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Introduction: The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims.
Methods: A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria.
Results: The following criteria were identified as geriatric-specific criteria: (1) GCS score <14 in the presence of known or suspected traumatic brain trauma; (2) SBP <100 mmHg; (3) fall from any height with evidence of traumatic brain injury: (4) multiple body-system injuries; (5) struck by a moving vehicle; and (6) the presence of any proximal long bone fracture following motor vehicle trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center.
Conclusions: The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the overall mortality in the elderly.
Introduction: Emergency preparedness experts generally are based at academic or governmental institutions. A mechanism for experts to remotely facilitate a distant hospital’s disaster readiness is lacking.
Objective: The objective of this study was to develop and examine the feasibility of an Internet-based software tool to assess disaster preparedness for remote hospitals using a long-distance, virtual, tabletop drill.
Methods: An Internet-based system that remotely acquires information and analyzes disaster preparedness for hospitals at a distance in a virtual, tabletop drill model was piloted. Nine hospitals in Cape Town, South Africa designated as receiving institutions for the 2010 FIFA World Cup Games and its organizers, utilized the system over a 10-week period. At one-week intervals, the system e-mailed each hospital’s leadership a description of a stadium disaster and instructed them to login to the system and answer questions relating to their hospital’s state of readiness. A total of 169 questions were posed relating to operational and surge capacities, communication, equipment, major incident planning, public relations, staff safety, hospital supplies, and security in each hospital. The system was used to analyze answers and generate a real-time grid that reflectied readiness as a percent for each hospital in each of the above categories. It also created individualized recommendations of how to improve preparedness for each hospital. To assess feasibility of such a system, the end users’ compliance and response times were examined.
Results: Overall, compliance was excellent with an aggregate response rate of 98%. The mean response interval, defined as the time elapsed between sending a stimuli and receiving a response, was eight days (95% CI = 8–9 days).
Conclusions: A web-based data acquisition system using a virtual, tabletop drill to remotely facilitate assessment of disaster preparedness is efficient and feasible. Weekly reinforcement for disaster preparedness resulted in strong compliance.
Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities.
Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions.
Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted.
Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters.
Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countries.
After disasters, the individual health and well-being of first responders and affected population are affected for years. Therefore, psychosocial help is needed. Although most victims recover on their own, a minority of survivors, members of rescue teams, or relatives develop long-term, disaster-related psychic disorders, such as post-traumatic stress disorder (PTSD). This subgroup especially should receive timely and appropriate psychosocial help. Many European countries offer post-disaster psychosocial care from a variety of caregivers (i.e., professionals and volunteers, non-governmental organizations, church or commercial organizations). Therefore, European standards for providing post-disaster psychosocial support currently is required. This article describes the project European Guideline for Target Group-Oriented Psychosocial Aftercare—Implementation, supported by the European Commission.
Gathering essential health data to provide rapid and effective medical relief to populations devastated by the effects of a disaster-producing event involves challenges. These challenges include response to environmental hazards, security of personnel and resources, political and economic issues, cultural barriers, and difficulties in communication, particularly between aid agencies. These barriers often impede the timely collection of key health data such as morbidity and mortality, rapid health and sheltering needs assessments, key infrastructure assessments, and nutritional needs assessments. Examples of these challenges following three recent events: (1) the Indian Ocean tsunami; (2) Hurricane Katrina; and (3) the 2010 earthquake in Haiti are reviewed. Some of the innovative and cutting-edge approaches for surmounting many of these challenges include: (1) the establishment of geographical information systems (GIS) mapping disaster databases; (2) establishing internet surveillance networks and data repositories; (3) utilization of personal digital assistant-based platforms for data collection; (4) involving key community stakeholders in the data collection process; (5) use of pre-established, local, collaborative networks to coordinate disaster efforts; and (6) exploring potential civil-military collaborative efforts. The application of these and other innovative techniques shows promise for surmounting formidable challenges to disaster data collection.
In 2001, a survey of Canadian emergency departments indicated significant deficiencies in disaster preparedness. Since then, there have been efforts on the part of Provincial governments to remedy this situation. This survey repeats the original study with minor modifications to determine if there has been improvement. The Hospital Emergency Readiness Overview study demonstrates that despite improvements, there remain gaps in Canadian healthcare facility readiness for disaster, specifically one involving contaminated patients. It also highlights the lack of any standardized assessment of healthcare facilities' chemical, biological, radiological, or nuclear readiness.
During large-scale, sudden-onset disasters, resscue personnel experience severe stress due to the brief window of opportunity for saving lives. Following the earthquake in Haiti, rescue personnel worked in Port-au-Prince under harsh conditions in order to save lives and extricate bodies. Reactions to this disaster among rescue personnel were examined using self-report questionnaires. Correlations between psychosocial factors and psychological trauma (dissociation and post-traumatic stress disorder (PTSD) symptoms) were examined in a sample of 20 rescue personnel who worked in Haiti. The study indicated that negative affect and crisis of meaning were associated with higher levels of dissociative and PTSD symptoms. The results suggest that rescue personnel who are overwhelmed by the destruction and number of bodies being extricated may exhibit negative affect and loss of meaning along with dissociative and PTSD symptoms.
Preparativos de los “Hospitales de Alta Complejidad” ante la presencia de un evento con un saldo masivo de víctimas, dando una respuesta oportuna, eficiente y eficaz de los recursos, salvando al mayor número de víctimas y disminuyendo las secuelas.
Método
Se relata la experiencia de la Unidad Hospitalaria La Paz, (de Alta Complejidad) que atiende frecuentemente a saldo masivo de víctimas en la Ciudad de Puebla, Pue., México.
Desarrollo
La presencia de 2 o más pacientes críticos en una sala de urgencia normalmente ocasiona caos, disminuyendo la eficacia de sus recursos, aumentado la mortalidad y/o las incapacidades. Los hospitales que son clasificados por su mayor capacidad resolutiva como “Alta Complejidad”, que deben de recibir a las víctimas de prioridad I, (lesiones que ponen en peligro su vida de manera inmediata) destinando recursos mediante la preparación de un “Plan en caso de Desastre Externo” que contempla las acciones a desarrollar el antes, durante, y después del ingreso al hospital, cubriendo los criterios internacionales para dar atención a 100 víctimas de diferentes prioridades, iniciando con la realización del 1er. TRIAGE afuera de la sala de urgencias, arriba de la ambulancia, para corroborar o ratificar la clasificación prehospitalaria e ingresar o referir a las víctimas con prioridad I al área de reanimación inmediata en donde son atendidos por 5 a 6 médicos y enfermeras por cada 2 pacientes, resolviendo sus prioridades, posteriormente el jefe de cirugía realiza un 2do. TRIAGE para distribuir a las víctimas en las áreas de Cuidados Intensivos, Cirugía u Hospitalización con base a sus prioridades.
Conclusiones
El propósito es salvar al mayor número de víctimas en la atención de un saldo masivo de víctimas, realizando un “Plan en caso de Desastre Externo” mediante la organización del personal Médico, de Enfermería y Administrativo.
Social networking has been utilized for information sharing and communication since the beginning of time. Current communication technology allows for rapid information sharing across social networks through the increased utilization of social media—Facebook, Twitter, Flickr etc. Social media tools have been used increasingly in recent emergency response efforts including the response to the 2010 earthquake in Haiti and the BP oil spill in the US Gulf Coast. Veterinarians have been engaged in emergency preparedness and response activities for many years. The American Veterinary Medical Association founded in 1863 and representing approximately 83% of United States veterinarians and the American Veterinary Medical Foundation, established by the AVMA in 1963, have been active in emergency preparedness and response including the development of a world class veterinary disaster response program (VMAT) since 1993. Animals and humans share a special bond in the United States. According to the 2007 AVMA U.S. Pet Ownership and Demographics Sourcebook there are 72 million dogs, 81.7 million cats, 11.2 million birds and 7.3 million horses in U.S. households. Approximately 60 percent of all U.S. households own at least one pet and 64 percent own more than one pet. Following Hurricane Katrina in 2005 thousands of animals received veterinary medical care at the Lamar Dixon Animal Shelter in Baton Rouge, LA. Social networking was utilized by responders to obtain supplies yet current social media capabilities were not utilized to enhance veterinary medical response and care at the largest disaster animal shelter in US history. Several challenges (volunteer management, lack of veterinary supplies, and referral of critical veterinary patients etc.) in veterinary disaster response could be met through utilization of targeted social media messaging. Social media has the potential to enhance the efficiency and quality of disaster veterinary medical response now and into the future.
In order to counteract disasters and emergencies, it is necessary to build cooperation and collaboration among all entities and actors. Field teams of rescuers require support from the State experiencing a disaster. The responses to the earthquake in Haiti demonstrated a lack of cooperation and collaboration and the rescuers encountered concomitant difficulties. Thus, the problems in the field are not only related to natural and technological aspects, but also social and political contexts. It is time to explore the role of the impact of State power on national and international disasters and emergencies. One modern and fruitful instrument for analysis of these complicated social and group processes is Complex Network modeling. Complex Network tools have been applied successfully to understanding and counteracting such threats as they relate to the spread of infectious diseases and/or to terrorist activities. Another significant utilization of the Complex Network approach is to develop good governance, management, and organizational processes in national and corporate landscapes.
Methods
Based on a Complex Network Scope, a novel, three-layer network model of public connections for diverse State regimes for further simulation is proposed. Quantitative assessments and practical processes should be implemented for countering global disasters using international and interdisciplinary teams. Contrary to the known hierarchical layer approach for knowledge acquisition, this new model describes an overall national Society Network by dividing the approach into the three layers: (1) Formal (State), as hierarchical governments structures; (2) Informal (presented by different long-term sustainable link groups); and (3) Informal (aquatinters with short term links (“weak ties”).
Results
According to each of these layers, one of three types of network topologies exist: (1) hierarchical; (2) scale-free; and (3) random, respectively.
EXPO 2010 Shanghai China attracted about 246 nations and international organizations as well as 73 million visitors from home and abroad. To provide good medical services to is a challenge.
Methods
Eight Level A hospitals are designated as EXPO Hospitals to provide advanced medical services to those who need critical care. There are five first aid stations in the EXPO park to provide first aid to EXPO visitors and staff. First aid at scene and emergency response are the emphasis. Practical, realistic, and systematic and forewarning emergency plans are made. An agile and efficient structure is organized. All EXPO staff members underwent first aid training, especially the CPR training and the use of AED. The public are trained for self rescue skills via different approaches and provided with first-aid kits. A medical rescue team is recruited; the team consists of Critical Care physicians, surgeons, anesthetists and nurses. The team is able to deal with different situations under all conditions. The team is a standing army, after the EXPO, the team will be responsible for providing medical services in the regional disaster rescue. Drills are performed periodically to practice the rescue skills, enhance the communication and cooperation among different government departments.
Results
By joint efforts, a safe, wonderful and unforgettable EXPO was presented to the world. During the 184 days, medical personnel provided medical services to the 73 million visitors.
Conclusions
The medical preparedness for World EXPO should be practical, realistic, and systematic and forewarning. The public should have the easy access to the information and resources. Develop the contingency plans according to the real situation, ensure its timely updating and deliver training to every one involved. Drills should be performed periodically to practice the rescue skills, enhance the communication and cooperation among different government departments.
Short intervals between stroke onset and thrombolysis determine the efficacy of this procedure. Guidelines for stroke management were introduced in 2005 in the West-Tallinn Stroke Centre and in 2008 in the Tallinn Emergency Medical Services. Since 2006, annual joint stroke meetings of pre- and in-hospital staff have been held. These meetings included analysis of time delays of thrombolyzed patients.
Objective
The aim of the study was to analyze changes in time delays in acute stroke management and adherence to treatment guidelines.
Methods
Pre- and in-hospital data of all consecutive ischemic stroke patients who received intravenous thrombolytic therapy were recorded prospectively at the Stroke Centre. Data from the implementation period of thrombolysis (2005–2008 i.e., 1st period) were compared to recent data from 2009 to 01 September 2010 (2nd period). The data from all stroke patients presenting to ambulance services were analyzed separately from 01 September 2009 to 01 September 2010. Recorded procedures were compared to current treatment guidelines.
Results
A total of 115 patients received thrombolysis at the Stroke Centre. The Alarm Centre assigned the correct priority (C, lights and sirens) for 31% of thrombolyzed patients during the 1st period, and for 80% during the 2nd period. The mean time ambulance personnel spent at the home was 20 minutes during both periods. In-hospital door-to-needle time was < 60 minutes in 11% of patients during the 1st period, and in 56% during the 2nd period. Ambulance personnel treated 1,094 stroke patients during the study. All procedures were performed and documented correctly in 10% of visits. The most frequent deviation from guidelines was under-reported values of blood glucose. In 44.7% of patients, an ECG was performed, which is not required by guidelines.
Conclusions
Acute stroke management improved significantly. Adherence to recently developed stroke guidelines in the ambulance services must be improved.
During the authors' recent experience in Haiti during the early aftermath of a major earthquake, it was discovered that more optimal use of field hospitals could be achieved through increased coordination across the deployed medical resources. Moreover, if it were possible to standardize both the capabilities of these resources and their inter-operational guidelines, further improvement in resource utilization could be achieved. Resolving the bottleneck particularly was crucial as the impact on mortality that specialized field hospitals may affect in disasters is observed primarily early on. Confronted with tremendous need in the face of massive devastation, a solution was improvised: For every patient requiring a higher level of care sent by a light hospital, it would have to take a patient being cared for by the authors' in exchange. This arrangement allowed the admission patients who had been screened by other health professionals as requiring an acute intervention that the authors were in a unique position to provide, and ensured that patients would remain under medical care until they were stable enough to be discharged. Additionally, senior medical staff to light hospitals to help identify which patients would most likely benefit from being transferred to the authors' facility. With the other hospital teams' cooperation, surgeons performed needed morbidity and mortality reducing operations on more patients than would have otherwise been possible. Implementing a collaborative healthcare system would help achieve more optimal use of all the medical resources available in a disaster. Further optimization could likely be achieved if participating countries and organizations adhered to a standardized classification and coordination system. Both levels of coordination, at the preparatory and deployment stages, would likely lead to decreased mortality, morbidity, and disability among the devastated population.
Limited research has been conducted to understand the relationship between heat wave warnings with public awareness and behavioral changes in the Asian population. The Hong Kong Observatory introduced the “very hot weather warning” in 2000 to alert the public of heatstroke and sunburn in Hong Kong. However, the population's behavioral responses to these weather alerts is unclear. Moreover, the relationship between perceived health risks and behavioral changes has not been examined. The goal of this study is to examine the health risk perceptions and behavioral changes following public heat wave warnings in Hong Kong.
Methods
A cross-sectional, population-based, telephone survey, using the last-birthday method was conducted within two weeks following a heat wave warning in 2009. A heat warning and a health study instrument, based on Intergovernmental Panel on Climate Change (IPCC) guidelines and related literature was developed and validated. Descriptive and multivariate logistic regression analyses were conducted.
Results
The questionnaire was completed by 1,123 individuals whose socio-demographic characteristics were comparable to 2009 Hong Kong population census data. Of respondents, 83.6% were aware of the heat wave weather warning. Multivariate logistic regression of socio-demographic factors indicated that being female, those in middle age groups, and those with higher educational attainment was significantly associated with heat wave warning awareness. Among those aware of the public warning, the majority were unconcerned about potential adverse health effects, < 40% were aware of the community heat-related preparedness plans, and < 50% changed their behavior to mitigate the potential adverse health impacts of hot weather.
Conclusion
This is the first study to examine climate change and health behavioral responses in an urban Chinese population. Future research direction should further investigate correlations between awareness and health protective actions, as well as the drivers for health behavioral changes that mitigate the impact of climate change.
This presentation will focus on outlining the issues and challenges to developing a framework for a PHC approach for emergencies and disasters. The emphasis will be how the use of the PHC principles to achieve equity and social justice can improve disaster response. These approaches include; universal coverage/equity, community participation, intersectoral collaboration and the use of appropriate technology. Discussion will include; the revitalization of PHC and the role of PHC in emergencies and the challenges of the PHC approach in emergencies. Responding to emergencies from the perspective of disaster risk management, community based health work force and self care will be reviewed. Finally, pre-emergency preparedness focusing on community based benchmarks, community based disaster management planning and strengthening health systems based on PHC will be discussed.
Heat stress is an occupational hazard for all personnel requiring Personal Protective Equipment (PPE). Even “breathable PPE” increases measurable heat stress in active troops and surgical personnel. A novel negative-pressure, semipermeable surgical cooling vests for use in the operating theater was jointly developed by Mountain Laurel Biomedical, Hamilton Sundstrand, and Hartford Hospital.
Materials and Methods
Surgical personnel alternated between wearing cooling garment vs no cooling under their surgical gowns (PPE) during surgical procedures lasting up to several hours. Tympanic temperatures were monitored for safety. A questionnaire was completed after the conclusion of surgery to assess perception of comfort. Trials began at ∼18 deg C, but ambient temperature was increased to 24 deg C (40–50% RH) for the third series of trials. Results: The study was terminated prematurely. After wearing the cooling vest, surgeons refused to complete additional control trials due to the heat. They demanded to use the cooling device for all surgery, even outside the protocol! Vest wearers remained dry and reported a statistically significant (p < 0.0001) greater level of comfort compared to control subjects. The weight, fit, and mobility restriction of the vest was not clinically significant.
Conclusion
Active cooling and drying using a negative pressure cooling vest improves subjective thermal comfort with minimal perceived impact on mobility during surgical procedures. This technology may have utility in other fields that utilize PPE. The Chemical Biological Warfare (CBW) ensemble, in particular, is a promising candidate. Heat stress from PPE ensemble even if “breathable” -Cooling at ∼100 watts with 18 deg C water -Semipermeable membrane allows condensation removal. Wearer stays cool and dry. -Negative pressure prevents coolant loss if punctured -Minimal perceived restriction of shoulder, neck, and waist range of motion - Light weight ∼1.5 lbs. (0.68 kg) - Quick disconnects allow options for cooling source.