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Prehospital first responders historically have treated hypoglycemia in the field with an IV bolus of 50 mL of 50% dextrose solution (D50). The California Contra Costa County Emergency Medical Services (EMS) system recently adopted a protocol of IV 10% dextrose solution (D10), due to frequent shortages and relatively high cost of D50. The feasibility, safety, and efficacy of this approach are reported using the experience of this EMS system.
Methods
Over the course of 18 weeks, paramedics treated 239 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes. Of these, 203 patients were treated with 100 mL of D10 initially upon EMS arrival, and full data on response to treatment was available on 164 of the 203 patients. The 164 patients’ capillary glucose response to initial infusion of 100 mL of D10 was calculated and a linear regression line fit between elapsed time and difference between initial and repeat glucose values. Feasibility, safety, and the need for repeat glucose infusions were examined.
Results
The study cohort included 102 men and 62 women with a median age of 68 years. The median initial field blood glucose was 38 mg/dL, with a subsequent blood glucose median of 98 mg/dL. The median time to second glucose testing was eight minutes after beginning the 100 mL D10 infusion. Of 164 patients, 29 (18%) required an additional dose of IV D10 solution due to persistent or recurrent hypoglycemia, and one patient required a third dose. There were no reported adverse events or deaths related to D10 administration. Linear regression analysis of elapsed time and difference between initial and repeat glucose values showed near-zero correlation.
Conclusions
In addition to practical reasons of cost and availability, theoretical risks of using 50 mL of D50 in the out-of-hospital setting include extravasation injury, direct toxic effects of hypertonic dextrose, and potential neurotoxic effects of hyperglycemia. The results of one local EMS system over an 18-week period demonstrate the feasibility, safety, and efficacy of using 100 mL of D10 as an alternative. Additionally, the linear regression line of repeat glucose measurements suggests that there may be little or no short-term decay in blood glucose values after D10 administration.
KieferMV, HernHG, AlterHJ, BargerJB. Dextrose 10% in the Treatment of Out-of-Hospital Hypoglycemia. Prehosp Disaster Med. 2014;29(2):1-5.
To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado.
Methods
Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians.
Report
After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs.
Conclusions
Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.
KanterRK, AbramsonD. School Interventions After the Joplin Tornado. Prehosp Disaster Med. 2014;29(2):1-4.
High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA.
Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.
SchulzCM, SkrzypczakM, RaithS, HinzmannD, KrautheimV, HeuserF, MayerV, KreuzerC, HimslM, HollM, LippC, KochsEF, WagnerKJ. High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise. Prehosp Disaster Med. 2014;29(2):1-7.
On March 11, 2011, a 9.1 magnitude earthquake occurred in the eastern Pacific Ocean off the coast of northern Japan. A resulting tsunami struck the Japan Pacific coast, causing >20,000 deaths, injuries and missing persons.
Survivors’ post-tsunami health and nutritional status were surveyed one month after the disaster in a school shelter in Ishinomaki City. Hyogo College of Medicine's disaster relief team observations and survivors’ questionnaires were used to assess the disaster's effects on survivors’ lifestyles and gastrointestinal symptoms while residing in temporary shelters. Of 236 disaster evacuees 9-88 years of age (mean age 52 years), 23% lost weight and 28% reported decreased food intake one month after the earthquake. Up to 25% of the participants presented with gastrointestinal symptoms, including constipation (10%), appetite loss (6.4%), vomiting (6.4%), and nausea (2.1%). Although the victims preferred more vegetables (44%) or fruit (33%), most food aid received, such as rice balls or bread, was carbohydrate-based, possibly because of easy provision and abundance in emergency food pantries. The authors asked the volunteers and the Japan Self-Defense Forces to provide a more balanced diet, including vegetables and fruit. Consumption of imbalanced diets may have caused more gastrointestinal symptoms for the survivors. Because of the victims’ hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.
InoueT, NakaoA, KuboyamaK, HashimotoA, MasutaniM, UedaT, KotaniJ. Gastrointestinal Symptoms and Food/Nutrition Concerns after the Great East Japan Earthquake in March 2011: Survey of Evacuees in a Temporary Shelter. Prehosp Disaster Med. 2014;29(3):1-4.
Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care.
Hypothesis
The investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement.
Methods
Critically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test.
Results
Patients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction.
Conclusion
Prehospital aeromedical point-of-care lactate measurement levels ≥4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.
MullenM, CerriG, MurrayR, TalbotA, SanseverinoA, McCahillP, MangoldsV, VolturoJ, DarlingC, RestucciaM. Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment. Prehosp Disaster Med. 2014;29(1):1-4.
Despite federal and local efforts to educate the public to prepare for major emergencies, many US households remain unprepared for such occurrences. United States Armed Forces veterans are at particular risk during public health emergencies as they are more likely than the general population to have multiple health conditions.
Methods
This study compares general levels of household emergency preparedness between veterans and nonveterans by focusing on seven surrogate measures of household emergency preparedness (a 3-day supply of food, water, and prescription medications, a battery-operated radio and flashlight, a written evacuation plan, and an expressed willingness to leave the community during a mandatory evacuation). This study used data from the 2006 through 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state representative, random sample of adults aged 18 and older living in 14 states.
Results
The majority of veteran and nonveteran households had a 3-day supply of food (88% vs 82%, respectively) and prescription medications (95% vs 89%, respectively), access to a working, battery-operated radio (82% vs 77%, respectively) and flashlight (97% vs 95%, respectively), and were willing to leave the community during a mandatory evacuation (91% vs 96%, respectively). These populations were far less likely to have a 3-day supply of water (61% vs 52%, respectively) and a written evacuation plan (24% vs 21%, respectively). After adjusting for various sociodemographic covariates, general health status, and disability status, households with veterans were significantly more likely than households without veterans to have 3-day supplies of food, water, and prescription medications, and a written evacuation plan; less likely to indicate that they would leave their community during a mandatory evacuation; and equally likely to have a working, battery-operated radio and flashlight.
Conclusion
These findings suggest that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events. Further research should examine household preparedness among other vulnerable groups including subgroups of veteran populations and the reasons why their preparedness may differ from the general population.
Der-MartirosianC, StrineT, AtiaM, ChuK, MitchellMN, DobalianA. General Household Emergency Preparedness: A Comparison Between Veterans and Nonveterans. Prehosp Disaster Med. 2014;29(2):1-7.
Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries.
Methods
An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding.
Results
The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded.
Conclusion
Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce.
IngrassiaPL, FolettiM, DjalaliA, ScaroneP, RagazzoniL, DellaCorte F, KaptanK, LupescuO, ArculeoC, von ArnimG, FriedlT, AshkenaziM, HeselmannD, HreckovskiB, Khorrram-ManeshA, KomadinaR, LechnerK, PatruC, BurkleFMJr., FisherP. Education and Training Initiatives for Crisis Management in the European Union: A Web-based Analysis of Available Programs. Prehosp Disaster Med. 2014;29(2):1-12.
When the world is faced with a new potential pandemic outbreak, the media report heavily about it. Media are an important disseminator of health threat information. This study examined potential media effects during the 2009 outbreak of A/H1N1 influenza.
Hypothesis
To examine the relationship between media reports of the swine flu and self-registrations in an emergency department (ED) of a tertiary hospital in Flanders, Belgium.
Methods
All articles concerning swine flu published in seven Flemish newspapers were selected during the biggest flu peak in Belgium. This number was compared with the number of patients who presented themselves with a self-diagnosis of swine flu symptoms during the same time frame. The Pearson's correlation coefficient was selected to determine the relationship. The cross-correlation function determined the direction of this relationship.
Results
A strong correlation was found between the number of potential patients (n = 308) and the number of articles in the Flemish press (n = 1657). The number of patients was the leading indicator; increases in the volume of written press followed increases in the number of patients.
Conclusion
Media reporting is extensive when a new infectious disease breaks out and intensifies when it is feared that pandemic levels are reached. This was also the case with the swine flu outbreak in Flanders. These findings suggest that a rise in the number of media reports follows a rise in the number of cases, rather than the reverse.
NelissenS, BeullensK, SabbeM, Van den BulckJ. The Swine Flu Emergency Department: The Relationship Between Media Attention for the Swine Flu and Registrations in an Emergency Medicine Unit. Prehosp Disaster Med. 2014;29(2):1-5.
Competency models attempt to define what makes expert performers “experts.” Successful disaster psychosocial planning and the institutionalizing of psychosocial response within emergency management require clearly-defined skill sets. This necessitates anticipating both the short- and long-term psychosocial implications of a disaster or health emergency (ie, pandemic) by developing effective and sustained working relationships among psychosocial providers, programs, and other planning partners. The following article outlines recommended competencies for psychosocial responders to enable communities and organizations to prepare for and effectively manage a disaster response.
Competency-based models are founded on observable performance or behavioral indicators, attitudes, traits, or personalities related to effective performance in a specific role or job. After analyzing the literature regarding competency-based frameworks, a proposed competency framework that details 13 competency domains is suggested. Each domain describes a series of competencies and suggests behavioral indicators for each competency and, where relevant, associated training expectations. These domains have been organized under three distinct categories or types of competencies: general competency domains; disaster psychosocial intervention competency domains; and disaster psychosocial program leadership and coordination competency domains.
Competencies do not replace job descriptions nor should they be confused with performance assessments. What they can do is update and revise job descriptions; orient existing and new employees to their disaster/emergency roles and responsibilities; target training needs; provide the basis for ongoing self-assessment by agencies and individuals as they evaluate their readiness to respond; and provide a job- or role-relevant basis for performance appraisal dimensions or standards and review discussions.
Using a modular approach to psychosocial planning, service providers can improve their response capacity by utilizing differences in levels of expertise and training. The competencies outlined in this paper can thus be used to standardize expectations about levels of psychosocial support interventions. In addition this approach provides an adaptable framework that can be adjusted for various contexts.
CoxRS, DanfordT. The Need for a Systematic Approach to Disaster Psychosocial Response: A Suggested Competency Framework. Prehosp Disaster Med. 2014;29(2):1-7.
The goals of conducting disaster research are to obtain information to: (1) decrease the human, environmental, and economic losses; (2) decrease morbidity; (3) decrease pain and suffering; and (4) enhance the recovery of the affected population. Two principal, but inter-related, branches of disaster research are: (1) Epidemiological; and (2) Interventional. In response to the need for the discipline of disaster health to build its science on data that are generalizable and comparable, a set of five Frameworks have been developed to structure the information and research of the health aspects of disasters: (1) Conceptual; (2) Longitudinal; (3) Transectional Societal; (4) Relief-Recovery; and (5) Risk-Reduction. These Frameworks provide a standardized format for studying and comparing the epidemiology of disasters as well as evaluating the interventions (responses) provided prior to, during, and following a disaster, especially as they relate to the health status of the people affected or at-risk. Critical to all five Frameworks is the inclusion of standardized definitions of the terms used to describe factors that lead to and affect the occurrence and severity of a disaster. The Conceptual Framework describes the progression of a hazard that becomes an event, which causes structural damage and a decrease or loss of function (functional damage), that, in turn, produces needs that lead to a disaster. The Longitudinal Framework describes this chronological progression as phases in order of their appearance in time, even though some of them occur concurrently. In order to study and compare the effects of an event on the complex amalgam that constitutes a society, the essential functions of a society have been deconstructed into 13 Basic Societal Systems that comprise the Transectional Societal Framework. These diverse, but inter-related Basic Societal Systems interface with each other through a 14th system called Coordination and Control. Epidemiological research studies the relationships and occurrences that influence and result from a disaster. Interventional research involves the evaluation of interventions, whether they are directed at relief, recovery, hazard mitigation, capacity building, or performance. The Relief-Recovery and Risk-Reduction Frameworks are based on a Disaster Logic Model. The Relief-Recovery Framework provides the structure necessary to systematically evaluate specific interventions provided during the Relief and Recovery phases of a disaster. The Risk-Reduction Framework details the processes involved in mitigating the risk that a hazard will produce a destructive event and/or that capacity building will augment the resilience of a community to the consequences of such an event. It incorporates a cascade of risks that lead from the presence of a hazard to the development of a disaster. Risk is described as the likelihood that each of the steps leading from a hazard to a disaster will take place; it also includes the probable consequences of the occurrence of each of the elements in the Conceptual Framework. The Conceptual, Longitudinal, and Transectional Societal Frameworks are useful in epidemiological research, i.e., the study of the incidence of, and factors influencing events and disasters. The Relief-Recovery and Risk-Reduction Frameworks are added to the Conceptual, Longitudinal, and Transectional Societal Frameworks for conducting and reporting of interventional research/evaluations. Examples of the application of these Frameworks are provided.
Situational awareness (SA), or being aware of what is going on and what might happen next, is essential for the successful management of prehospital emergency care. However, far too little attention has been paid to the flow of information. Having the right information is important when formulating plans and actions.
Problem
The aim of this study was to analyze and describe the type of information that is meaningful for SA in the work of paramedic field supervisors, and to create an information profile for them in the context of prehospital emergency care.
Methods
Data were collected from January through March 2012 from semi-structured interviews with ten paramedic field supervisors representing four rescue departments in Finland. The interviews were based on three different types of real-life scenarios in the context of prehospital emergency care, and deductive content analysis was employed according to the information exchange meta-model. Data management and analysis were performed using Atlas.ti 7.
Results
A paramedic field supervisor information interest profile was formulated. The most important information categories were Events, Means, Action Patterns, and Decisions. The profile showed that paramedic field supervisors had four roles – situation follower, analyzer, planner and decision maker – and they acted in all four roles at the same time in the planning and execution phases.
Conclusion
Paramedic field supervisors are multitasking persons, building SA by using the available data, combining it with extensive know-how from their working methods and competencies, and their tacit knowledge. The results can be used in developing work processes, training programs, and information systems.
Norri-SederholmT, KuusistoR, KurolaJ, SarantoK, PaakkonenH. A Paramedic Field Supervisor's Situational Awareness in Prehospital Emergency Care. Prehosp Disaster Med. 2014;29(2):1-9.
The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.
Methods
A systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.
Results
Across all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.
Conclusions
The rate of noncommunicable health issues varies across events and very serious emergencies are rare.
AlquthamiAH, PinesJM. A Systematic Review of Noncommunicable Health Issues in Mass Gatherings. Prehosp Disaster Med. 2014;29(2):1-9.
The case of a patient with a zone II penetrating neck injury who was intubated successfully utilizing the gum elastic bougie (GEB) is reported. He presented at a forward operational base in Afghanistan with a shrapnel wound in his neck as well as a cough and hoarseness. There were two wounds on each side of his laryngeal cartilages. The patient's breathing rate gradually increased and labored inhalation developed while the aeromedical evacuation was delayed for tactical reasons. Subcutaneous emphysema and edema concealed the anatomical landmarks, making a cricothyrotomy unsafe, and no fiber optic devices were available on site. Intratracheal intubation was decided upon by the doctors involved. Because of the anticipated difficultly of intubation, the GEB was used from the outset. During direct laryngoscopy, edema, blood, and mucus concealed the anatomic reliefs of the larynx. The glottis was not visible. On the second attempt, “clicks” were clearly perceived and the tube was railroaded over the bougie. Finally, the patient was evacuated to an Afghan military hospital.
In this report, the benefit-risk balance for the use of the GEB in penetrating neck trauma is discussed. Although the use of the GEB cannot be recommended in all cases of penetrating neck injury, it should be considered as an option. This technique is not without risk, but in very remote settings or hostile environments, especially when cricothyrotomy is not possible, it can be lifesaving.
DanielY, de RegloixS, KaiserE. Use of a Gum Elastic Bougie in a Penetrating Neck Trauma. Prehosp Disaster Med. 2014;29(2):1-2.
Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the “typical” patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations.
HuttonA, RanseJ, VerdonkN, UllahS, ArbonP. Understanding the Characteristics of Patient Presentations of Young People at Outdoor Music Festivals. Prehosp Disaster Med. 2014;29(2):1-7.
Telecommunication systems are important for sharing information among health institutions to successfully provide medical response following disasters.
Hypothesis/Problem
The aim of this study was to clarify the problems associated with telecommunication systems in the acute phase of the Great East Japan Earthquake (March 11, 2011).
Methods
All 72 of the secondary and tertiary emergency hospitals in Miyagi Prefecture were surveyed to evaluate the telecommunication systems in use during the 2011 Great Japan Earthquake, including satellite mobile phones, multi-channel access (MCA) wireless systems, mobile phones, Personal Handy-phone Systems (PHS), fixed-line phones, and the Internet. Hospitals were asked whether the telecommunication systems functioned correctly during the first four days after the earthquake, and, if not, to identify the cause of the malfunction. Each telecommunication system was considered to function correctly if the hospital staff could communicate at least once in every three calls.
Results
Valid responses were received from 53 hospitals (73.6%). Satellite mobile phones functioned correctly at the highest proportion of the equipped hospitals, 71.4%, even on Day 0. The MCA wireless system functioned correctly at the second highest proportion of the equipped hospitals. The systems functioned correctly at 72.0% on Day 0 and at 64.0% during Day 1 through Day 3. The main cause of malfunction of the MCA wireless systems was damage to the base station or communication lines (66.7%). Ordinary (personal or general communication systems) mobile phones did not function correctly at any hospital until Day 2, and PHS, fixed-line phones, and the Internet did not function correctly at any area hospitals that were severely damaged by the tsunami. Even in mildly damaged areas, these systems functioned correctly at <40% of the hospitals during the first three days. The main causes of malfunction were a lack of electricity (mobile phones, 25.6%; the Internet, 54.8%) and damage to the base stations or communication lines (the Internet, 38.1%; mobile phones, 56.4%).
Conclusion
Results suggest that satellite mobile phones and MCA wireless systems are relatively reliable and ordinary systems are less reliable in the acute period of a major disaster. It is important to distribute reliable disaster communication equipment to hospitals and plan for situations in which hospital telecommunications systems do not function.
KudoD, FurukawaH, NakagawaA, AbeY, WashioT, ArafuneT, SatoD, YamanouchiS, OchiS, TominagaT, KushimotoS. Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-5.
Faith-based organizations represent a source of stability and are an established presence in a community. They frequently serve their community following disasters. They are not formally included or identified as a disaster resource; thus, there is an opportunity to increase the effectiveness with which faith-based organizations prepare for and respond to disasters.
Problem
This pilot study aimed to assess perceptions of the level of disaster preparedness and resiliency among faith-based organizations as a first step in understanding how to improve disaster preparedness and resiliency among these organizations and their communities.
Methods
Survey and semi-structured interviews were conducted with six faith-based organizations, one with a leader and one with a staff member. Frequency distributions of survey questions were obtained. Interviews were transcribed and thematic analysis was supported by analytical software, ATLAS. ti.
Results
Results of the survey indicated strong social networks among congregation and community members. However, half of the members indicated that they did not socialize often with other races and other neighborhoods. Additionally, trust of other groups of people was generally low. Themes that emerged from qualitative analysis were: (1) perceived disaster preparedness and resiliency; (2) barriers to community preparedness and resiliency; (3) lessons learned from past disasters; (4) social services and networks; and (5) willingness to be prepared.
Conclusions
The results suggest that there is a need for interventions to improve disaster preparedness and resiliency among faith-based organizations.
MullerV, BurkeR, BergB, LinA, UppermanJ. A Mixed-methods Pilot Study of Disaster Preparedness and Resiliency Among Faith-based Organizations. Prehosp Disaster Med. 2014;29(2):1-7.
Geographically isolated islands are vulnerable during natural or technological disasters. During disasters, island health facilities should be able to secure power and water in order to continue operations.
Objective
This study sought to determine the existence of Greek island health facility backup systems for water and power. When such systems existed, reserve capacity was quantified and compared to the Pan American Health Organization (PAHO) Hospital Safety Index standards.
Methods
A standardized, self-administered questionnaire was sent to major health care facilities belonging to the national health system in all Greek islands. The biggest facility available in each island was included (hospital, health center, or health post). For Crete and Euboea, all hospitals were included.
Results
Fifty-four of 85 facilities queried (27 hospitals, 17 health centers and 41 health posts) responded, for a response rate of 64%. Responding to the survey were 16 hospitals, 12 health centers and 26 health posts. In 70% of responding facilities (all 16 hospitals, 10 health centers, and 12 health posts) a backup water tank was available, while 72% (all 16 hospitals, 11 health centers, and 12 health posts) had a backup power supply system. Twenty-seven facilities provided data on water reserve, with 15 (56%) reporting a reserve for three or more days. Twenty facilities provided data on fuel stock and power consumption; six (30%) had energy reserves for more than 72 hours, and eight (40%) had reserves for 24-72 hours.
Conclusions
Greek state-supported island health facilities responding to the questionnaire had water and power reserves for use in an emergency. Health centers and health posts were less prepared than hospitals. Of the responding health facilities, half had a water backup system and approximately one-third had power backup systems with reserves that would last for at least 72 hours.
AlexakisLC, CodreanuTA, StrattonSJ. Water and Power Reserve Capacity of Health Facilities in the Greek Islands. Prehosp Disaster Med. 2014;29(1):1-5.
This section of Prehospital and Disaster Medicine (PDM) presents a report and summary of a session at the 18th World Congress on Disaster and Emergency Medicine (WCDEM) held in Manchester, UK in May of 2013. Additional reports and summaries were published in PDM (Volume 28, No. 6). Abstracts of Congress oral and poster presentations were published in May, 2013 as a supplement to PDM (Volume 28, Supplement 1).
Report and session summary from the 18th World Congress on Disaster and Emergency Medicine. Prehosp Disaster Med. 2014:29(1):1-3.