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The recent H1N1 pandemic presented severe challenges to many emergency departments (ED). At our institution it caused overcapacity issues with increasing length of stay and increasing patients leaving before treatment. The emergency department space at the hospital was already fully used including hallway beds. Other clinical space could not be taken for ED expansion, as it was also all maximally used.
Methods
Portable mobile ED expansion modules were developed consisting of ED supply carts, pharmacy items and a wireless ED information system (EDIS) integrated with computers on wheels. This EDIS provided internet access from anywhere in the hospital, enabling access to clinical databases, order entry for testing, medications and discharge instructions, providing full operability of ED functions. This complete assembly can be stored in a small storage area. The H1N1 pandemic allowed for practical testing of this system. This system was deployed to a nearby hospital clinic that closed at 5 pm. The expansion module operated from 6pm to 10pm staffed with two providers. Data was compared between days when the surge clinic was in operation and days it was not. Data was collected on patients seen and left without being seen rates.
Results
During the trial period of 9 days, 1323 patients were seen in the ED and 112 were seen in the modular clinic setting, representing 8.5% of the total ED volume. No technical problems were noted and the system worked as designed. We observed increased satisfaction from both staff and patients. No reduction in the number of patients leaving without treatment was noted in either group (5/day).
Conclusion
A modular portable ED expansion setup is practical and may increase ED capacity at times of maximal patient volumes. These materials are easily storable and build surge capacity for other events.
This study aimed to assess the training needs of public health nurses (PHN) and compare the job performed by them with job descriptions.
Materials and Methods
A descriptive study was conducted by utilizing triangulation research method. It was conducted in Eastern and Central regions of Nepal with 13 PHNs (of 13 districts among 75 districts of Nepal) and their supervisors were included as the samples. Data was collected by using standardized tools.
Results
The mean age of the PHNs was 43.69 ± 9.4 years. Near half (46%) had 10 to 20 years job experienced. Most of the respondents (85%) had done PCL Nursing. All most all (92%) subjects had undergone some in-service education. Most of them (57%) used to visit health posts. The majority of PHNs (85%) assisted in planning and implementation of program for a health post. The Majority (85%) were involved in educational activities. Most (85%) were used to supervise the staffs working at health post. The majority of PHNs (77%) were not involved in research activities. Most of them (85%) prioritized the needs of training on recent concepts to bridge the gap between traditional and recent concepts of public health.
Conclusion
PHNs have broad areas of nursing expertise and opportunities for work if needed in a sufficient manpower at the district level. Most of them completed PCL nursing a number of years previously and therefore need training on recent advances and need to recruit more PHNs to improve public health services in Nepal.
Difficulties have been reported in patient distribution during mass-casualty incidents (MCIs). In this retrospective, descriptive study, the regional Patient Distribution Protocol (PDP) and the management of the patient distribution after the Turkish Airlines airplane crash on 25 February 2009 near Schiphol Airport in Amsterdam were analyzed.
Methods
Analysis of the of PDP involving the 126 surviving victims of the crash, by collecting data on Medical Treatment Capacity (MTC), number of patients received per hospital, triage classification, Injury Severity Scale (ISS) score, secondary transfers, distance from the crash site, and critical mortality rate.
Results
The PDP holds two inconsistent definitions of MTC. The PDP was not followed. Four hospitals received 133–213% of their MTC, and five hospitals received one patient. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); thre hospitals within 20 km of the crash did not receive any patients. Major trauma centers received 89% of the “critical” casualties and 92% of the casualties with ISS score ≥ 16. They also received 10% of “minor” casualties and 29% of casualties with ISS score < 8. Only three patients were secondarily transferred, and no casualties died in, or on the way to, the hospital (critical mortality rate = 0%).
Conclusions
Patient distribution was effective, as secondary transfers were low, and the critical mortality rate was zero. The regional PDP could not be followed during this MCI. Uneven casualty distribution was seen in the hospitals. The regional PDP is inconsistent, and should be updated in a new cooperation between Emergency Services, surrounding hospitals and vSchiphol Airport, a high risk area, for which area-specific PDPs must be designed.
In the 2011 East Japan Great Earthquake over 200 DMAT immediately headed to the disaster stricken area.
Progress
Land lines and all mobile telephones had interrupted service. Radio communication could only be used at a short distance in one area. Satellite phones were the only means of communication, but since there were limited number of devices, power shortages. DMAT used a management browser called EMIS (Emergency Medical Information System) to exchange information and coordinate activity, but the internet itself did not work. Without communication equipment, the victims could not send or receive information and even DMAT had trouble understanding the situation. There was rumor of many victims in a wide range of isolated evacuation shelters that were left behind. The land was flooded, vehicles were carried away, the town was buried under debris and mud, and fires occurred one after another. The wounded and sick could not access hospitals immediately. Because of the blackout, the suspension of the water supply, and prospect of restoring heating were not in sight, an immediate confirmation of medical needs and triage of the sick and wounded were required. Therefore, as the disaster front headquarters, the fire department, police department, self-defense force, Japan Red Cross medical care relief squad, the city, the prefecture, and the public health center, many organizations in collaboration held meetings every day at 5:30 and 18:30 aiming to gather information and establish strong collaboration. Four teams from the Japan Red Cross medical care squad and 4 teams from the Ground Self-Defense force were dispatched in replacement of the insufficient DMAT to manage the disaster front. They restored roads and headed to isolated shelters and hospitals. With the cooperation of the Air Self-Defense Force, DMAT was sent by helicopter to an isolated peninsula.
Result
We use helicopters, ambulances, and Self-Defense Force vehicles to transport as many patients to hospitals in other regions, because there was no place to return home. In one of the isolated hospitals, they had to use candlelight in a room temperature below zero, they were unable to use the aspirator, and four patients were already deceased. The remaining 38 inpatients were transported out of the disaster area and preventable death could be prevented.
Consideration
Because the local staff suffered damage from the earthquake, all organizations consisted of groups dispatched from other regions. With a communications network not functioning in the disaster stricken area, it is necessary to exchange information and share the best plans. Taking this into perspective, having two disaster relief measures meetings in one day was very effective.
A variety of models, methods, and computer-aided systems have been used to predict and analyze disasters and emergencies, and manage a pertinent medical response effectively. The list of these instruments traditionally comprises: computerized databases, geographic information systems (GISs), graph theory, complex networks, mathematical programming, simulation, and agent-based modeling. As a rule, each type of those is applied asunder. It makes sense to put in one silo diverse instruments to get multidisciplinary solution with its synergy effect for problems of disaster and emergency medicine.
Methods
Within this study, an original, agent-based model was developed. The model combines the advantages of the principal computer-aided instruments and considers all the types of information: semantic, topographical, metric, and topological. The model is severely dynamic, fits to real actors and principally covers all the disaster situation.
Results
In line with the model, a so called Topometric Agent-Based System (TABS) with its key visualization component has been designed. A TABS-specific simulation to investigate behavior of the attacked network of vulnerable actors has been conducted leading to critical findings. It has been shown a severe significance of order within combination of threats: man-made + natural or those of natural + man-made. A well-balanced financial distribution to protect actors of diverse status also has been found.
Conclusions
A TABS similar to GIS focuses on mapping. Topometric Agent-Based System mapping brings an efficient and clear language for information sharing not only within national emergency medical services but between experts from different fields and countries.
Natural disasters cannot be prevented but their human impact can be mitigated. Effective medical and public health mitigation and responses require multidisciplinary efforts and appropriate training. Whilst Asia is currently ranked as the most natural disaster prone area globally, limited disaster medical and public health response training opportunities are available in the region. Our paper reports efforts to identify the training gaps and ways to fill them to prepare frontline practitioners and academic researchers in disaster and medical humanitarian emergency relief efforts in Asia.
Methods
Grounded on the disciplinary principles of academic training in public health, emergency & disaster medicine and primary care, our paper reviews the current disaster related academic training offered in these disciplines and maps out the training and knowledge gaps in disaster mitigation and response for frontline practitioners and academic researchers. We suggest ways to fill such gaps.
Results
A two-dimensional (clinical versus non-clinical), three-tier education training framework (Entrant level, Continuous medical education needs and Expertise level) is developed. Experiences and key training needs in Asia are highlighted.
Conclusion
The proposed framework identifies areas for comprehensive training for medical and public health practitioners who are interested to engage in medical disaster relief. The proposed framework also aims to strengthen mitigation and response capacities in health systems.
Transportation capacities belong to the key factors of the response to a major incident. Available resources, both in terms of personnel and equipment, must be transported, usually by ambulances, to the incident location. In the other direction, casualties must be transported to hospitals and other health care facilities for further treatment. For this reason, the efficiency of the response is greatly determined by ambulance travel times and the ability of health care facilities to absorb large numbers of patients. We propose methods to compute the travel times to and from the incident location based on a classified road network. The methods take into account different attributes that depend on ambulance type and capacity, road quality, time of day, weather or actual traffic density. Correctly computed travel times are crucial not only for optimal deployment of all resources within the analyzed region, but also for the evaluation of the readiness of the emergency health care system for a major incident. We have included the methods in an agent-based simulation of transport during the response. From the simulation outputs and with the help of geographical information systems and information visualization methods we have synthesized maps that represent the capability of a region to absorb a major incident defined by a scenario. When combined with risk maps and maps of population density the synthesized maps allow emergency management authorities to find critical points and gaps in the emergency health care service.
Frailty, Dementia and Disaster: an e-learning initiative for Health care providers D. Maltais1, M. Gibson2, L. Hardy3, S. Ruthe4, 1University of Quebec, Chicoutimi 2St. Joseph's Health Care London, London 3Health and Social Services, Yukon Territory Government, Whitehorse 4Emergency Program, Corporation of the District of Oak Bay, Victoria, Canada.
This poster describes the development, piloting, evaluation, and dissemination of the e-learning tool: “Frailty, Dementia and Disasters: What Health Care Providers Need to Know”. The purpose of the e-learning tool is to contribute to international efforts to reduce the disproportionate vulnerability of older adults in emergencies and disasters. Key literature on geriatric emergency preparedness and response issues, including the roles and responsibilities of health care providers, was identified and synthesized. Content was piloted in a facilitated workshop in Ontario. A Canada-wide health provider reference group provided feedback on the transition from a traditional powerpoint presentation to an e-learning format. The evaluation process included facilitated review of the tool by health care providers in two in-person workshops in each of Yukon and Quebec and in an independent review by health care providers in British Columbia (virtual). The learning objectives of the e-learning resource are to help health care providers, administrators and policy makers understand the: · disproportionate vulnerability of older adults who are frail and those who have dementia, in emergencies and disasters; · components of the emergency management cycle and how they apply to this target population; · best practice resources that can be used to improve emergency preparedness, response, recovery and mitigation; and · role of health care organizations and providers in emergency management for these older adults. The e-Learning tool is hosted with open access on www.dementiaknowledgebroker.ca (DKB), a platform facilitated by the CDRAKE - the knowledge exchange theme of the Canadian Dementia Knowledge TranslationNetwork (CDKTN).
Nurses are leaders and primary health responder/providers in natural, anthropic and technological disasters. Preparation and education for nursing emergency and disaster response should begin before nursing program graduation and before disaster events occur. In Louisiana, 17 federally-declared disaster declarations were experienced from 2000 – 2009, ranging from the Space Shuttle “Columbia” to Hurricane “Katrina”. This presentation overviews Louisiana nursing programs' disaster preparedness and operational planning as demonstrated to Louisiana's Schools of Nursing Aligned for Emergency Responsiveness (SAFER) Conference, New Orleans, 2010. Co-sponsored by Dillard University, Division of Nursing, New Orleans, and Northwestern State University, College of Nursing, Shreveport, the invitational conference brought expert nurse and physician preparedness speakers from federal, state and local venues to review disaster planning, experiences, needs, and nurse preparedness competencies with nurse faculty leadership.
Methods
A multiple choice survey was developed, trialed and emailed to 42 Louisiana Nursing Programs. Programs surveyed included Associate degree, Bachelors and Graduate-level providers for Registered Nurses as well as Vocational Technical programs for the Licensed Practical Nurse. National Planning Scenario threat priorities; impacts of federally declared disasters on Louisiana nursing programs; nursing program roles in disaster; and awareness of nurse emergency preparedness competencies were queried.
Results
34 of 42 surveys were returned. 20 were complete. Nursing programs were located state-wide and found in 7 of 9 Louisiana regions. Surveyed programs offered a Bachelors degree (45%); Graduate degree (35%); Associate degree (35%) and vocational or Licensed Practical Nursing (35%).
Conclusions
The majority of Louisiana nursing programs and their health communities have been impacted by federally declared disasters. Coordinated efforts to improve nursing program preparedness education, roles and responsibility are warranted as vulnerability increases.
Japan is one of the world's famous countries for natural disaster. Seven years ago, The Japanese government indicated the necessity of providing disaster prevention education in schools. However, such education has not yet been introduced.
Objective
The aim of this study was to evaluate the 90min triage program in senior high schools.
Method
Sixty nine students attended the program. The effects of the program were evaluated using pre and post examination by paired t-test and McNemar's test.
Result
Compare pre-test with post-test, the average score of the tests was a significant increased. Compare pre-questionnaire with post-questionnaire, the number of interested students in a regional disaster drill has increased.
Discussion
The results showed that this program increased the interest in disaster prevention and provided students with a chance to participate in disaster drills in their own resident area.
Conclusion
Carrying out this program in senior high schools, would provide students with a chance to learn disaster prevention.
Natural Disasters result in a sudden onslaught of huge numbers of catastrophic and disabling injuries including spinal cord injuries, traumatic brain injuries, limb amputations, long bone fractures and peripheral nerve injuries. In addition to these there are persons with pre-existing disabilities in the affected disaster zones. Oftentimes disasters overwhelm the available resources and rehabilitation services are usually underdeveloped in most parts of the disaster affected zones. Both challenges are frequently neglected and not included in disaster response planning. As a consequence, Physical and Rehabilitation Medicine (PRM) has traditionally played no or little role in the post disaster phase and disaster planning.
Methodology
The data was derived from an English language literature search (1950–2010) using Pubmed, Google Scholar, Sciencedirect, Ovid, and Sagepub. Other sources of data included discussion with subject matter experts and the author's personal experience.
Results
PRM has not historically become actively engaged in medical rehabilitation of injuries until 24-48 hours post-event. The emergence of the discipline of disaster rehabilitation however, advances PMR into the emergency response phase. This paper describes the disability pattern after disasters, shortcomings in the traditional disaster response with reference to PMR interventions and disabled populations and its negative consequences. It then explores the rehabilitation interventions offered in different disaster scenarios during the last decade and its positive impact in achieving a better outcome for the new onset and pre-existing disabled population.
Conclusions
This is the first paper in biomedical literature exploring the possible role of PRM in the post disaster phase. The paper offers recommendations to include PRM in the disaster response phase and possible plans of action for organizations working in the fields of disability and disaster management. It is expected that this paper will guide future research and establishment of the field of Disaster Rehabilitation.
A Mega Mass-Casualty Event (MMCE) is a unique and exceptional event, that results in a very large number of casualties (500–5000) needing emergency care in the prehospital and hospital settings. This type of event usually goes beyond the capabilities of a certain region and requires reinforcement of resources from adjacent and remote regions. Due to its exceptional nature, a MMCE dictates a different organization of all emergency services and agencies involved. As a result of the recent experience, and in order to adequately prepare for such future events, a novel MMCE doctrine was developed by a committee of diverse emergency professionals. This doctrine was transferred to guidelines referring to MMCE recognition and the following series of actions that need to taken at all levels. It holds organizational, operational, and clinical aspects, as well as command and control elements. In November 2009, a large-scale drill of 1,000 mock casualties was performed in order to validate and evaluate the MMCE plan. This drill emphasized the need for the involvement of all pertinent emergency services and agencies, and their optimal collaboration and coordination, subjected to regional and national headquarters' command and control. In addition, the need for dedicated educational programs and o-going training was recognized. It was accepted that adequate planning is obligatory for better outcomes in the future.
Le feu dans un hôpital ou une maison de retraite présente des caractéristiques de risque particulier. A propos de la combustion d'un mètre cube de couches culottes pour adulte au Centre hospitalier de Pfastatt dans le Sud de l'Alsace, ces risques particuliers seront montrés. Ce feu globalement insignifiant en terme de quantité de comburant a cependant entraîné quatre morts par inhalation des fumées et plusieurs intoxiqués ainsi que l'évacuation de tout une aile de l'hôpital avec hospitalisation d'une cinquantaine de patients dans d'autres structures de soins sans compter les pertes matérielles et financières liées à la réparation des dégats. Les opérations d'extinction, de triage et d'évacuation des patients se sont déroulées simultanément nécessitant la mise en oeuvre du plan rouge pour nombreuses victimes, une opération de mise en sécurité des patients hospitalisés et l'évacuation vers les structures adaptées avec une coopération et une coordination entre les diférentes structures de secours intervenantes. Les investigations médico-légales secondaires ont permis de montrer chez tous les patients décédés une forte intoxication aux cyanures liée à la nature du comburant et responsables du décès rapide. Ceci pose le problème du stockage de ce type de produit et surtout de la disponibilité d'Hydroxocobalamine, antidote spécifique, en quantité suffisante pour des établissements à risque possédant beaucoup de produits synthétiques. Enfin il convient de signaler que le personnel hospitlier doit être entraîné à avoir les bonnes réactions devant un développement de fumées car c'est en premier de leurs attitudes que dépend la vie des patient en particulier s'ils sont alités.
Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital F. Plani1, E Degiannis, P Lingham No disaster training had ever been carried out at the CHBH, the biggest hospital in the world with over 2900 beds and over 5000 staff members. The 2010 Disaster Plan required that all clinical staff undergo the appropriate training. Basic Interprofessional Training for Trauma Disasters 411 staff members attended a half day course during May/June 2010, presented and sponsored by CHBH Trauma Directorate consultants. The aims of the course were to disseminate the trauma disaster plan in interdisciplinary and interprofessional fashion, clarify hospital triage, familiarize staff with Trauma Unit equipment, and practice resuscitations in mass casualty incidents. The course started with presentations on CHBH Disaster Plans and Protocols and Principles of Triage and Standard of Care in Disasters. This was followed by 3 multiple patient scenarios with rotating groups, over a whole hospital floor with: 1) 50 mixed patients outside the hospital; 2) 10 serious patients in the ER; 3) 10 patients deteriorating later in a ward or ICU. Next were individual patient resuscitations, Primary, Secondary, Tertiary Survey and “hand-over”, patient resuscitations in a disaster, using the contents from “Disaster Bags” and questionnaires to assess confidence and suitable treatment areas (Red, Yellow, Green, OT) for allocation in a disaster. The course was wrapped up by a familiarization visit to ED and the colour coded areas.
Results
Final questionnaires demonstrated that all participants were a lot more confident in the triage of patients and the initial resuscitation using the implements found in the resuscitation room and the “Disaster Bags”. The course has been adopted as part of staff orientation at all professional levels from 2011 onwards, and is in the process to be extended to secondary level hospitals in Gauteng, RSA.
Research into how war-displaced communities value or prioritize aid response is limited. A clearer conceptualization of what affected populations seek from the international humanitarian response to their needs would be valuable in planning for emergencies.
Aim
Exploring internally displaced person's (IDP) experiences and perceptions of the humanitarian response, with a focus on health risks, resources, and health services received during their displacement.
Method
A mixed-method approach using both quantitative and qualitative methods was used. This study assessed the perceptions of IDPs on provision of health and other services using an interviewer-administered-questionnaire (survey) using a sample frame that included the entire displaced population of 150,000 IDPs living in 97 camps. Findings from the survey were synthesized with the key themes that emerged through the qualitative methodology. In-depth interviews were conducted with health cluster actors. An innovative child-to-child (CTC) based research methodology was used to ascertain the insights and perceptions of displaced children and adolescents.
Results
The survey revealed community satisfaction with health care services immediately after displacement (within IDP camps) improved considerably from 63% to 80% (6 months after the acute phase). Significant gains also were registered for shelter (54.2% to 81.4%), and sanitation (47.4% to 62%). Satisfaction of services rendered by primary healthcare workers also were high; 81.7% for public health midwife (who provided maternal and child health care), and 76.8% for public health inspectors (who provided environmental health and disease control). However, CTC workshops revealed inequalities in access to food based on ‘caste’ and occupation. Protection issues relating to violence from community and militant groups were reported.
Conclusions
Despite IDP satisfaction with healthcare services, there were gaps in food security and violence/protection activities. Recognizing of the role/impact community health volunteers play in health care is an important factor in enhancing primary health care services in IDP camps.
Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.
Material and Method
76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.
Results
Of the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.
Conclusions
Triage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.
Measles still remains an important cause of morbidity and mortality among children in many developing countries, especially in refugee settings where fatality rates as high as 33% have been documented. From January to April 2004, concurrent measles and rubella outbreaks had occurred in four transit camps hosting 2,767 Liberian refugees in Cote d'Ivoire.
Objective
This study describes the epidemiology of concurrent measles and rubella outbreaks, and the investigation of a Disease Surveillance Team.
Methods
Patients meeting the case-definition (rash and fever > 38°C) were detected actively. Blood sample were collected for measles and rubella IgM antibody confirmation.
Results
Sixty rash and fever cases were identified. During weeks 8 to 13, measles IgM testing had resulted in 61.1% positive tests. The highest incidence (18.5%) was observed in children below 9 months. Ninety-three percent of children aged between 6 months and 12 years received a measles vaccination but the rash and fever cases continued to occur. This prompted a systematic test for both measles and rubella IgM antibodies. Rubella IgM testing had resulted in 74.0% positive tests. The highest incidence (3.88%) was found in children between 5–15 years. Supplemental immunization with a measles-mumps-rubella (MMR) vaccine was conducted, following which, no fever and rash cases were documented.
Conclusions
This study indicates the importance of an early serological testing for measles and rubella together or the use of the MMR vaccine rather than only measles vaccine in disasters settings. Good management of surveillance data will be an asset for effective immunization strategies in refugee settings.
Although most victims of disasters recover on their own, a minority of survivors, uniformed services, and relatives develop long-term disaster related psychic disorders such as Posttraumatic Stress Disorder (PTSD). Especially this subgroup should receive timely and appropriate psychosocial help. In many EU countries is offered post-disaster psychosocial care by a variety of caregivers (i.e. professionals and volunteers, NGOs, church or commercial organizations). Therefore, European standardization of providing post-disaster psychosocial support is currently required. The presentation describes the project supported by the European Commission and named European Guideline for Target Group Oriented Psychosocial Aftercare – Implementation (EUTOPA-IP), supported by the European Commission. EUTOPA-IP has integrated two materials: German “Target Group Intervention Programme” and Dutch “Multidisciplinary guideline”, also with the experiences of experts in the area of psychosocial support from the EU countries. Main target is to develop a guideline for the uniformed services on the basis of the Multidisciplinary guideline for early psychosocial interventions, the adaptation of the Target group Oriented Intervention Program (TGIP) to the International Classification of Functioning, Disability and Health (ICF) and preparation and implementation of training program for various professional groups. The project aims at standardization of psychosocial aftercare in case of disasters as well as at the development of European network based on current findings in psychotraumatology. Early screening, supportive context, early preventive and curative psychosocial interventions, management of interventions, implications for the clinical field and future research are topics discussed in the project. Project consortium:
– City of Cologne (Germany)
– Centre of Psychotraumatology (Germany)
– Impact (The Netherlands)
– Spanish Society for Psychotraumatology and Traumatic Stress (Spain)
– Charles University in Prague (Czech Republic)
– Capital City of Dusseldorf, Department of Public Health (Germany).
Developing world disaster Health research - Present Evidence & future priorities
Introduction
Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. The existing & available evidence on disasters in peer-reviewed journals about the developing world, was examined for quality and quantity in this systematic review.
Methods
The free PubMed database was searched using the MeSH (Medical Subject Heading) terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ and ‘conflict’ and then refined using the MeSH terms ‘developing country’. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation & region of the study.
Results
Citations using MeSH search terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ & ‘conflict’ yielded 63,196 results. After these results were refined using the second MeSH term “developing country”, 438 articles were retained. Less than 1% (0.69%) citations in PubMed dealt with developing country disasters. Half of the manuscripts (46.5%) were found to be original research articles (36.1%) or reviews (10.4%), while more than a quarter (29.5%) were commentaries. 97.4% (149/153) of all ‘original research articles’ were Level IV or V evidence. A fifth (20.3%) of the authors of all manuscripts on developing world disasters were from the developing world (82/404); Predominant themes (29.1%) were missions, healthcare provision and humanitarian aid during the acute phase of developing world disasters.
Conclusion
Less than 1% of all disaster-related publications are about developing world disasters. Also, the developed world, authors four-fifths of the articles about developing world disasters, and contributes the predominant perspective. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters, than short-term humanitarian aid missions to the developing world.
Due to the limited resources of specialized hospital departments, the allocation of patients to different hospitals according to severity is an extraordinarily complex and time-critical problem. The emergency capacity was determined for all medical centers (n = 135) in the State of Hessen, Germany, for patients of various triage categories (red, yellow, green) during normal working hours, and during weekends and nights and included logistic specifications of a potential helicopter landing. These data were entered into a state register. Using the data from the “acute-care-register”, a Ticket System was developed that allows operations management to assign patients according to the severity of their condition, urgency, and specialization requirements (e.g., neurosurgery, ophthalmology, pediatrics) to a hospital without exceeding the admission and/or treatment capacity of the hospital/facility. During a non-critical period, the order of allocations depending on the distance from the clinic is planned in advance so that no further modifications are necessary during the acute intervention phase of an emergency response. Additional notification of hospital capacities for severe casualties provided during the emergency response can be easily and immediately supplemented. Due to the relatively low frequency of such emergency responses, a cost-effective concept that is easily adaptable to the respective fields of application was decided upon. The system is a sticker set customized for the respective rescue teams. The sets will be carried permanently in the rescue equipment by the organization manager of the rescue service team. The equipment is not dependent on electronic components. The cost per sticker set is approximately US$50. Keeping track of the patient allocations is assured.