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The objective of this study was to compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers.
Background
Injuries from terrorism and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that often are far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking.
Methods
A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000–12/2006).
Results
Terrorism and war accounted for trauma hospitalizations among 1,784 civilians and 802 soldiers. Most civilians (93%) were injured in terrorism and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely due to terrorism than war. Soldiers tended to present with less severe injuries from war than from terrorism. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terrorism who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terrorism (7%) than war (2%) casualties, and particularly among civilians.
Conclusions
This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terrorism and war.
Safe Hospital Program and Safe Medical Unit in Mexico. The program was established in 2006 within the General Coordination of Civil Protection of the Department of Government and includes a National Evaluation, Diagnosis and Certification integrated of all the institutions of the Public Health Sector, Private and Social. They have about 700 accredited assessors more than 2,700 who have taken the training. There have been more than 1,700 self-assessments and have been assessed in 205 hospitals. The legal framework has been integrated the Safe Hospital Program in the Civil Protection General Law, is included in the Official Mexican Standard that relates to health facilities, has gained access to the Disaster Prevention Fund that manages the Interior Secretary and has established that prior to the Certification of Quality Health Council General (including international standards of the Joint Commission) is evaluated as Safe Hospital. Of the hospitals classified as unsafe have been evacuated two (which will be demolished) with alternative of building new high level of security. In a large number of hospitals have improved fire detection systems, evacuation routes and emergency stairs, as others.
Hospitals handle numerous tasks whose fundamental purpose is to provide medical treatment. Amongst these, the hospital prepares for the treatment of trauma patients who have been involved in car accidents, injuries at work and industrial accidents. These preparations, although part of the operative conventions of the hospital, do not guarantee the ability to handle Mass Casualty Events which require unique and dedicated preparation and a different operational approach. This paper presents the hospital approach of handling Emergency Mass Casualty Events.
The Approach
The preparations require involvement of a national level that must participate in the definition of the activities, task assignment and preparation of an annual plan. The peak of the preparations is a multidisciplinary drill, implemented as part of the annual activity of the hospital.
The Implementation
In an emergency situation, the aim is for the hospital staff to be capable of providing its patients (and family members) the best professional care in any given scenario. To achieve the above, the hospital is required to perform the following tasks: Defining procedures, personnel training, logistics infrastructure, control, drills and lesson learned implementation. The tasks should be performed under a multi-annual plan that covers various Mass Casualties Events scenarios including: a train accident, an event involving dangerous industrial materials (e.g. ammonia spill), biological scenarios (e.g. bird-flu) and radiation events (e.g. nuclear reaction).
Conclusions
Only precise preparations, disconnected completely from the on-going hospital routine can answer the need to handle Mass Casualties Events.
In Germany, emergency physicians in the prehospital rescue system ensure primary care. The rescue helicopter in Dresden covers the city of Dresden (population 517,000), surrounding areas with distances up to 70 km. Typical reasons for alerting the rescue helicopter are heart diseases or injuries during accidents. There also is a high number of patients with attempted or completed suicides. The goal of the study was to analyze cases associated with suicide.
Methods
Data of all emergency transports from the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden between January 2008 and December 2009 were recorded on a standardized protocol and transferred to a central computer database. Subsequently, all cases were analyzed with special regard to suicides.
Results
There were a total of 3,051 cases during the study period. Fifty-nine cases (1.9%) were related to suicide. The helicopter was on the scene within 10.9 minutes. The mean NACA Score was 4.9. The mean age was 51.6. A total of 52.5% of patients were male. In 15.2% of the cases, the patient called for emergency help; in 37.3%, bystanders contacted authorities. The reason for attempted suicide was unknown in 57.6% of the cases. In 16.9%, it was related to partnership, in 20.3% to health problems, in 5.1% to financial problems. The main method of attempt was the use of medical pills (47.4%). Other frequent methods were strangulation (18.6%), stab wounds and gunshots (8.5%), intoxication (3.4%), or unknown (16.9%). Six patients received cardiopulmonary resuscitation, four reached a Return of Spontaneous Circulation, and 10 patients died.
Discussion
Helicopters often transport suicide victims. This study demonstrates the need for better prevention as well as an improvement of education for emergency physicians working in the prehospital setting.
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 or community-based care centers 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. Additionally, if planned for correctly these facilities can also be used to decant less critical patients from inpatient wards thereby increasing the surge capacity of acute care hospitals.
Methods
A model concept of operations plan for alternate care sites to be used during pandemics and large-scale public health emergencies was developed over a 3 year period, 2007–2010. Subject matter experts were convened and best-practice methods were used to design operational plans, clinical protocols, modified standards of care, and checklists for facilities appropriate to locate such a facility. This model plan was designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting and then ultimately return to their homes for convalescence, following a public health emergency where regional surge capacity had been exceeded.
Results
Over three years of interagency, comprehensive planning, training and review was conducted to create the model alternate care site/community-based care center concept of operations plan. Accomplishments and milestones included: Creating stakeholders, engaging community partners, site selection, staffing issues, detailed medical protocols and clinical pathways, functional role development, equipment and supplies, site security, media and communications plans, designing training programs and conducting drills and exercises.
Conclusion
The key tenets of the concept, planning, operation and demobilization of an alternate care site or community-based care center will be discussed in this session. Participants will learn what has worked based on our planning experience. Lessons learned and best-practices developed in our program will be presented to assist attendees in beginning or continuing the process of creating surge capacity in the out-of-hospital setting, by planning to operate alternate care sites in their local areas.
Tsunami left 7997 people dead in Tamil Nadu. Nagapattinam, Cuddalore and Kanyakumari districts were worst affected in terms of human and property loss.. Highest number of children death (1776) were reported in Nagai District. In Project Area, Totally 522 children died due to tsunami in Pondicherry (152), Cuddalore (222), Chennai (48) respectively. Considering massive death of Children in Tsunami Disaster, Rural Development Integrated organization (RIDO) along with partnership of Plan International and Technical Support from National Institute of Mental Health and Neuroscience (NIMHANS) provided psychosocial care for tsunami affected children in the regions of Union territory of Pondicherry, Cuddalore and Chennai. Totally 150 community level workers; 50 from each region were selected and trained for a period of 1 week on psychosocial care for children affected in Disaster through using different mediums by master trainers who underwent intensive Training of Trainers program on psychosocial care for tsunami affected children at National Institute of Mental Health and Neurosciences, Bangalore which is a nodal agency in India on psychosocial care in Disaster management. Psychosocial care program for tsunami affected children was carried out over a period of 2 years in afore said regions and handholding support was given to the community level workers periodically in the field. The psychosocial care program was provided for children in their own community by their own community volunteers through group based activities using different mediums. Mediums used to provide psychosocial care were unique in their own way which brought out the underlying emotions of children related to tsunami. Emotional perceptions differed among children across the age groups. Involving the community level workers in providing the psychosocial care for children survivors of tsunami disaster showed encouraging results. Challenges, limitations and lessons learnt in providing psychosocial care for tsunami affected children through community level workers will be discussed.
History is replete with interoperability and resource reporting deficits during disaster that impact medical response and planning. Situational awareness for disaster and emergency medical response includes communicating health hazards as well as infrastructure and resource status, capability and GIS location. The need for actionable, real-time data is crucial to response. Awareness facilitates medical resource placement, response and recovery. A number of internet, web-based disaster resource and situational status reporting applications exist but may be limited or restricted by functional, jurisdictional, proprietary and/or financial requirements. Restrictions prohibit interoperability and inhibit information sharing that could affect health care delivery. Today multiple United States jurisdictions are engaged in infrastructure and resource situation status reporting via “virtual” states and regional projects considered components of “Virtual USA”.
Methods
This report introduces the United States' Department of Homeland Security's “Virtual USA” initiative and demonstrates a health application and interoperability via “Virtual Louisiana's” oil spill related exposure reporting during the 2010, British Petroleum Gulf Horizon catastrophe. Five weekly Louisiana Department of Health and Hospital summary reports from the Louisiana Poison Center; Hospital Surveillance Systems; Public Health Hotline; and Physician Clinic Offices were posted on the Louisiana Office of Homeland Security and Emergency Preparedness's “Virtual Louisiana”.
Results
227 total spill-related, exposure cases from five reporting weeks were provided by five Louisiana source agencies and reported in Virtual Louisiana. Cases were reported weekly and classified as “workers” or “population”; associated with the parish exposure locations (8), offshore (1), or unknown (1); and shared with four other virtual states.
Conclusions
Real-time health and medical situation status, resource awareness, and incident impact could be facilitated through constructs demonstrated by “Virtual USA”.
Hospitals are obliged to maintain emergency preparedness plan to support the army's rear. Hospital preparedness plans contain several scenarios that are aimed to provide an answer to different crisis situations. The basis of these scenarios is common to all situations. Haifa region three hospitals cooperation in emergency preparedness plans extracted Ten Commandments for utmost emergency deployment: a. Creating a clear management policy b. Assigning high proficiency qualified key persons. c. Creating a multidisciplinary management team: Physician, nurse and administrator, with the notion that there is only one manager. d. Emergency activities are similar as possible to routine level. e. Using am assignment method for f. Clear and elaborated checklists are the basis for emergency activities. g. Trainings and drills are a solid basis for knowledge. h. High materials and infrastructure availability and stocks. i. Accessible communication channels. j. Debriefing is the basis for organizational learning and quality improvement. These Ten Commandments are the milestones for a quality model, developed for emergency preparedness. The quality model outlines our constant quest to achieve a state of the art emergency preparedness system in a region that has been involved and is prone e to a variety of emergency scenarios. Ten Commandments for Emergency Preparedness Deployment – a Basis for Quality Model.
A guide was created by the Chicago Healthcare System Coalition for Preparedness and Response to help hospitals and health facilities design, implement, and evaluate emergency exercises following the US Homeland Security Exercise and Evaluation Program (HSEEP) format. The HSEEP provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. As a part of a toolkit for hospital use, the pediatric at-risk population is represented with an Exercise Evaluation Guide titled “Pediatric Medical Surge”. Pediatric Medical Surge is defined as the rapid expansion of the capacity of the existing healthcare system in response to an event that results in an influx of children and an increased need for personnel (clinical and non-clinical), support functions (laboratory and radiological), physical space (beds, alternate care facilities), and logistical support (clinical and non-clinical equipment and supplies). The Exercise Evaluation Guide is fully customizable and includes the following activity sections: (1) Pediatric Pre-Event Mitigation and Preparedness; (2) Incident Command; (3) Pediatric Bed Surge Capacity; (4) Pediatric Surge Staffing Procedure; (5) Pediatric Decontamination; (6) Receive, Evaluate, and Treat Pediatric Surge Casualties; (7) Provide Pediatric Surge Capacity for Behavioral Health Issues; and (8) Demobilization. Each of these sections includes a number of exercise tasks and details the potential tasks/observation keys that are completely modifiable in an electronic format. All or a limited number of these activity sections can be used in an exercise. Following the Activity and Tasks, a section for Observations is provided, and includes Strengths and Areas for Improvement. Upon completion of the Exercise Evaluation Guide, the findings are then utilized to complete the After Action Report for the exercise. This planning document is one tool to assure that children are not neglected in health care based exercises.
Although Injury is being looked into as a major public health problem in India, most of the data coming is mortality related data from the National Crime Records Bureau and projections based on that data. There is complete absence if injury related data both surveillance data as well as outcome based data. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi is one of the pioneering centers to understand the need to record the injury related data of all trauma cases which are admitted to the Apex Center, thus establishing a first of its kind hospital based Trauma Registry in India. This trauma registry will serve as a means for collating trauma data that will further help in the evaluation, prevention, and research of trauma care and can be used for quality control and planning future research and injury prevention activities, in India. Later, the center has an objective of networking all regional hospitals for data collection with an aim to establish a National Trauma Registry. Although several trauma registry software's exist from Western hemisphere but the Apex Trauma Center decided to formulate and designed its own Trauma Registry form and develop the related software which includes: Basic Identification; Demographic profile; Brought by personnel and vehicle; Condition at time of arrival; ED Interventions; Detailed Diagnosis; Definitive Procedures; Disposition/ Outcome The Trauma registry is being maintained, under the leadership of a Faculty and the data is collected and entered by the Trauma Nurse Coordinators, who follow the patient from admission to discharge. The data collection for the JPNATC Trauma Registry had started w.e.f. April 2009, but initially there were usual problems of data loss and non-availability of data. This has been overcome gradually and we hope that the registry will attain its full potential in another year or so.
Tsunamis most commonly occur in the “Ring of fire” in the Pacific due to frequency of earthquakes and volcanic activity. Damaging tsunamis occur 1–2 times yearly. On September 29, 2009, an earthquake on the Pacific floor caused a tsunami that struck American Samoa, Samoa and Tonga, with only 20 minutes warning.
Objective
To evaluate the disaster response in American Samoa by emergency medical services (EMS), the territorial hospital, and the Department of Health.
Methods
A retrospective review of EMS logs, public health records, hospital emergency department charts, and key-informant interviews over a 2-week period. Descriptive statistics were used to evaluate data.
Results
Three 5-meter waves struck the American Samoan islands, with land inundation as far as 700 meters. Many low- lying villages, including the capital city Pago Pago were affected. A total of 33 people (8 male, 23 female, including 3 children) were killed by the water, with approximately 150 significantly injured. EMS runs increased 250% from normal daily averages, with island-wide responses significantly delayed by flood damage. The hospital in Pago Pago, situated near the shore and only 10 meters above sea level, utilized 75 staff to evacuate 68 in-patients to high ground as soon as tremors were felt. This process was completed in 20 minutes with no associated morbidity or mortality. Patient injury patterns for the event are similar to recent literature reports. Mobile clinics and alternate care sites established at outlying dispensaries were used to decentralize healthcare from the hospital. DMAT/DMORT teams from Oregon and Hawaii supported local healthcare initiatives. Post-disaster public health surveillance focused on identifying and limiting food/water-borne illnesses, dengue fever, and influenza-like-illness outbreaks, as well as disaster related PTSD.
Conclusion
The disaster response to the tsunami in American Samoa was effective. Disaster planning was appropriate and rapidly implemented. Post-disaster public health emergencies were minimized.
Australia is a vast and isolated country and often the only viable option of transporting multiple casualties is using fixed wing aircraft. A number of civilian aeromedical services and the military are responsible for the evacuation of casualties, both nationally and internationally. Due to Australia's increased operational commitments, the military can no longer be expected to provide a rapid aeromedical deployment. This situation, coupled with the limited surge capacity of Australia's civilian fixed wing aeromedical services, highlights the need for Australia to improve preparation and readiness for a large scale civilian aeromedical response.
Discussion and Observations
Historically, the use of large jets configured for aeromedical use has been exclusively the domain of the military. Yet in recent years the use of large civilian jets configured for aeromedical capability has been suggested as a solution. The purpose of this paper is to explore the role of large civilian jets configured for aeromedical use in the event of a disaster with multiple casualties. This study involved an extensive literature review and an international study tour of aeromedical services that are at the forefront of using large jets in aeromedical evacuation. The findings identified that standard civilian jets can easily be reconfigured for transporting multiple casualties. It is argued that this strategy can be an inexpensive and effective option and should be included in emergency preparedness arrangements. The aim of this paper is to prompt disaster health agencies in Australia to consider the use of a civilian jet system that can be used for a disaster requiring a large scale aeromedical response.
During 2008 Russian Federation realized major aggression against its direct neighbor, the sovereign republic of Georgia. It was Russia's attempt to crown its long time aggressive politics by force, using military forces. EMS physicians from Tbilisi went to the Gori district on August 8 at first light, 14 brigades were sent. At noontime of August 8, their number was increased up to 40. 6 brigades of disaster medicine experts joined them as well.
Results
Destination site for the beginning was the village Tkviavi, where a military field hospital was assembled and a Military Hospital in Gori. Later 6 brigades were withdrawn towards the village Avnevi. During fighting, wounded victims were evacuated from the battlefield, where initial triage was done. Evacuated victims were brought to the military hospital where the medical triage, emergency medical care and transportation to Gori military hospital or to Tbilisi hospitals was done. A portion of the wounded was directly taken to Gori military hospital and later to different civil hospitals in Tbilisi. Corpses were transported to Gori morgue as well. On August 9, the emergency care brigades and field hospital left Tkviavi and moved to the village Karaleti, then to Gori. On August 12, the occupied territory was totally evacuated by civil and military medical personnel. Although withdrawal of wounded was done on following days. Up to 2232 military and civil persons were assisted by EMS brigades during war period (8–12 August), from them 721 patients were transported among which 120 were severely injured.
Conclusion
Close collaboration between military and civil EMS gave the system opportunity to work in an organized manner. On the battlefield prepared military rescuers were active taking out wounded victims to the field or front-line hospitals from which civil emergency care brigades transported them to Tbilisi hospitals. Only 3 fatalities occurred during transportation.
The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.
Methods
Members of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.
Results
New York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.
Conclusions
Providing surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.
The post-disaster response strategy in The Netherlands is unique in that it links scientific institutes, national government and local emergency response organizations. The lynch pin is the Centre for Environmental Health which was founded by the Ministry of Health to improve post-disaster care in The Netherlands. The recently refined Dutch strategy for post-disaster response will be presented and illustrated with a few examples from recent disasters. We will focus on both the role of the Centre and the role of public health Hazmat advisors who are part of the local emergency response organization. The latter advise on the health risks of exposure to CBRN agents. One of the main objectives of the Centre is to prepare guidelines and a structure to ensure transparent and authoritative advice is given to local governments and public health services on the need and value of post-disaster care. The Centre operates a front office, available 24/7, to deliver integrated advice on public health and psychosocial care to local emergency response organizations. A network of experts with a wide range of expertise is on stand-by, whereby the characteristics of the disaster determine which experts compile the advice. The Centre also works closely with several other advisory organizations within the national emergency response organization. Three kinds of advice are delivered. Firstly, as an immediate response (usually within an hour), advice is given on the registration of victims. Secondly, usually within 24 hours, advice is given on the need and value of a health outcome assessment (HOA). Thirdly, if a HOA is decided on, detailed advice is given on its implementation. Another objective of the Centre is strengthening the unique position of regional public health services to deal with post-disaster care. The Centre produces guidelines, tools and training on demand to achieve harmonization and uniformity among these services.
Decision-making is the major component in triaging emergency department patients. Influencing factors on decision-making have been identified but it`s not clear how much of the decision is based upon scientific criteria. The objective of this study was to determine frequency of using reliable and valid guidelines by nurses in emergency departments.
Methods
It was a descriptive survey study. The questionnaire was composed of demographic data, evidence-based triage questions (15) and triage decision-making questions (10). The questionnaire reliability was 0.87 using the test-retest method. Content validity was considered based upon Canadian Triage and Acuity Scale.
Results
70 nurses from 10 emergency departments participated. 40 % of nurses` responses to evidence-based questions was correct. The percentage of inter-rater agreement between nurses was moderate (0.56) related to decision-making questions. No valid and reliable guideline was utilized in emergency departments.
Conclusion
Nurses` decision-making was poorly based on evidence-based criteria. Low level of nurses` knowledge about triage may be derived from lack of official and specialized triage training courses. Academic triage courses establishment and development of national triage scale are recommended.
The World Association for Disaster and Emergency Medicine (WADEM) has been the primary innovator and incubator for the concept of disaster health. This presentation puts forth 7 options for consideration for evolving the concept of disaster health.
Discussion
(1) Promote disaster health from an adjective to a noun phrase. Disaster health has been a modifier for too long, tucked into expressions such as disaster health management or disaster health education. It is time for disaster health to emerge in its own right. (2) Elevate disaster health from a discipline to an endpoint, a defined and desired outcome. (3) Liberate disaster health from the confines of medicine and health care. Disaster health originated there, but is much more expansive. One of the distinctions of disaster health is its multidisciplinary nature. (4) Fully integrate the mental health and psychological dimension of disaster health. WADEM has been at the forefront, championing psychosocial issues in disasters, yet to date, this dimension of disaster health has been underdeveloped and underappreciated. (5) Consider the parallels inherent in optimizing disaster health for both disaster responders and disaster survivors. Also consider using plain language to create a common set of strategies for achieving disaster health that is equally applicable for responders and survivors. (6) Consider disaster health applied at the community level in a manner that subsumes community health, resilience, and disaster resistance. (7) Give disaster health its own framework. Clear and comprehensive WADEM-driven frameworks now exist for disaster health education, for example. Disaster health needs a framework that is simple, supple, and explanatory.
Conclusion
WADEM has promulgated disaster health as a vital, pivotal concept. The 7 options presented here have come from our own engagement with this concept. They are, in fact, defining features of our SAFETY FUNCTION ACTION framework for disaster health.
It is extremely rare in disaster mental health annals to have consistent psychosocial interventions pre-disaster. For the third year in a row, the Red River Valley of the United States and Canada has experienced catastrophic flooding, on the heels of almost two decades of yearly major flooding. This paper describes the community and individual psychosocial responses to the current Red River flood, based on resiliency paradigms and the backdrop of successful mitigation of serial disasters. In addition, the author will present examples of real-time networking with colleagues around the world who are responding to natural disasters.
The field ‘Public Health in Disasters and Complex Emergencies’ is replete with either epidemiological studies or studies in the area of hospital preparedness and emergency care. The field is dominated by hospital based or emergency phase related literature. The social science perspective to public health is largely missing. It is in this context that the study of 26/11 Mumbai Terror Attack Survivors, was carried out. The study is an outcome of the ongoing work with the survivors over a period of two years following the attack. The qualitative study uses a case study approach and focuses on lived experiences of the 26/11 Mumbai Terror Attack Survivors who had firearm injuries. The paper highlights the special health issues faced by the survivors, issues of professional competence, hospital preparedness as perceived by the survivors, issues with disability assessments and issues of ill informed care and compensation policies. The paper also explores the interface between health and psychosocial well being two years after the attack and proposes a conceptual framework for understanding psychosocial well being of survivors within a public health perspective.
In 2009 in Delhi, 7,516 road traffic crash victims were admitted to hospitals as unknown or unattended.
Objective
The aim of this study was to assess the morbidity and mortality of unknown or unattended patients and problems they faced relative to the provision of nursing care.
Methods
This is a retrospective analysis from February 2010 to August 2010 wherein all unknown or unattended patients with head injuries (Glasgow Coma Scale (GCS) score = 1–15) admitted to the neurosurgery department were included. The duration of hospital stay, admission GCS, and outcome were assessed and an attempt also was made to analyze the problems faced by nursing personnel.
Observations
The total number of patients enrolled was 38. Of these, 22 were unknown, and 16 were unattended. The average hospital stay of unknown and unattended victims was 35 (1–151), and 21 (7–120) days, respectively. The mean GCS score of unknown patients upon admission was 9 (3–15), and during discharge, 8 (3–15). The mean GCS scores of unattended patients during admission and discharge was 12 (13–15) and 14 (3–15). respectively. Of the 22 unknown patients, 24% were identified during their stay, 33% were transferred to rehabilitation homes, and 43% died without being identified. Of the 16 unattended patients, 25% went home, 63% were transferred to rehabilitation homes, and 12% expired. The most common problems faced during nursing care were contractures (8%) and pressure sores (11%), due mainly to their long hospital stays.
Conclusions
Patients remaining unknown/unattended is a unique problem as far as developing countries are concerned. Managing these patients is difficult, as they occupy hospital beds for a longer duration, and require more nursing care, and have higher mortality and morbidity. It remains surprising that in spite of advancements in the field of mass communication, almost 76% of the unknown patients remain unidentified.