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India has witnessed many major infectious public health emergencies (PHE) during 21st century. They include outbreaks of Severe Acute Respiratory Syndrome (SARS) 2002–03, avian flu in 2006, chikungunya in 2006–07, and the H1N1 pandemic in 2009. Periodic dengue and Japanese Encephalitis epidemics also are common. The premier institute of the country, PGIMER Chandigarh, always has received a huge inflow of patients from North India during such emergencies. These patients pose special challenges to hospital administration in terms of effective and efficient management of crisis situation, and require special measures. The authors' experience has shown that the major challenges faced are allocation of scares resources, capacity building, motivation of employees, infection control, and inter-sectoral coordination. The response during the initial phase is erratic due to a lack of clear guidelines and prior preparedness. Learning from these experiences, a contingency plan was prepared after consultation with all stakeholders. It was implemented during 2009 influenza pandemic. The contingency plan identifies: (1) area responsibilities; (2) disaster and screening areas for the handling of patients; (3) isolation and critical care facilities; (4) deployment of manpower; (5) allocation of drugs, consumables, equipment, and sterile supplies; (6) communication and reporting system; (7) awareness, education, and training; and (8) decision-making hierarchy and effective inter-sectoral collaboration. Also, a disaster plan has been prepared that includes standard operating procedures (SOPs) to be followed during infectious PHEs. A hospital infection control manual also has been prepared to address the issue of hospital acquired infections. The contingency plan and SOPs were effective during recent 2009 influenza pandemic in streamlining the response.
Conclusion
A well-documented contingency plan prepared in consultation with concerned stakeholders and implemented by a motivated and committed administration is essential in ensuring uninterrupted services during PHEs. It emphasizes that sound PHE plan is never an accident; it is always a result of high intentions, sincere efforts, intelligent direction, and skillful execution.
Inhalant abuse has become less common in Singapore. Awareness of glue sniffing and its complications has decreased among local physicians. Prolonged toluene exposure can result in renal tubular acidosis, with electrolyte and acid-base derangements, and should be considered in the differential diagnosis of any young patient with unexplained hypokalaemic periodic paralysis and normal anion gap metabolic acidosis. We present a typical case to illustrate the abnormalities and to heighten awareness among emergency physicians who may not have laboratory results on hand when evaluating causes of limb weakness.
The January 12 2010 7.0-magnitude earthquake's epicenter hit just 10 miles west of Porte-au-Prince and its 2 million inhabitants at 4:53 pm.
Problem
Although assistance arrived to major ports and cities from all corners of the globe, access from rural and remote areas to centralized hospitals remained difficult. Many of the injured were without access to transportation even a month after the earthquake. Earthquake victims in remote areas have less access to wound care and running water, and therefore more pone to infection and tetanus.
Response
Our group was comprised of a civilian mobile medical team able to negotiate difficult terrain by foot with vehicle support provided by the 82nd Airborne military. The military support supplied vehicles and experience needed to tackle the difficult terrain. Because the vaccines are temperature sensitive, delivery of them to remote areas with long travel times in hot climates is logistically difficult and requires coordination. In order to assure vaccines would not be wasted, they were picked up from the WHO the morning of deployment and stored in coolers without direct contact with ice. An advance team would arrive to the target site first to coordinate with local community leaders and gather patients with tetanus prone wounds in a central area. A second team would transport the amount of vaccine needed as estimated by the advance team.
Result
Our group vaccinated approximately 300 people without access to the centralized hospitals per day using this system, with no vials of vaccine wasted or spoiled.
Emergency medicine (EM) is a long-awaited specialty to be established in Nepal, although it has been practiced for a long time starting with hospitals in Nepal. Currently, almost all hospital emergency departments in Nepal are run under general practitioners (GPs) as emergency consultants (emergency physicians) and medical officers work as 24-hour duty doctors.
Methods
This was a five-year observational study (2006–2010) after the Department of General Practice joined with MD in Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
Results
There are no academically trained MD physicians working in Nepal according to the Nepal Medical Council's Registered Doctors, however, there are Nepalese doctors trained and working in EM in foreign countries. There is a demand of training those GPs interested in EM in a Fellowship/MPhil/MD program. There is a need for developing curriculum of EM for the Fellowship/MPhil/MD or for a different level of training collaborating with universities abroad. There is no ideal prehospital EM/emergency medical services capable of ambulance services. There must be a national code for mobilization and it must be under an umbrella of a governmental Department of GP and EM. Development of infrastructure for the EM department in every hospital in different parts of country is also a challenging task. Standards must be developed for EM and the EMS according to the need of the country. All known and unknown challenges can be addressed by coordinating with international support.
Modern emergencies and disasters are progressively changing from relatively simple, predictable events controllable with standard management solutions to complex critical situations for which managers and first responders require innovative and affordable tools.
Methods
The European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. Use of simulation technologies offers a significant improvement on current management activities allowing decision makers to confront several organizational alternatives not only with static situations but with evolving scenarios.
Results
SICMA simulates main structural and behavioral elements of maxi emergency and mass casualties, from individual casualties and evolution of their health status, activity of the police force and fire brigade on the accident site, crowd dynamics, sanitary personnel expertise, to ambulance and helicopter transportation depending on traffic and weather conditions. The system also simulates rescue doctrines (i.e. “Casualty Clearing Station” or “Scoop and run”), transportation priorities according to color codes, doctrines for assignment of new casualty to neighboring hospitals, hospital resources and involvement, final clinical outcome of individual casualties. Patient health status and physiological reserve of single casualty is based on the ABCD ATLS system, considering with a simple algorithm both level of damage and rate of worsening in time.
Conclusion
Utilizing this simulation system, managers who predispose organizational and logistic procedures may modify the main elements in order to identify the optimal resource allocation and the best procedures to save the most human lives.
In 2007, several atoll islands in the Federated States of Micronesia (FSM) were inexplicably flooded by sea water.
Objectives
To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations.
Methods
Households of Lukunoch and Oneop islands, FSM were assessed for demographics, asset damage, food availability, and water quantity and quality. Every fourth household on Lukunoch, (n = 40), was randomly selected and surveyed. All Oneop households were surveyed (n = 72). Prevalence data were analyzed.
Results
A total of 112 total households were surveyed representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%–30%) reported a complete loss of taro and four (10%) of the 40 households (95% Cl. 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11(28%) of 40 households, (95% Cl. 15%–43%) reported damage from well salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well.
Conclusion
These findings suggest that FSM populations experienced disastrous losses due to a sea level rise event damaging crop productivity and freshwater sources.
The process of identification of disaster and mass casualties' victims (Disaster Victim Identification - DVI) impose requirements on the interdisciplinary cooperation of experts in many professions. When working with survivors and witnesses, it is necessary to maintain general ethical principles and follow the guidelines of optimal crisis communication with the affected people. The important thing is not to cause further secondary trauma. It is therefore necessary to understand the normal reactions of the human psyche in extreme stress and psychosocial needs of the people in stressful situations. Also members of DVI teams deserve adequate psychosocial support during and after the completion of difficult tasks. It is likely that these workers are psychologically resistant to extreme stress comparing to the general population but they are also increasingly exposed. To maintain work performance and life satisfaction is the possibility to use a specific psychological support very important. Keywords: acute stress reaction (ASR), DVI teams, disaster victim identification, crisis communication, survivors, crisis and disaster psychology, psychosocial crisis management, psychosocial care, posttraumatic stress disorder (PTSD).
In Germany, emergency medical care is provided by ambulances. Emergency physicians also are used in the German rescue system to ensure primary care. Additionally, rescue helicopters are insertable. The rescue helicopter in Dresden covers the city of Dresden and its surrounding areas, with 517,000 inhabitants and distances up to 70 km. The goal of this study was to evaluate emergency cases in helicopter rescue missions according to primary diagnoses and severity of the mission on the basis of NACA Score.
Methods
Data from all emergencies using the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central computer database (MEDAT®). Data from all emergency cases between January 2006 and July 2010 were analyzed.
Results
There was a total of 6,310 emergencies during the study period, with a significant increase over time. The helicopter was on-scene within 10.9 minutes. In total, 54% of the patients were male. The rate of female patients > 80 years of age was 64.5%. A total of 63.4% of patients suffered life-threatening injuries or dysfunctions and a NACA score ≥ 4. A total of 7.6% of patients were classified in NACA 6 or 7. The most common cause for rescue missions was an acute coronary syndrome (20.4%). Other frequent diagnoses included brain injury (13.3%), unconsciousness (12.5%), stroke (12.9%), general cerebral convulsion (7.9%), polytrauma (6.4%), and cardiac arrest (5.0%). The rate of prehospital endotracheal intubation was 15.1%. In 1.1% of patients, a thoracic drainage was established.
Conclusions
In recent years the number of helicopter rescue missions increased, along with injury severity. The total number of patients with NACA 6 and 7 was extremely high, and demonstrates the need for an efficient emergency medical rescue system that includes helicopters.
Nurses have pivotal roles before, during, and after disasters. Enhancing their professional skills to help the injured is one the basic principles in health management in disasters. The aim of this study is to investigate the effectiveness of training disaster nursing preparedness on improving the preparedness of nurses.
Method
Using a quasi-experimental method, 113 nurses were selected randomly. The preparedness program, which consisted of a one-day workshop on disaster management, a tabletop exercise, and an operational maneuver, was executed for the participants. The preparedness of all participating nurses was measured by disaster preparedness questionnaire, one week and also one month after the program. Data analysis was performed by using the ANOVA test.
Results
The mean scores of knowledge, attitude, and performance improved from 5.55 to 19.88, from 66.18 to 72.41, and from 3.36 to 12.48, respectively (p < 0.001). In addition, the mean of total preparedness score was increased from 75.14 in pretest to 104.77 in the follow up (p < 0.001).
Conclusions
Preparedness plan training improves participants' preparedness for responding disasters, because preparedness and reliability for responding to disasters is influenced directly by the training courses and previous experiments. Therefore, based on the results obtained in this project, in order to improve the preparedness of nursing staff, including a disaster preparedness plan in academic, educational curriculum and as a continuing educational program is recommended.
Injury and trauma are major causes of premature deaths worldwide. At present, Haiti does not have an existing emergency medical system. Basic first responders training was developed for lay people and medical professionals in rural Haiti.
Methods
The training was conducted in Terrier Rouge, Haiti. Participants included medical professionals, laborers, health professionals, teachers, students, and truck drivers from six towns in northeastern Haiti. A three-day training course taught by U.S. board certified emergency medicine physicians was instituted. Basic life support (BLS), first aid, and BLS/first aid instructors courses were taught based on the American and Canadian Heart Associations curriculum. The BLS/first aid instructors course was limited to health professionals, whereas the first aid course was open to all members of the community. The program included the development of local teaching tools and manuals translated to local languages. Twelve newly trained local Haitian instructors assisted in the final day of training.
Results
The course was well received by participants. A total of 54 people completed the BLS course, 67 completed the first aid course, and 12 participants completed the BLS/first aid instructors course. Ninty-five program participants completed the end of course survey. Forty-four of the participants were male, 49 were female, and 2 did not answer. Forty-one participants had no prior BLS/first aid training or exposure. The ages of participants ranged from 13 to 52 years. The course participants included two physicians, 22 students, eight nursing students, seven nurses, 20 teachers, 12 health workers, five drivers, and 14 laborers. Of those surveyed, 92 stated they would recommend this course to a friend. Eighty-eight participants stated that hands on learning helped them better learn the course material.
Conclusion
This sustainable, locally controlled training model increased local skill level for basic first responders in rural Haiti.
Managing epidemics, or preferably, preventing them, is a priority for the International Federation of the Red Cross (IFRC). The IFRC response to the cholera outbreaks in Zimbabwe in 2009 and in Haiti in 2010 both included: the Emergency Response Unit system as the backbone, and the International Red Cross Movement helped the National Red Cross Society fulfill its humanitarian mandate during the emergency. Water and Sanitation units and Basic Health Care Units cooperated seamlessly to ensure consistency and effectiveness in the activities. A large part of the International Red Cross and Red Crescent Movement response is performed by community-based volunteers. During both outbreaks, the Red Cross put special focus on community-level interventions. In both countries, the National Red Cross Society, supported by the International Federation of the Red Cross, trained volunteer groups using a local adaptation and translation of the IFRC training package for emergency health and epidemic control. Research has shown that community volunteers frequently lack the background information necessary for a quick and efficient response to epidemics, especially when they are located in areas that do not benefit from the support and guidance of health professionals. This is particularly true in developing countries that often lack sufficient healthcare facilities and staff. To help fill those gaps, the IFRC launched a training package — Epidemic Control for Volunteers — more effectively involving volunteers in the epidemic management. It provides volunteers with a basic understanding of the diseases that can easily turn into epidemics. This training package is intended for volunteers and trainers in local branches of Red Cross and Red Crescent societies. It teaches them how they can help limit the number of victims, act quickly and effectively, and define their role in the community before, during, and after an epidemic.
To report a rare case of Acute Myocardial Infarction (AMI) along with Upper Gastrointestinal bleeding (UGIB).
Presentation and Intervention
A 58 year old male with history of black coloured stools was admitted in ER for chest pain and coffee ground emesis. ECG showed an acute inferior wall MI. After doing the necessary interventions, patient was inserted with a nasogastric tube and started on medications in the Emergency for UGIB followed by immediate endoscopy. Endoscopy confirmed presence of multiple superficial Ulcers in the stomach along with Esophagitis.
Conclusion
We support Esophagogastroduodenoscopy (EGD) prior to cardiac catheterisation in patients with AMI associated with overt Upper GI Bleed. This results in fewer complications as compared with direct catheterization
Populations that participated in this project represented > 46% of the total H1N1 patients hospitalized and 34% of deaths in the state of Oregon.
Methods
A committee was convened by the Oregon Health Authority to increase access to vulnerable populations. The committee determined the project must be supported by: (1) a local advocacy group; (2) a local Health Department; and (3) an emergency medical services (EMS) provider agency to provide immunization. This project involved outreach to a vulnerable population that may not be able to utilize mass vaccination clinics and may have limited access to medical services. Outreach was accomplished using three models: (1) volunteers delivering meals; (2) mailings to those receiving in-home meals; and (3) a community organization that conducted a flu clinic frequented by people with disabilities. Three models were developed for receiving calls and scheduling appointments. All projects followed the same procedure for vaccine administration.
Results
Seventy home-bound individuals met the criteria for vaccination. Post-survey results indicated: 55.2% lived alone and were homebound. Over 70% had previously received their vaccinations from their healthcare provider and 38.9% were not previously vaccinated due to vaccine availability. Fifty-eight individuals were vaccinated. Partner organizations were surveyed after their efforts were completed. Findings indicated that relationships between the EMS agencies and providers were greatly enhanced.
Conclusions
Outreach using nontraditional partners was an effective method to reach a vulnerable population. The project demonstrated that qualified vaccinators can be mobilized quickly. However, because this resource-intensive effort is more costly than providing mass vaccination, similar projects should only be utilized when less costly means are not effective, or when the risk level of the vulnerable population being served warrants it.
Veterinarians have been engaged in emergency preparedness and response activities for many years. The American Veterinary Medical Association (AVMA) 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 US Pet Ownership and Demographics Sourcebook, there are 72 million dogs, 81.7 million cats, 11.2 million birds and 7.3 million horses in US households. Approximately 60% of all US households own at least one pet, and 64% own more than one pet. Additionally, nearly 60% of pet owners consider their pets to be members of the family, and nearly 50% of pet owners consider their pets to be companions. Few US pet owners consider their pet to be property (approximately 2%). Following Hurricane Katrina, the Pets Evacuation and Transportation Standards Act of 2006 (PETS Act) became US law to ensure that state and local emergency preparedness plans address the needs of individuals with household pets and service animals following a major disaster or emergency. Recently a US effort to identify best practices in disaster veterinary care was sponsored by the US Department of Agriculture and the National Alliance of State Animal Agriculture Emergency Programs and chaired by members of the AVMA. Best practices were identified, including physical examination and triage, vaccination and parasite treatment and prophylaxis, decontamination, euthanasia, medical care of search and rescue dogs, field diagnostics, and components of a disaster veterinary medical equipment cache.
Integration of Psycho-social Social Support and Mental Health Services in to National Disaster Management Guidelines India is vulnerable, in varying degrees, to a large number of natural as well as man-made disasters and also a high risk country for disasters due to expanding population, urbanization and industrialisation, development within high-risk zones, environmental degradation and climate changes. The creation of National Disaster Management Authority (NDMA) in 2005, as the apex body for disaster management, has brought out a paradigm shift in the area of disaster management. One of the important mandate of NDMA is to issue National Disaster Management Guidelines (NDMG) to the ministries/ departments to assist them to formulate their respective Disaster Management (DM) plans. In this direction NDMA has issued number of NDMG on different themes to provide basis of preparation of DM plans at different levels. There are policies & guidelines on Psycho-social Support and Mental Health Services (PSSMHS) in disasters at the international level in the form of Inter Agency Standing Committee guidelines (IASC) which advocates PSSMHS in disasters. In India there was no such policy which streamlines the Psycho-social Support and Mental Health Services in Disasters. During preparation of various National Disaster Management Guidelines, one remarkable factor noticed was the need for psycho-social care, subsequently preparation of NDMG on Medical Preparedness and Mass Causality Management brought out an overwhelming consensus to formulate a separate NDMG for PSSMHS. In order to translate the critical need for psycho-social care and support into guidelines, NDMA adopted a mission-mode approach for integrating PSSMHS in disaster response by involving participatory and multi step methodology to formulate NDMG on Psycho-social Support and Mental Health Services in Disasters.
Mass gatherings pose a significant risk on health and safety. The mass gathering in the subway systems in Beijing represents a daily risk. An average of 4.52 million passengers rode the subway each day between 15 November and 30 November 2010, with the highest daily passenger number totaling 5.14 million. The purpose of this study is to identify the health and safety aspects of mass gatherings in Beijing subways, and proposes strategies that may mitigate these risks.
Methods
The methods included a literature review, field visitation of the subway systems, and interviews of 20 passengers and 10 management personnel from the subway system.
Results
Many safety and health measures has been taken by the Beijing Subway System, including emergency exit signs and other safety signs, prohibition of smoking, firefighting equipment and explosion-proof tanks, safety inspection of bags, and safety education in the subways. However, additional key health and safety aspects were indentified, including: (1) lack of strict flow control of passengers in interchange subway stations; (2) lack of platform safety gates in Line 1, Line 2, Line 13; (3) lack of passenger control during peak hours; (4) lack of biomedical monitoring systems in the subways; and (5) lack of health facilities and rescue equipments in the subways.
Conclusions
Mass gatherings pose great risks on subway passengers in Beijing, including psychosocial risks, biomedical risks, and environmental risks. Additional safety measures need to be taken to ensure the safety and health of passengers in subways in Beijing.
Disaster could greatly affect physical, psychological and social health of people affected. However, current crisis intervention protocols after natural or man-made disasters often overlook the psychosocial impact of crisis on victims. In its executive board meeting in 2005, WHO has called for action in implementing programs that can repair the psychological damage of war, conflict and natural disasters. Currently there are three main post-disaster psychological interventions available in the field: Critical Incidence Stress Management developed by Mitchell and Everly in 1980's; Psychological First Aid developed by the National Child Traumatic Stress Network and National Center for PTSD after millennium; and Mental Health First Aid developed by the Kitchener and Jorm after millennium.
Methods
A comparative descriptive analysis among the three different interventions was performed. Specific objectives, target populations, content, training duration, empirical evidence, instructor training and various adaptations were compared. Public health implications for implementation in disaster settings are discussed.
Results
The study is among the first that provided a detail comparison among the different protocols available in the field. More importantly it discussed the empirical evidence that support the use of the specific protocols at different scenarios. Implication the results of the study could be used as a guidance for choosing psychological interventions immediately post-disasters by emergency responders, public health practitioners and academic researchers.
This presentation summarizes our ongoing hybrid sociological-geological research into China's earthquake disaster management systems. Our methodology is a grounded research approach, based firstly on field observations related to the Wenchuan earthquake, including interviews with survivors and professionals responsible for disaster management; secondly on an extensive review of the English-language disaster management literature. China's earth scientists, frequently in collaboration with international scientists, have created a substantial English-language literature, but the social literature on disasters in China is scant. China's geographic variation is complex, with significant fault lines criss-crossing the nation.
Discussion
Approximately half of the population lives in areas with a high risk of earthquakes. The two most-devastating of these since 1949 were the 1976 point-source Tangshan earthquake with mortality of 242,419, and the 2008 huge-area Wenchuan earthquake with mortality of 69,226. Our research has found that China's earthquake disaster management systems at the local, provincial, and national levels respond rapidly to earthquakes. National mobilization for rescue-relief after the Tangshan earthquake began within six hours, and within two hours for the Wenchuan earthquake. These systems are also characterized by reconstruction planning that functions in parallel to, and melds into, the relief effort streams. China's major infrastructure projects, such as hydro-electric power dams, are designed to resist extreme earthquake; however, rural mountain populations and the historic built-environment have low earthquake resistance, conditions which will endure for a long time.
Conclusions
As a result of the Wenchuan earthquake, China has undertaken ambitious three-dimensional monitoring and response programs. We recommend studies and action to reconnoiter, investigate, and prevent population exposure to geo-hazards, particularly in the Qinghai-Tibet Plateau. In summary, China excels at disaster response but has not yet entered a development era of preventing the population's exposure to earthquake hazards.
A disaster creates disruption and threats to life and society, mental anguish, and leads to feelings of instability around such areas as security and safety. It causes suffering and requires assistance from experts within a structured and tested response framework. After 11 September 2001, the demarcation between disasters caused by natural hazards and terrorism virtually disappeared. The two now get treated concurrently, but there is a danger that anti-terrorism might hijack the agenda, overshadowing important work that must be done in the field of disasters caused by natural hazards. With this in mind, the Health Emergency Management Unit in South Australia was born. The unit was established for preparedness planning around the growing concerns of the potential for an impending pandemic caused by avian influenza. From those shaky beginnings, South Australia now has a dedicated and trained team. The unit provides a 24/7 health responses to planned events and unexpected incidents caused by natural or deliberate forces that may occur in the region. It also participates as part of the National Disaster Deployment Program. Currently, the unit is focused on risk reduction and increasing resilience by implementing a sound, comprehensive approach including all elements of prevention, as well as preparedness, response, and recovery strategies. The unit also provides an extensive education, training, and exercise program to health facilities across South Australia. This paper will describe the ongoing journey of the unit, how it works and interacts with all levels of health service staff and other emergency services, and some of the recent events and incidents in which it has been involved in within Australia and overseas.
Hospitals, as one major cornerstone of contingency planning, are often expected to be fully functional during a major incident. However, the continuous streamlining of todays healthcare system with a constrained economy, lean production principles and increasing complexity together with changing levels of the threats may result in an evacuation, should hospitals themselves be the targets for a disastrous action.
Objective
The aims of this study were 1) to evaluate an appropriate risk and vulnerability analysis model as a basis for hospital evacuation plan, 2) to identify hazards triggering an evacuation 3) to evaluate the response needed in an evacuation situation and 4) to clarify the impact of such an evacuation plan on the ordinary emergency medical plan.
Material and Methods
A systematic online literature search based on the following keywords; evacuation/closure, hospitals/medical facilities, and disaster/hazards; alone or with planning, and also a risk and vulnerability analysis as a case study at the hospital in Lidkoping, Sweden, were conducted.
Results
Our findings indicate that hospitals are vulnerable to different risks such as technological dysfunctions, climate changes and terror actions, which can result in an evacuation of patients. In such a situation, well functional transport organization and availability of temporary facilities along with good communication are necessities to assure patient safety. Such functional abilities may be assessed by planning, education and continuous training.
Discussion and Conclusion
There is a need for an elaborated evacuation planning for hospitals. Such plan should continuously be drilled based on a risk and vulnerability analysis and be integrated in the ordinary medical emergency plan. Simulations of different scenarios are one way to determine risks and identify proper actions before a major incident or disaster strikes.