22 August 2024: Due to technical disruption, we are experiencing some delays to publication. We are working to restore services and apologise for the inconvenience. For further updates please visit our website: https://www.cambridge.org/universitypress/about-us/news-and-blogs/cambridge-university-press-publishing-update-following-technical-disruption
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
In the present Swedish military medical organisation all medical personnel, including surgeons, have to be recruited from civilian hospitals. Even if there are many civilian surgeons well qualified to perform trauma surgery, the injury patterns seen in e.g. Afghanistan are quite different compared to what is generally seen in trauma patients arriving to the ED at a civilian hospital. In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in international missions, the (extended) military version of the Definitive Surgical Trauma Care (DSTC) Course has been implemented. DSTC is given with the intention not to duplicate ATLS, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. The course, made up by a mix of lectures, case discussions and skill stations has been given at the Swedish Armed Forces Centre for Defence Medicine in Gothenburg since 2007. It has gradually evolved to incorporate also anaesthesiologists and nursing staff into an integrated team. The faculty during these courses has been made up by a mix of international and Swedish instructors. Course candidates have primarily been military health staff, but vacant slots have been offered clinicians working in civilian hospitals in the western part of Sweden. During the last course in September 2010 17/20 (85%) of the physicians and 13/17 (76%) of the nurses rated the course as very beneficial or indispensible. The Swedish Armed Forces Centre for Defence Medicine will continue to run the military version of the DSTC course. Due to a certain over-capacity, course participation can be offered the civilian health care system.
Nepal, a landlocked country between China and India, is developing disaster and emergency medicine. In 2007, the Nepal Disaster and Emergency Medicine (NADEM) Center was formed with the aim of developing this specialty in Nepal. The first hospital was built in July 1889. It wasn't until 1988 that a Disaster Response Team was organized following a stampede incident in the national stadium in Kathmandu. The country often experiences disaster and emergency situations due to geographic and natural hazards and political tensions.
In 1984, the Institute of Medicine, Tribhuvan University Teaching Hospital created emergency services with general practitioners (GPs) directing and providing services. Since then, almost all emergency services of different hospitals are run by GPs with house officers, nurses, and paramedics. There still is a lack of training and proper management, and limited equipment and infrastructure to provide needed disaster and emergency services to the people. The NADEM Center is developing coordination objectives between different emergency service providers to organize ways of service providing. This will be done through NADEM's continuing medical education and publication of Journal of Nepal Disaster and Emergency Medicine (J-NADEM) and NewsHealth; coordination among emergency medical services (prehospital), in-hospital services, and disaster and critical care medicine; and planning and implementation of different research, training, workshops, seminars, and conferences in disaster and emergency medicine with cooperation from the world. The NADEM Center will develop International Institute of Disaster and Emergency Medicine.
Disaster drills have been performed officially for disaster medical preparedness by wide regional emergency medical centers in Korea. Government evaluates these disaster drills every year, but this evaluation is performed based on administrative aspect not disaster medical aspect. Also there are insufficient number of research on disaster drill not on disaster itself, especially national level. So these disaster medical drills were analyzed and reevaluated.
Methods
Disaster drills performed by wide regional emergency medical centers in Korea were evaluated and analyzed from August 2006 to July 2008. Disaster drill planning, performance, kinds of disaster drill, contents of drill and resources of drill were collected and analyzed in medical aspect based on the disaster drill report and additional compensation of incomplete data by direct contact with the participating institutions. The appropriateness and evaluation results referred to the guideline of National Emergency Medical Center of Korea.
Results
All the wild regional emergency medical centers had their own disaster drill planning and resource application planning for drills and real disasters. Most of disaster drill planning were appropriate, but disaster facility was the weakest point in the planning. Types of disasters in disaster drills were fire and structural collapse(44.4%), special disaster(13.7%), natural disaster(1.7%). Average duration of disaster drills were 6.12 hours and 1.26 days. Real field drill rate was 80.3%. Sixty five percent of drills were connected to multiple institutions or organizations other than hospitals. Number of participating persons from wide regional emergency medical centers were 21 on average.
Conclusions
Medical situation on disaster drills is that there are various levels and kinds of disaster drills done by wide regional emergency medical centers, so the quality and quantity should be enforced in low level centers. It is recommended that international situation or database can be extracted based on this research.
Manual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.
Objectives
The objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.
Methods
A qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.
Results
Three surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.
Conclusions
Satisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.
Can Health Professionals do something to diminish the risks in big cities? Civilian society is in need of protection and training when emergencies occur. The objective is to develop the capacity to feel competent when daily violence occurs and to diminish the risks of possible tragic, daily and unexpected events. Inexperience and lack of knowledge has a direct impact on Public Health. Through orientation and training with appropriate tools we prevent and diminish the effects on daily catastrophes: insecurity, violence, loss of material things, mourning to elaborate for loss after tragedies, car accidents, effects on financial emergencies, social alert states, etc.
Methodology and Objective
Through questionnaires and observation directed to city residents data was generated for evaluation. We reached the conclusion that non-government organizations (NGO) and government organizations (GO) together can diminish the effects of daily tragedies. Approximately 4500 citizens were trained directly and indirectly to give them the tools and techniques to support groups in communities in order to diminish the risk among high impact psychosocial events and abrupt events produced by nature or men that expose persons to disruptive situations that need to be solved. The modules include First Aid, Psychological Support, Debriefing and Stress.
Conclusion
Diminishing the risks depends on the people's vulnerability, resilience, social, institutional and family support groups and training. The use of participative techniques allows participants to assimilate the content of the course directed to men and women from different ages. It is necessary to generate an emergency culture for a society at risk.
UGIB remains a common disease affecting 100 to 170 adults per year, with an associated mortality ranging from 5 to 14%, causing thereby an important burden to healthcare resources. UGIB in children is uncommon (1–2/10,000 per year) but potentially life threatening. Since various specialists (general practitioners, emergency physicians, gastroenterologists and hepatologists, pediatricians, intensivists, radiologists and surgeons) may be involved and given the absence of evidence-based medical (EBM) recommendations - for adults as well as for children - there is considerable variability in the management of UGIB. Moreover, as even RCTs on the management of UGIB in children are lacking, many treatment strategies are simply deducted from the management of adult UGIB.
Aim
To provide EBM guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture.
Method and Results
An interuniversity interdisciplinary team of Belgian experts was launched. Statements based on the published literature up to September 2010 were collected and proposed after expert opinions reconciliation and graded accordingly to the class of evidence. The current guidelines for the management of UGIB include recommendations for the diagnosis process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension induced bleeding. Specificities and differences in the approach to UGIB in children compared to adults are highlighted.
Conclusion
Interdisciplinary guidelines for the management of UGIB based on current standards for EBM will provide an opportunity for clinicians to improve the management of their patients. However, clinical guidelines are not mandatory tenets appropriate for all patients, but should constitute a canon or principle tailored to the individual patient. In addition, EBM might provide quality indicators for the assessment of care to bleeding patients at a local, national or international level.
The growing number of children suffering polytrauma from traffic accidents dictates the expansion of the indications for osteosynthesis. Elastic-stable intramedullary osteosynthesis (ESIN) is the optimum treatment of fractures of long bones in children.
Methods
Closed intramedullary osteosynthesis of diaphyseal femur fractures with flexible nails was performed in 74 patients (76 fractures) during 2006–2010. The patients were children ages 1–8 years. Titanium elastic nails (TEN) (Synthesis, Switzerland) were used in the procedures. AO Foundation recommendations were adhered to when selecting the size of the implant (i.e., diameter approximately 1/3 the diameter of the femur medullar canal at its narrowest part).
Results
There was a prevalence (n = 53) of simple fractures (Ð3 by AO classification) in this group of patients. Sixteen children had Ð2-type fractures, five with spiral (Ð1), and two with slanting (Ð2) fractures. There were no type Ð1 or Ð3 complex fractures in this group. Good functional results of closed intramedullary osteosynthesis with TEN at diaphyseal fractures of the femur in children with isolated and associated damages were achieved. There were no post-operative complications. This method provided stability of osteosynthesis, which allows activating patients in the short- term, i.e., during the post-operative period.
Conclusion
Treating femur fractures in children with ESIN provides optimum treatment of polytrauma. Osteosynthesis without exposure to the area of damage, and the early activation of children can prevent infectious complications and contractures.
En la actuación de Cruz Roja Haitiana/ Cruz Roja Española en la emergencia de Artibonite (Haití), se evaluaron posibles puntos de intervención para el tratamiento de agua dentro de hospitales regionales convertidos en Centros de Tratamiento de Cólera (CTC) improvisados.
Objetivo
Evaluar las capacidades de Agua y Saneamiento del Centro Hospitalario de L'Estere, así como su respuesta de emergencia ante el brote epidémico de cólera a finales de Octubre de 2010.
Metodología
Tras la confirmación de los primeros casos de cólera en la zona de Artibonite, se desplazó a la zona un equipo especializado de delegados en Agua y Saneamiento de la Cruz Roja Haitiana/Española que realizaron una valoración y evaluación de emergencia en la región, identificando el Centro Hospitalario de L'Estere, donde una brigada médica cubana ya ofrecía atención médica a la población previo al brote epidémico de cólera. Las tareas de apoyo a dicho centro fueron principalmente de potabilización y distribución de agua de diversas fuentes (aljibe propio y río), mantenimiento de niveles altos de cloración del agua, fabricación de letrinas y drenajes, así como capacitación en promoción de la higiene a usuarios y familiares de pacientes del Centro Hospitalario de L'Esfere y comunidades cercanas al mismo.
Resultados
Del 21 de Octubre de 2010 al 26 de Octubre de 2010 se valoraron un total de 1966 pacientes; (424 hombres, 374 mujeres, 229 menores de 15 años, 596 de 5 a 10 años y 370 menores de 5 años), de los cuales 798 fueron diagnosticados de cólera. El número total de fallecidos en este periodo fue de 16.
Conclusiones
Una evaluación y respuesta rápida de apoyo en Agua y Saneamiento a estructuras sanitarias regionales permite capacitar y mejorar la respuesta de los mismos ante enfermedades epidémicas como el cólera.
Emergency physicians often encounter patients who require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries like fracture reduction, joint dislocation reduction, wound care, and pain relief. Its complications include airway or circulatory compromise. Ultrasound (US) guided peripheral nerve block is a safe alternative that utilizes minimal amounts of local anesthetic and does not require hemodynamic monitoring or prolonged post-procedure observation.
Objective
The objective of this study is to determine the feasibility and safety of ultrasonography-guided nerve blocks, performed by emergency physicians.
Methods
A prospective study involving 28 patients > 12 years of age presenting to an emergency department (ED) were recruited after informed consent. Ultrasonography-guided nerve blocks were performed by emergency physicians who underwent a minimal training of 10 supervised nerve blocks. Brachial plexus, forearm, and lower-limb nerve blocks were performed as deemed necessary. Verbal analogue scale (VAS) was used to quantify pain, before and five minutes after the procedure. The outcomes for feasibility and safety were the percentage of cases in which no further anesthesia was required, the median reduction in VAS score, median time to completion of procedure and the complication rate noted during the procedure.
Results
All procedures were completed without additional anesthesia. The different nerve blocks performed were brachial plexus (20 cases, 71.4%), forearm (3 cases, 10.7%), femoral (2 cases, 7.1%), combined femoral and sciatic (2 cases, 7.1%) and tibial (1 case, 3.6%). Median reduction in VAS score was 7.0 points (interquartile range 6.0, 8.0; p < 0.001). The median time to completion of nerve blocks was 5 minutes per patient (interquartile range 2 minutes 25 seconds, 10 minutes 0 seconds). There were no immediate complications noted after the procedure.
Conclusions
Emergency physicians with minimal training can perform ultrasonography-guided nerve blocks safely, quickly and without the need for additional anesthesia in the ED.
Evacuation/Oxygen Bus The Chicago Fire Department (CFD) identified a need to treat multiple stable fire/inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of or fire in any building, hospital, or treatment facility. As a partner with the Chicago Department of Public Health (CDPH) and an active participant in the “Chicago Healthcare System Coalition for Preparedness and Response”, the CFD determined that a bus could be an adjunct in city responses and emergencies. With the support of the Coalition, the CFD approached the Chicago Transit Authority (CTA) to obtain a bus. Once the actual bus was given to the CFD, an operations order was written and the appropriate equipment was purchased. The Evacuation Committee of the Coalition identified equipment and supply needs. Supplies purchased and retrofitted for the bus include modulators for patient oxygen use, oxygen tanks, masks, nebulizers, automated external defibrillators (AEDs), first line advanced life support (ALS) medications, evacuation chairs for moving patients, and special emergency lighting. The bus is able to accommodate thirty five people who require treatment simultaneously. The use of the bus includes but not limited to: (1) hospital evacuation and treatment of stable patients with oxygen and nebulizers prior to transportation to an alternate facility; (2) long-term care facility evacuation and treatment of stable patients with oxygen needs prior to placement and transport to another facility; (3) responding to building fires to treat victims who may need oxygen and nebulizer treatments on site; (4) assisting with the evacuation of home-based, at-risk oxygen dependent patients; and (5) treating evacuated children from specialized treatment facilities who may be oxygen dependent. The outside of the bus has both CFD and CDPH logos to identify that this is a collaborative effort between city agencies and a Healthcare Coalition.
Disasters tend to exacerbate and bring to surface the socio-economic, political, environmental vulnerabilities of the different sections of a community and thus, are seen as opportunities for reduction of vulnerability. In a post-disaster recovery program, organizations often come together in an effort to create safe conditions, reduce pressures and address root causes. These programs, at times, may further strengthen the existing vulnerabilities, thereby making some groups of the community better off than the others. Vulnerability is a dynamic process and no individual is completely vulnerable or resilient. Root causes, dynamic pressures and unsafe conditions also change with time and depends on the context of analysis. This study examines changes in vulnerability after intervention by organizations using a case study of one of the villages affected by the 2001 Gujarat Earthquake. The case study of the village gives an insight into the intra-societal vulnerabilities and how these vulnerabilities change with time. The study is qualitative in nature and has used purposive sampling technique to collect data. Data analysis was done using inductive coding methods. The study is of practical significance for the local authorities to understand peoples' perception of their vulnerabilities and ways to decrease them. It also adds to the body of knowledge by understanding vulnerability and resilience as social processes and offer lessons for future recovery processes.
The provision of mechanical ventilatory support for large numbers of casualties in disasters is a complex, controversial issue. Some experts consider this modality unsuitable for large disasters and a waste of resources better devoted to eminently salvageable victims. However, the reality has usually been that rescue teams bring with them some ventilatory capability, even if only for perioperative support. Also, there are many instances when the environment, the existing and potential capacities, allow for significant numbers of victims to be saved by providing artificial ventilation, that would otherwise have likely died. It is therefore important to discuss the issue, with all its complexity, so that the disaster preparedness and relief community fully understands its implications and makes informed, locally relevant decisions before and after disasters strike. The purpose of this presentation is to describe the ethical dilemmas, the technical and clinical considerations for such an endeavor. Ethical considerations: providing the most care to the most victims is the dictum of disaster medical management. Lowered standards of care are accepted and often the norm. However, in many moderate and even major disasters, the ability exists to save lives that will certainly be lost otherwise, by providing intensive care including mechanical ventilatory support, or may be provided if the managers so determine. Is it then ethical, to allow certain victims to die when such support may be available? What is the cost-benefit ratio of such a decision? Who should receive this limited resource? The young and healthy? The very sick? The salvageable? The postoperative? For how long? Until the international team leaves? Types of ventilator-dependency in disasters: (1) Primary ventilatory failure, normal lungs, prolonged ventilator dependency, e.g. botulinum toxin; (2) Combined ventilatory and hypoxemic failure, short to medium-term ventilator dependency, e.g. Sarin gas intoxication; (3) Primary hypoxemic failure, parenchymal lung injury, prolonged ventilator dependency, e.g. Anthrax, mustard gas, ricin; (4) Perioperative and prophylactic ventilatory support, short term but unpredictable. Ventilator supply versus demand: (1) Insufficient ventilators for first few hours only, then supplies come in; (2) Insufficient ventilators for days, then national or international relief expected; (3) Insufficient ventilators and no expected supplies. Care environment: (1) ICU, minority of casualties; (2) General floors: inexperienced nursing, medical staff; (3) Insufficient monitoring devices; (4) Insufficient numbers and quality of respiratory therapists; (5) Commercial companies normally providing technical support understaffed. Basic requirements from the ventilators: allows spontaneous ventilation, incorporates some alarms (ideally disconnect and minute volume), made by a reputable and stable company (will be there when the disaster strikes), low cost, user friendly, long shelf life, quick activation from storage, low weight and volume, few spares, few or generic disposables, little and simple maintenance, independent of compressed oxygen (i.e. electric, multiple voltages, long-life battery). The system: Mechanical ventilation is a complete patient care unit comprising: Bed and space, Oxygen supply, Vacuum, Cardiorespiratory monitor, Mechanical ventilator, Nursing staff, Medical staff, Expert consultatory staff, Logistic and technical support staff. Potential mechanical ventilators: (1) BVM or bag-valve-tube; (2) Transport-type, pneumatic or electrical ventilators; (3) Intermediate capability pneumatic, electrical or electronic ventilators; (4) Full capability intensive care ventilators; (5) Single patient use ventilators.
During disaster relief, personnel's safety is very important. Mental well-being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.
Methodology
The study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6 + Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.
Conclusions
The study proved the ability to monitor mental well being and detect psychological distress, by self administered validated tools, during a real disaster relief mission. For practical reasons however some tools should be adapted to the specific use in the field. This study opens a whole new research area within the mental well-being and monitoring field.
Violent incidents (VI) in emergency departments (EDs) are under-reported concerns for emergency care providers (ECP). There are limited data from EDs in India.
Objective
This is a study of pattern and factors associated with VIs in the ED of a Level-1 Trauma Center.
Methods
A qualitative survey questionnaire was distributed to 42 ECPs who worked in the ED of the All India Institute of Medical Sciences. Responses of ECPs were compiled and analyzed.
Results
A total of 78.6% of nurses, 19.1% doctors, and 2.4% registration clerks participated in the study. A total of 54.8% were female. A total of 85.7% had five years of work experience in the ED. A total of 59.5% witnessed and experienced verbal abuse; 19.04% witnessed and experienced physical abuse. The remaining experienced and witnessed verbal abuse as well as physical abuse. A total of 57.1% had experienced VI multiple times in last six months. Of these, 88.2% faced the incident between 8 pm and 8 am. The ECP reported the incident to hospital authority's 54.8% of the time, 19.1% reported it to the police, and 14.29% did not report, while 7.1% reported to police and hospital administration. Eighty-five percent experienced insecurity & emotional disturbance. Patient-related factors included intoxication and anxiety. Healthcare system-related factors included delay in investigations, non-availability of beds, overcrowding of ED, and lack of staff. A total of 47.7% of participants felt that there was improper communication between healthcare workers and 40.1% felt that non-availability of senior doctor were the system deficiency factors. A total of 16.6% of ECPs had formal training regarding communication skills, and 11.9% had grief counseling. All respondents felt that steps should be taken to decrease and mitigate the VIs in the ED.
Conclusions
Verbal and physical abuse of emergency care workers is common.
Advancing age and co-morbid illness result in loss of the ability to perform activities for daily living (ADLs), and are important determinants of loss of independence and autonomy among older persons. Acute illness reduces the functional status of previously healthy older persons.The aim of the current study was to determine the change in ADLs due to acute destabilization in old age one month following discharge.
Methods
Older subjects admitted to the General Medical Wards from the emergency services of the All India Institute of Medical Sciences were included between August and February 2008. The Barthel index of ADL was assessed in a longitudinal design at the time of admission and one month post discharge. The values of the indices were compared using paired samples t-test.
Results
Of 108 subjects who presented to Emergency Geriatric Services at the hospital, 11 were excluded due to incomplete records, inability to trace on follow-up, incorrect telephone numbers, or had since died. Advancing age did not show a significant correlation with pre-morbid ADL score (r = −0.040; p = 0.749) or post-morbidity ADL score (r = −0.65; p = 0.636). A 45% decline in ADL score was noted one month following discharge after acute illness in older subjects (pre-ADL = 15.85; post-ADL = 8.78).
Conclusions
Older subjects are at a higher risk of poor functional outcome because they are less likely to recover function lost before admission and more likely to develop new functional deficits during hospitalization and after discharge.
Cardiopulmonary resuscitation (CPR) guidelines throughout the world stress the importance of high quality chest compressions soon after cardiac arrest as the most significant factor in determining survival. Little evidence exists, internationally, documenting the quality of compressions provided by healthcare providers. In this study investigators sought to determine the quality of chest compressions delivered by rescuers. It was hypothesized that greater variably in compression quality exists between rescuers than variability in individual rescuers over time.
Methods
In this observational pilot study, basic life support (BLS) providers from prehospital and in-hospital settings were invited to participate in the investigation. Ten minutes of continuous chest compressions were recorded on the Resusci Anne and the Laerdal PC Skillreporting System. An adequate compression was defined as a compression with depth > 38mm, full chest recoil, and correct hand position. The Quality Compression Index (QCI) was developed to factor rate into the characteristics of an adequate compression. QCI is a scaled performance index calculated every 30 seconds.
Results
Providers came from a variety of clinical backgrounds, aged 35.5 ± 11.0 years. Of the 103 total participants, 94 (91.3%) completed 10 minutes of compressions. The most significant degradation in the quality of compressions occurred within the first two minutes. There was greater variability between different rescuers than the variability over time. Mean Square Error (MSE) due to subjects was comparatively greater than the MSE due to time (63.2 vs. 7.68). Performance of CPR, male sex, < 45 years of age, and prehospital background, correlated with higher quality. Time since last BLS certification and the number of times a rescuer completed a BLS class did not correlate with the quality.
Conclusions
Greater variability in the quality of compressions exists between different rescuers than a rescuer over time. Some participants were not able to deliver ideal compressions from the start, when the effects of fatigue were minimal.
After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district.
Methods
The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported.
Results and Conclusion
Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.
Patient assessment (PA) is one of the key points to Emergency Technicians and Doctors (ETD) in Emergency cases. Objective of this study is to investigate the general level of PA skill in ETD in a secondary hospital Ningbo and how ETD practice in different scenarios during PA process.
Methods
A retrospective study was carried out by using a questionnaire .33 ETD which includes 3 Emergency Technicians and 30 Emergency Doctors (Male: Female = 2:1) were taken into the study. Thus the analysis of position dependent PA skill variation is difficult to carry out. Mean age of the subject was 28.2 years. Average working experience was 3.91 years.
Analysis
12% ETD did not carryout scene size-up before approaching victims.The same proportion (12%) of ETD didn't call Police /Fire Agency in risk situations. 1/3 doctors insisted in entering the dangerous spot. Almost 30% doctors ignored bystanders safety when assessing patients.10% doctors did not collect patient history during transferring. Only 30% of the doctors practice complete physical examination, others (70%) were inclined to assess main parts. 84% of the ETD would not carry cervical collar when approaching the injured. During assessment, 69.9% ETD neglected patient's medical tag. 94.1% ETD accepted Emergency Training with only once or twice a year.
Conclusion
Awareness on safety of scene and self protection is weak in ETD in PA. Less doctors examine patient completely. Most of ETD does not look for medical tag which is considered an important element in PA although it is not prevailed yet in Ningbo. No significant differences are perceived upon the gender of the worker. Systematic education programs and ongoing trainings with identified shortcomings in patient assessment skill of ETD in Secondary hospitals in Nigbo area are highly recommended.
El programa se estableció en el año 2006 dentro de la Coordinación General de Protección Civil de la Secretaría de Gobernación e incluye un Comité Nacional de Evaluación, Diagnóstico y Certificación integrado por todas las instituciones del Sector Salud Público, Privado y Social Se han acreditado cerca de 700 evaluadores de más de 2,700 que han tomado el curso. Se han realizado más de 1,700 autoevaluaciones y se han evaluado de 205 hospitales. En el marco legal se ha integrado el Programa Hospital Seguro en la Ley General de Protección Civil, se ha incluido en la Norma Oficial Mexicana que tiene relación con instalaciones de salud, se ha logrado el acceso al Fondo de Prevención de Desastres que maneja la Secretaría de Gobernación y se ha establecido que previo a la Certificación de Calidad del Consejo de Salubridad General (que incluye los criterios internacionales de la Joint Commission) sea evaluada como Hospital Seguro. De los hospitales calificados como no seguros ya se han evacuado dos (que serán demolidos) con alternativa de construir nuevos con alto nivel de seguridad. En un gran número de hospitales se han mejorado los sistemas de detección de incendios, rutas de evacuación y escaleras de emergencias, entre otros
In the blink of an eye, a disaster caused by either natural or man-made hazard can change the sociocultural, psychological, physiological, and geopolitical integrity of all those that are directly and indirectly impacted. Disasters occur in every part of the world and are nondiscriminatory. Nurses, as the largest group of healthcare providers worldwide, are and should be at the center of disaster planning, management, and evaluation. Nurses are there when prevention is needed, during the crisis, and when the cameras and media are gone and the real work of recovery begins. Nurses remain there when the evaluation of the response, in its broadest sense, occurs and when recommendations must be made for applicable modification prior to the next disaster, as nurses are aware there will be more on the way somewhere in the world. As the second largest nursing organization in the world, the Honor Society of Nursing, Sigma Theta Tau International (STTI), has committed to being a leader in improving the health of the world's citizens. This leadership extends to being at the forefront of disaster planning, management, and evaluation. Through its member's use of knowledge, research, scholarship, service, and learning, STTI has created an environment in which they will impact the shaping of how nurses plan for, respond to, and evaluate disasters globally. This presentation will highlight the expertise that STTI has in the area of disaster planning, management, and evaluation, as well as the work that leaders are conducting to make an impact on the world during times of such crises. Discussion also will center on how STTI is continuing to provide leadership, education, service, and research opportunities in the area of disaster planning, management, and evaluation that can be applied throughout the world.