from 17.6% to 33.8% in the 80+ age group). However, these proportions returned to baseline during the EPS. The proportions of the categories “dialysis,” “respiratory device,” “social,” and “syncope” in geriatric patients in ED visits were significantly higher than younger patients. The increases of the categories “medication,” “dialysis,” “respiratory device,” and “social” represented two-thirds of absolute increase in both ED visits and admissions for the 65-79 age group, and half of the absolute increase in ED visits for the 80+ age group. The categories “social” and “respiratory device” peaked one day after the disaster, “dialysis” peaked two days after, and “medication” peaked three days after in ED visit analysis.
Conclusions
There was a disproportionate increase in ED visits and hospitalizations in the geriatric population compared with the younger population during the IPS. The primary factor of the disproportionate impact on the geriatric population appears to be from indirect effects of the hurricane, mainly due to the subsequent power outages, such as “dialysis,” “respiratory device,” and “social.” Further investigation by chart review may provide more insights to better aid with future disaster preparedness.
GotandaH, FogelJ, HuskG, LevineJM, PetersonM, BaumlinK, HabbousheJ. Hurricane Sandy: Impact on Emergency Department and Hospital Utilization by Older Adults in Lower Manhattan, New York (USA). Prehosp Disaster Med. 2015;30(5):496–502.
Smartphone applications (or apps) are becoming increasingly popular with emergency responders and health care providers, as well as the public as a whole. There are thousands of medical apps available for Smartphones and tablet computers, with more added each day. These include apps to view textbooks, guidelines, medication databases, medical calculators, and radiology images.
Hypothesis/Problem
With an ever expanding catalog of apps that relate to disaster medicine, it is hard for both the lay public and responders to know where to turn for effective Smartphone apps. A systematic review of these apps was conducted.
Methods
A search of the Apple iTunes store (Version 12; Apple Inc.; Cupertino, California USA) was performed using the following terms obtained from the PubMed Medical Subject Headings Database: Emergency Preparedness, Emergency Responders, Disaster, Disaster Planning, Disaster Medicine, Bioterrorism, Chemical Terrorism, Hazardous Materials (HazMat), and the Federal Emergency Management Agency (FEMA). After excluding any unrelated apps, a working list of apps was formed and categorized based on topics. Apps were grouped based on applicability to responders, the lay public, or regional preparedness, and were then ranked based on iTunes user reviews, value, relevance to audience, and user interface.
Results
This search revealed 683 applications and was narrowed to 219 based on relevance to the field. After grouping the apps as described above, and subsequently ranking them, the highest quality apps were determined from each group. The Community Emergency Response Teams and FEMA had the best apps for National Disaster Medical System responders. The Centers for Disease Control and Prevention (CDC) had high-quality apps for emergency responders in a variety of fields. The National Library of Medicine’s Wireless Information System for Emergency Responders (WISER) app was an excellent app for HazMat responders. The American Red Cross had the most useful apps for natural disasters. Numerous valuable apps for public use, including alert apps, educational apps, and a well-made regional app, were also identified.
Conclusion
Smartphone applications are fast becoming essential to emergency responders and the lay public. Many high-quality apps existing in various price ranges and serving different populations were identified. This field is changing rapidly and it deserves continued analysis as more apps are developed.
BachmannDJ, JamisonNK, MartinA, DelgadoJ, KmanNE. Emergency Preparedness and Disaster Response: There’s An App for That. Prehosp Disaster Med. 2015;30(5):1–5.
Exercises that simulate emergency scenarios are accepted widely as an essential component of a robust Emergency Preparedness program. Unfortunately, the variability in the quality of the exercises conducted, and the lack of standardized processes to measure performance, has limited the value of exercises in measuring preparedness.
Methods
In order to help health organizations improve the quality and standardization of the performance data they collect during simulated emergencies, a model online exercise evaluation toolkit was developed using performance measures tested in over 60 Emergency Preparedness exercises. The exercise evaluation toolkit contains three major components: (1) a database of measures that can be used to assess performance during an emergency response exercise; (2) a standardized data collection tool (form); and (3) a program that populates the data collection tool with the measures that have been selected by the user from the database. The evaluation toolkit was pilot tested from January through September 2014 in collaboration with 14 partnering organizations representing 10 public health agencies and four health care agencies from eight states across the US. Exercise planners from the partnering organizations were asked to use the toolkit for their exercise evaluation process and were interviewed to provide feedback on the use of the toolkit, the generated evaluation tool, and the usefulness of the data being gathered for the development of the exercise after-action report.
Results
Ninety-three percent (93%) of exercise planners reported that they found the online database of performance measures appropriate for the creation of exercise evaluation forms, and they stated that they would use it again for future exercises. Seventy-two percent (72%) liked the exercise evaluation form that was generated from the toolkit, and 93% reported that the data collected by the use of the evaluation form were useful in gauging their organization’s performance during the exercise. Seventy-nine percent (79%) of exercise planners preferred the evaluation form generated by the toolkit to other forms of evaluations.
Conclusion
Results of this project show that users found the newly developed toolkit to be user friendly and more relevant to measurement of specific public health and health care capabilities than other tools currently available. The developed toolkit may contribute to the further advancement of developing a valid approach to exercise performance measurement.
AgboolaF, BernardD, SavoiaE, BiddingerPD. Development of an Online Toolkit for Measuring Performance in Health Emergency Response Exercises. Prehosp Disaster Med. 2015;30(5):503–508.