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China is one of the countries most affected by natural disasters, it is an important restricting factor for economic and social development. However, Disaster Medicine training is not included in medical education curriculum in China, continual training is separated among public health professionals and clinical personals.
Methods
WHO provides technical and financial support for public health emergency preparedness through intensive training and workshop. We intended to develop a new working mechanism under the support of WHO and MOH, China for capacity building of disaster preparedness in China with the combination of public health professionals and clinical personals though TOT training.
Results
Through the new mechanism, public health professionals from CDC system and clinical personals from hospitals could benefice mutually fro each side and strengthen the effectiveness for the disaster preparedness.
Conclusion
The new mechanism increases the effectiveness of capacity building for disaster preparedness, TOT training should transit from national level to local level.
Agriculture emergency responders always will require equipment and supplies. A rapid and effective logistical response depends upon having the right item in the right quantity at the right time at the right place for the right price in the right condition to the right responder. Established in 2004 by U.S. Homeland Security Presidential Directive 9, the National Veterinary Stockpile (NVS) within the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service, Veterinary Services is the nation's repository of critical veterinary supplies, equipment, vaccines, and services appropriate to respond to the most damaging animal diseases affecting human health and the economy. An overview of the NVS program, its capabilities, training and exercise strategy, and outreach to stakeholders will be presented.
The NVS Program
The goals of the NVS program are to deploy countermeasures against the 17 most damaging animal disease threats within 24 hours, and to help states/tribes/territories plan, train, and exercise the receipt, processing, and distribution of NVS countermeasures. To meet these goals, the NVS program heavily relies upon science-based logistics to identify animal vaccines and other countermeasures to respond, and sound business processes to purchase, hold, maintain, and deploy the countermeasures. Significant resources also are dedicated to the NVS outreach activities, which interface directly with federal/state/tribe/territory animal health stakeholders. NVS team members work hand-in-hand with these leaders to help develop written NVS-specific plans for their jurisdictions, provide logistics training, and sponsor discussion-based and operations-based exercises in accordance with the Homeland Security Exercise and Evaluation Program.
Conclusion
The USDA NVS exists to provide states/tribes/territories the countermeasures they need to respond to catastrophic animal disease outbreaks created by either terrorists or nature. As logistical experts, the NVS team develops plans for logistical emergency response, manages their supply chain of countermeasures, and helps stakeholders improve logistical response capabilities.
Social media and social networks are integral components of our daily personal, professional, and community lives with Facebook, Friendster, and Twitter alone having > 750,000,000 registered users worldwide. All types of communication modalities are utilized in disasters for a variety of purposes. Experience with Exercise 24 and the Haiti Earthquake and public health response amplify both the power of social media and social networks and the need to research, understand, refine, and train in their utilization in disaster management. A Haiti Epidemic Advisory System was established to provide a mechanism for care providers to report health status in camps and treatment centers, exchange technical and logistical information, provide reach-back services such as GIS mapping and data shepherding, and provide a platform for emotional support. This information was incorporated into additional platforms including Haiti User Defined Operational Picture (UDOP) and Haiti Medical/Public Health Information Sharing Enterprise (MPHISE). Successes in the systems were seen in the early warning provided for cholera and social stress, the ability to link on-the-ground resources with local, national, and international assets, and the ability to inform policy makers through real-time reporting and advanced visualization. Many challenges were highlighted that deserve future study. These include: (1) how to manage the extreme volume of data flow including rating, ranking, filtering, and archiving; (2) how to effectively use social media and networks for response; (3) how to provide visualization in temporal and geospatial terms; and (4) how integrate social media with traditional media and official communications in an effective risk communication matrix.
La doctrine classique, en cas d'accident catastrophique en contexte chimique, consiste á confier aux sauveteurs (porteurs d'une tenue d'isolation leur permettant de ne pas Être eux-mêmes contamines) l'extraction et la décontamination d'urgence des victimes. Le médecin n'intervient alors qu'après passage des victimes dans la chaine de décontamination. Ce concept est actuellement remis en cause au vu des retours d'expérience. La plupart des accidents catastrophiques référencés sont constitués d'accidents Á effet limité, et se situent dans une dimension d'espace et de temps réduite. La présence médicale en zone d'exclusion apportera au moins les Eléments favorables suivants: •Caractérisation plus rapide du toxique sur une analyse séméiologique fine
• Pratique de gestes de survie (exsufflation d'un pneumothorax suffocant, intubation d'un trauma crânien inconscient, remplissage d'une hypo volhémie aiguë administration précoce d'un antidote)
• Soutien des Équipes de sauvetage
• Anticipation Évolutive au vu de la nature du toxique en cause (décision d'administration de l'antidote, méta-triage des victimes)
Il existe néanmoins certains inconvénients potentiels:
• Une présence médicale en zone d'exclusion devra Être précoce et donc susceptible d'amputer les effectifs médicaux initialement présents sur le terrain
• La présence d'un médecin implique de sa part une discipline et une intégration parfaites au sein des Équipes de secours, soulignant la nécessité d'un entrainement régulier
• Le travail en tenue de décontamination comporte des conséquences ergonomiques certaines, ralentissant la pratique des gestes techniques, et imposant des relèves
• Une présence médicale implique un renfort logistique (réapprovisionnement en drogues et matériel)
• Le médecin devra constamment garder Á l'esprit le contexte d'accident catastrophique pour ne pas ralentir le processus d'Évacuation de la zone contaminée
L'analyse du rapport favorable/défavorable concernant la présence médicale en zone d'exclusion lors d'un accident catastrophique en contexte chimique incite Á recommander cette présence, recommandation reprise dans les textes officiels récents.
Has been a tradition of the Mexican Social Security Institute (IMSS) have a great spirit of solidarity with any type of disaster. That is why the early hours of the earthquake in Haiti was appointed to a group of specialists trained in emergency care who participated in the first acts of rescue and stabilization of multiple victims. The first group of six specialists arrived Port au Prince on January 15 fieldwork being allocated in coordination with the rest of the Mexican aid mission in the sector 8 of the city, preferably at the University of Saint Gerard. Among the actions taken by this group were:
• Application of 300 doses of immunization.
• Tracking and signaling a radius of 3 km in search of survivors and bodies.
• Working in conjunction with the group of Topos, the Federal Police and the Navy in the initial care, resuscitation and transfer of 9 people rescued from the rubble.
• More than 60 dressings and sutures.
• Monitoring and maintenance of health of mission personnel.
The second group, consisting of specialists in trauma, reconstructive surgery, anesthesiology, surgical and intensive care nurses, was part of a Field Hospital was established in conjunction with the United States at the place called “Killi Point”, involving a network trauma care in which our doctors surgically intervened the hospital ship “Comfort”. Were to a large number of cases of traumatic amputation, children and adults burned, fractures, crushing limbs and carrying large infections for obvious reasons IMSS staff recognizes the professionalism and capacity of the entire Mexican mission of humanitarian aid to Haiti and the opportunity offered to us to help a sister nation, we reiterate that we are engaged, if required again to respond with the same promptly and sense of humanity shown so far.
Children frequently are the victims of disasters due to natural hazards or terrorist attacks. However, there is a lack of specific pediatric emergency preparedness planning worldwide. To address these gaps, the federal grant-funded New York City Pediatric Disaster Coalition (PDC) established guidelines for creating Pediatric Critical care (PCC) surge plans and assisted hospitals in creating their plans. To date, five hospitals completed plans, thereby adding 92 beds to surge capacity. On 01 May 2010, 18:00h, there was an attempt to detonate a car bomb in Times Square, a large urban attraction in the heart of New York City. The perpetrator was later convicted of the attempted use of a weapon of mass destruction. Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.
Methods
The unit director or a senior attending of nine major hospitals in the NYC area (five in close proximity and four at secondary sites) were surveyed for the number of their vacant pediatric critical care beds at the time of the event before activation of surge plans.
Results
At the time the car bomb was discovered, the nine hospitals, which have a total of 141 PCC beds, had only 29 vacant approved pediatric critical care beds.
Conclusions
Had the event resulted in many pediatric casualties, the existing PCC vacant beds at these hospitals may not have satisfied the need. Activating surge plans at five of these hospitals would have added 92 to the 29 available PCC beds for a total of 121. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans.
The European Center for Disease Control and Prevention (ECDC) identified young children as a group at higher risk of developing severe pandemic influenza A (H1N1) 2009 infection compared with the general population. Since children have high attack rates and seem essential in augmenting local outbreaks of influenza, vaccination of children was an important objective in the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign. Children < 13 years of age were recommended to take two doses of the pandemic vaccine (Pandemrix®).
Objective
The objective of this study was to compare the vaccination coverage among children 1–12 years of age in different councils in the County of Jämtland, Sweden that either implemented an active advocating or a passive vaccination strategy. The active strategy included direct information to parents promoting vaccination, individual appointments, collaboration between different care providers, and visits of vaccination teams to day care centers and schools, whereas no specific measures, except general information in press and media, were undertaken in councils using a passive approach.
Methods
All pandemic vaccinations in the County of Jämtland were registered in a Web-based registration software system. Vaccine coverage was determined by comparing the actual number of children residing in different councils with the number of vaccinated children.
Results
A total of 4,162 of 6,000 children (69.3%) residing in councils using an active vaccination strategy were vaccinated compared with 5,059 of 9,373 children (53.9%) living in councils using a passive vaccination strategy (p < 0.0001)
Conclusions
Implementation of an active advocating vaccination strategy during the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign resulted in a significantly higher vaccination coverage rate compared with a passive vaccination strategy.
The Korean Disaster Relief Team (KDRT) medical team, mainly composed of graduates from first government certified international disaster support education course, deployed to Haiti after the earthquake in January 2010, and operated a medical relief mission. The present study was designed to evaluate the KDRT medical team mission in Haiti.
Methods
Data were collected via an anonymous questionnaire that was distributed one day after the completion of the mission in Haiti. Questionnaires were composed of four categories.
Results
The response rate for this survey was 72% (18/25). The KDRT members were relatively young, with 72% of personnel.
The Pacific Arts Festival is a mass-gathering event occurring every four years in Oceania. The 10th festival in American Samoa, July 20 to August 2, 2008, brought 2200 performers and 2500 tourists (a 15% population increase) from 27 Pacific nations to the island. Anticipated healthcare concerns included hospital surge (175% in 2004), HIV/STI transmission, imported/communicable diseases, food/water/sanitation-borne illness, interpersonal violence, and healthcare resource utilization.
Objective
To describe the preparedness and response efforts for this mass gathering event by emergency medical services, the hospital, and the department of health.
Methods
A retrospective review of after-action reports, public health and emergency department surveillance records, and key-informant interviews was conducted. Descriptive statistics were used to evaluate data.
Results
A Unified Command structure was utilized for pre-/post-event response. Patient surveillance data was collected daily. During the festival 217 participants (42% female, 58% male, Average age 36) sought medical care. Acute illness (n = 166), injury (n = 39), other (n = 15), routine follow up (n = 9), chronic conditions (n = 6), mental health (n = 1), OB/GYN (n = 1) were complaints addressed. Predominant acute illnesses included headache (n = 49, 23%), respiratory illness (n = 30, 14%), musculoskeletal pain (n = 26, 12%), and gastroenteritis (n = 17, 8%). One fatality occurred among delegates. No public health outbreaks were reported. Visits per healthcare venue demonstrated a decentralization of patient surge from the hospital setting (37.4% venue aid stations, 28.1% delegation medical staff, 24% DOH clinic, 10.6% hospital).
Conclusion
A unified health command structure was effective in responding to this mass gathering event. Surveillance data was rapidly gathered and utilized to direct healthcare resources. Efforts to decentralize healthcare from the hospital were successful. Public health emergencies were avoided.
Emergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.
Methods
Emergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.
Results
Data collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.
Discussion
The implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.
Because of worldwide increase of catastrophes and recent terrorist attacks, hospitals and physicians are devoting increased attention to disaster and mass casualty incident (MCI) preparedness not only outside but also inside hospitals. In case of a terrorist attack physicians have to cope with injuries caused by conventional, biological, chemical, or radioactive weapons.
Objective
The aim of this study was to evaluate the current state of preparedness of German hospitals and physicians in case of an MCI or terrorist attack and to compare those results to the preparedness of hospitals and physicians from Austria, Switzerland, the United States of America and a worldwide collective.
Materials and Methods
Using an online questionnaire, we interviewed 1343 physicians in Germany, Austria, Switzerland, the US and a worldwide collective. The replies were analyzed statistically with the Shapiro-Walk test and the Mann-Whitney-U test.
Results
in Germany physicians are less prepared than their colleagues worldwide for disasters inside and outside hospitals. 48,4% of German physicians (37% worldwide) did not know their area of responsibility as a physician in case of an “internal” emergency (fire, water pipe burst, power cut), even though 30,2% of German physicians (29,1% worldwide) have already had a real emergency in their hospital. Only 65,3% of physicians in Germany (75,5% worldwide) knew their area of responsibility in case of an MCI; MCI training was given less often in Germany (42,7%) than worldwide (64,3%). Most physicians in every country were unaware of injury patterns and treatment strategies in patients following bombings or nuclear, chemical and biological contamination.
Conclusions
Hospital Physicians are insufficiently prepared for internal emergencies and MCIs. There is a need for more drills in hospitals. In spite of the recent threat of terrorist attacks, the physicians' emergency training should be modified to accommodate the increased risk of catastrophes and terrorist attacks.
Emergency medical services (EMS) personnel must continuously educate themselves on mass-casualty management. Emergency medical services personnel in Israel are provided with continuing education programs aimed at maintaining knowledge and skills to manage different types of mass-casualty incidents (MCIs). There are 11 Magen David Adom (MDA) regions that have different incidences and experience with MCIs.
Objective
The purpose of this study was to evaluate the effectiveness of an intervention for the management of conventional and mega MCIs.
Methods
A 17-item, multiple choice question pre-test (n = 640) and post-test (n = 536) were administered after a brief continuing education intervention based on lectures and discussion in all 11 EMS regions. The MCI and mega MCI scores were combined to provide an overall MCI score. An independent t-test and ANOVA were used to examine for differences by age, seniority, role, and area of employment of EMS personnel. (p = 0.05)
Results
Reliability of the pre- and post-tests was 0.70. The overall mean score and standard deviation for the pre- and post-test was 64.31% Â ± 14.2% and 75.0% Â ± 14.0%) respectively (p = 0.000). Distribution of scores on the pre- and post-tests were: 80%, 11.8% pre-test, 42.7% post-test. No significant differences were found in pre-/post-test scores by area. Older personnel (> 50 years of age), and those who had been working in EMS for longer periods were found to have significantly lower scores (p = 0.05). Overall scores of paramedics was significantly higher than driver/medics. (p = 0.05).
Conclusions
Both pre- and post-tests were reliable. Post-test scores improved significantly after the intervention. Age and seniority are factors that must be considered when developing continuing education interventions. Possibility should be given to implementing role specific continuing education interventions. Attrition of knowledge must be investigated.
Mass gatherings can be religious, political, socio-cultural, or sporting events, and vary in the form of processions, car races, conferences, fairs, etc. New Delhi hosted the 2010 Commonwealth Games, a mass gathering spread over a duration of 10 days with different venues and a high density of participants, spectators, security personnel, volunteers, and high-profile guests. Various organizations were involved in the planning and implementation of the games which called for a collaborative and coordinated effort to make the event a success. Security coverage was required for 23 sporting, 32 training, and seven non-sporting venues. Security arrangements were of utmost importance and required training, mobilization, and deployment of army, police, and other emergency workers, as well as establishing Standard Operating Procedures for responses to chemical, biological, radioactive, and nuclear events and availing specialized equipment. Areas of public health interventions in mass gathering include mass-casualty preparedness, disease surveillance and outbreak response, safety of water, food, and venues, health promotion, public health preparedness and response, pest and vector control, coordination and communication, healthcare facility capacity, and medical supplies. Methods adopted for the study included interviews with the stakeholders of the Commonwealth Games and use of secondary data to cite examples and support arguments. Existing knowledge must be documented and made available for use in planning for future mass gatherings. The size, duration, and interest of such events demands special attention toward preparedness and mitigation strategies to prevent or minimize the risk of ill health and maximizing the safety of people involved.
A lack of access to primary care services, decreasing numbers of general practitioners (GPs) and free of charge visits have been cited as factors contributing to the rising demand on emergency departments. This study aims to investigate the sources of patients' referrals to emergency departments and track changes in the source of referral over a six-year period in Queensland. Data from Queensland Emergency Departments Information Systems were analyzed based on records from 21 hospitals for the periods 2003–04 to 2008–09. The emergency department data were compared with publicly available data on GPs services and patients attendance rates. In Queensland, the majority of patients are self-referred and a 6.6% growth between 2003–04 and 2008–09 (84.4% to 90% respectively) has been observed. The number of referrals made by GPs, hospitals and community services decreased by 29.4%, 40%, 42% respectively during the six-year period. The full-time workload equivalent GPs per 100,000 people increased by 4.5% and the number of GP attendances measured per capita rose by 4% (4.25 to 4.42). An examination of changes in the triage category of self-referred patients revealed an increase in triage category 1-3 by 60%, 36.2%, and 14.4% respectively. The number of self-referred patients in triage categories 4–5 decreased by 10.5% and 21.9% respectively. The results of this analysis reveal that although the number of services provided by GPs increased, the amount of referrals decreased, and the proportion of self-referred patients to emergency departments rose during the six-year period. In addition, a growth in urgent triage categories (1–3) has been observed, with a decline in the number of non-urgent categories (4–5) among patients who came directly to emergency departments. Understanding the reasons behind this situation is crucial for appropriate demand management. Possible explanations will be sought and presented based on patients' responses to an emergency department users' questionnaire.
The increasing threat of the use of chemical, biological, radiological, and nuclear (CBRN) agents requires significant military medical preparedness and response, including training. The initiatives for CBRN training by Gulhane Military Medical Academy, which is under the Health Command of the Turkish Armed Forces, will be discussed, and the training program and educational model for medical CBRN defense will be highlighted.
Method
The training is given to military hospital staff once or twice a year. Hospital staff is trained over a period of five days, with practical issues regarding medical CBRN defense covered during the last two days. A questionnaire is given to trainees at the beginning and at the end to ascertain the adequacy of the course.
Results
So far, this medical CBRN training has been given to 150 military health staff including physicians, nurses, and medical non-commissioned officers. According to the survey, they benefited greatly from this training, and there was a statistically significant increase in CBRN knowledge when the initial and final scores of the survey were compared (x2 = 3.089; p = 0.002).
Conclusion
Through this planned trainings, staff are trying to become well-trained in detection, personal protection, decontamination, and the organization aspects of CBRN defense to apply the proper prophylactic measures, diagnosis, and treatment. Feedback suggests this program also helped “train the trainers”, providing extensive information to other staff working in military hospitals.
Developing alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites which can serve as areas for primary screening and triage or short-term medical treatment, can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Maintaining consistent standards of care in these settings is essential to a uniform approach to the medical management of a public health emergency.
Methods
Subject matter experts in emergency and disaster medicine, public health, pediatrics, and various other medical specialties were convened at regular intervals over an 18-month period. Through a consensus-based process this working group created a universal standard of care along with model clinical protocols to manage patients in an out-of-hospital setting using medical and non-medical personnel.
Results
These protocols were designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting for a limited period of time and then return to their homes for convalescence. Of particular importance are that these protocols applicable to all public health emergencies and do not rely on the active presence of physicians at the alternate care site to render care.
Conclusion
The development of consistent standards of care and the ability to care for patients in an out-of-hospital setting during a pandemic or public health emergency is essential to preserve the sustained operation of acute care hospitals and the entire healthcare system. Diverting patients to a community- based alternate care site or encouraging the early discharge of patients to these locations can assist in managing the large numbers of casualties anticipated during a pandemic or public health crisis.
Sri Lanka has learned, with contributions from a 30-year war and a tsunami, that disasters happen when and where least expected. Thus the Health Emergency and Disaster Management Training Centre (HEDMaTC) of the Faculty of Medicine, University of Peradeniya was established to prepare Sri Lankan healthcare workers for all forms of health disasters.
Description
HEDMaTC conducts training programmes for health professionals, including medical doctors, nurses, emergency technical officers, ambulance drivers and porters. As these are adult training programmes practical methods of training such as drills, workstations, group work and hands on training have been used, in addition to lectures. Emergency care equipment, specific kits and techniques and desktop exercises are used to demonstrate protocols of emergency management and discuss principles of risk management, disaster management concepts, conceptual and technical challenges in measuring disasters and their impact on public health and its effective management. Participants prepare action plans for their individual institution based on the knowledge gained and are discussed in follow up programmes a month later.
Outcome
HEDMaTC is the only institution in Sri Lanka that is accredited by the Ministry of Health, Sri Lanka to train their staff in disaster management. HEDMaTC has trained 200 personnel in Public Health Emergency and Disaster Management, 117 in Sexual and Reproductive Health Services in Crises and 1034 in pre-hospital emergency care. The trained personnel were mobilized to the North and East of the country to handle healthcare issues, ranging from administration to ground work, of almost 300,000 displaced civilians in 2009 with a very satisfactory outcome.
Recommendations
The training methods used in these programmes are especially beneficial in adult training and it is to be recommended. We also recommend that HEDMaTC to be developed as a regional training center for South Asia.
All first responders must be prepared to respond to suicide attacks. Staging safe and effective responses to these incidents requires knowledge of a number of unique considerations.
Methods
The research presented in this presentation used reviews of open source information along with site visits to multiple suicide bombing sites in Israel and the United Kingdom to determine the important considerations for first responders responding to suicide attacks. What is presented is not a specific standard operating procedure but rather a common framework that can help to facilitate a coordinated and effective response from all agencies involved.
Results
Civilians and private security guards can play an important role in detecting the planning and execution of suicide attacks and sometimes even in their interdiction in the imminent attack phase. The suspicions of civilians must be taken seriously and citizens should be encouraged to report these suspicions immediately. The first responding emergency services personnel must be able to effectively begin their agency's response to the attack while maintaining a strong situational awareness. Also on scene, strong frontline commanders are needed to work together to lead a coordinated response. Interagency communication and using a scaled response is of increased importance at these incidents when first responders could be targeted by the secondary attacks or an initial threat that has not yet been neutralized. First responders can take the initial steps to promote the return to normalcy that is important after terrorist attacks. In the aftermath of attacks, efforts should be made to establish a collective knowledge within the emergency services community to share lessons learned in the response.
Conclusion
The results of this research can help local agencies plan for suicide attack response and also provides a strong foundation for future research to further investigate responses to the varying types of suicide attacks around the world.
Triage of disaster and trauma victims is challenging, especially when responders have limited resources and brief periods of time. Over-triage of victims results in the consumption of resources that would be better utilized on more critical patients, and under-triage can result in increased mortality and/or morbidity, as victims do not receive the appropriate care. In addition, the same patient may be triaged multiple times as they move through echelons of care. These different echelons may have different objectives in the triage process Over the years, multiple triage schemes have been proposed and used, both in exercises and real events. None of these schemes is based on well-defined research, due to the difficulty of carrying out a randomized control study in real events. There has been a concerted effort to apply research findings in a effort to more effectively use resources and thus, improve patient outcomes as well as apply information garnered from after action reports. This presentation reviews the current issues and state of triage for disasters and mass-casualty incidents, drawing on examples from prior events. The ultimate objective of this presentation is to help the responder to better understand the process of triage and apply it to their clinical practice, thereby delivering care in an effective and timely manner.
International collaboration for disaster response is an increasing phenomenon. Japan-United States joint field exercises have been conducted annually since 2004, triggered by an incident in which a US helicopter crashed into a university campus in Okinawa, Japan. The fifth Japan-US disaster field exercise was conducted testing the disaster response of the Okinawa government and US military.
Methods
The simulated exercise involved a US Navy aircraft that crashed into a city center in Okinawa, Japan. There were 16 simulated casualties that included US military members and Japanese citizens. The participants in this exercise were US military members, including the Disaster Assistance Response Team (DART) and local rescue and medical teams including the Okinawa Disaster Medical Assistance Team (DMAT). Data were gathered from the joint debriefing session held by both medical teams. Furthermore, interviews with team leaders from both nations were conducted and feedback obtained.
Results
Lack of communication and inaccurate communication remained the root of most problems encountered. There were several miscommunications at the scene due to the language barrier and ignorance of different medical teams' capability and method of practice. Due to the unclear signage of the initial triage zone, another triage zone was developed later by a second medical team. Confusion regarding gathering information and order of transport also was witnessed. The capabilities of team members were not well known between teams, resulting in inappropriate expectations and difficulty in effective cooperation.
Conclusions
Understanding the systems and backgrounds of each medical team is essential. Signs or symbols of key elements including triage areas should be clear, universal, and multilingual. Communication remains the Achilles' heel of multi-national disaster response activities.