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.
Socioeconomic impact of “Hurricane Karl” on health facilities in Veracruz, Mexico with a population of 7 million 600 thousand in September 2010 Summary Hurricane Karl, thirteenth tropical cyclone of the season in the Atlantic hurricane of 2010, originated in the Caribbean Sea and slammed into the Yucatan Peninsula as a strong tropical storm, to emerge into the Gulf of Mexico where it gradually reorganized to achieve Category 3 (major hurricane) on the Saffir-Simpson scale and hit the east coast of Mexico on September 17th of 2010. Preparations On September 16th, the Federal Government, Federal Electricity Commission, Laguna Verde Nuclear Power Plants, The Ministry of National Defense, The Ministry of Marine Affairs and human elements and materials deployed for relief to the population. The health sector also was prepared to take appropriate measures under the concept of Safe Hospital PAHO / WHO. Impact In the state of Veracruz (more than 7 million 600 thousand habitants), Hurricane Karl arrived around 11:30 am on September 17th to 15 km north of the port of Veracruz reaching a capacity of 195 km per hour. Torrential rains flooded the streets of the phenomenon and avenues of the historic center of the port, the water reached 40 centimeters to 1 meter in height, to the south of the state and surrounding areas reached 2 meters in height. Caused serious damage since its inception in health infrastructure, such as suspension of public services, damage to the distribution system of drinking water, broken windows and flooding of a hospital as well as several units of Family Medicine.
Emergency medicine services (EMS) will play a key role in any response to a flu epidemic. In order to devise an effective preparedness plan for coping with pandemic, it is necessary to comprehend the factors affecting the willingness of EMS workers to respond during an outbreak.
Aims
This study aims to: (1) examine the willingness of the workers of Israeli EMS (Magen David Adom (MDA)) to come to work during a pandemic flu; and (2) identify the factors that will increase the willingness of workers to come to work and the obstacles that will keep them from working during a flu pandemic.
Methods
Between November 2009 and January 2010, a representative sample of MDA workers in Israel were given questionnaires asking about their knowledge and attitudes in regard to pandemic flu, and concerning factors that may influence their willingness to come to work. Data analysis included descriptive statistics, central and dispersion measures, analyzes of variance, and an exploratory factor analysis.
Results
The study population included 365 people (290 men and 75 women), with 84% aged 20–49 years. Of the respondents, 92% expressed willingness to come to work during a flu pandemic, even if they were asked and not obligated to report to work. An increase in willingness to come to work was found to be associated with the significance of the role of the workers, the guidance that they receive from the organization, their trust in the system, their knowledge, and their feeling of being protected.
Conclusion
Workers' perception of the significance of their role and their trust in the system were found to be central factors in determining workers willingness to come to work during a time of an emergency.
Le tableau croisé, un outil pour la maîtrise de l'accident collectif Dr J.-C. Pitteloud, Sion (Suisse) Lorsqu'on est confronté Á un accident Á plusieurs victimes, il est souvent difficile de garder en tête Á la fois les victimes et les moyens dont vous disposez. Le tableau croisé est un formulaire qui permet de diriger et de documenter efficacement une intervention sur un accident Á plusieurs victimes. Le principe du tableau croisé est que vous allez regrouper les informations sur les victimes, comme leur numéro et leur catégorie de triage sur les lignes horizontales de votre tableau (l'axe des X). Les information sur les vecteurs (heure d'appel, heure d'arrivée) seront notées sur les colonnes (l'axe des y). L'heure de prise en charge de chaque victime par une unité est notée Á l'intersection correspondante. L'heure d'Évacuation vers l'hôpital est notée au bout de chaque colonne et de chaque ligne. Ce formulaire permet de garder une vue d'ensemble des opérations de secours Á victime ainsi que de documenter l'action de chaque Équipe et le devenir de chaque patient. Il est utilisable dû l'arrivée de la première Équipe sur place, puisqu'il suffit d'un stylo et d'une feuille de papier pour le réaliser. Dans notre expérience, une feuille de format A4 européen permet de gérer une intervention pour une dizaine de victime, une feuille de format A5 jusqu'Á une trentaine.
Limited information is available on the health outcomes of the rural older population in developing countries is affected by disasters. In October 2010, Hainan Province experienced severe flooding following heavy rains. Nearly four million people were affected and many had undergone resettlement. This study investigated the impacts of the flooding on people living in the disaster-affected rural communities. The findings were compared with baseline information collected in 2010 about health issues in rural villages in Hainan. Health outcome comparisons also were made between ethnic groups (Han versus Li).
Methods
A two-stage cluster-sampling, cross-sectional post-disaster study was conducted. The entire Hainan Island was categorized into ranks of different severity in rainfall amount and associated damage in October (most severe, intermediate, least severe). The county with the most rainfall and the most severe ranking and the one with least rainfall and the least severe ranking were identified. In each county, one Han and one Li village were chosen by using a computer-generated random number, so four villages were sampled in total. More than 100 individuals ≥ 50 years of age were interviewed by face-to-face survey. Data on disaster-related injuries, socio-demographic information, non-communicable disease, lifestyle, and mental health were collected.
Results
Findings indicated the severity of impact was associated with self-reported health outcomes of older population. Gender and ethnic differences were found in reported health outcomes. Predictors of adverse post-disaster health outcomes in older populations in rural communities were identified.
Conclusions
The results demonstrated significant differences in the impacts of flooding in rural populations. Targeted services and interventions should be planned to address the disparity and meet the physical and mental health needs post-disaster.
Disease and injuries are expected consequences of disasters, either as direct result of the initial disaster or due to a collapse of the pre-existing public health infrastructure. While relief efforts are primarily directed at treating existing and preventing further disease and injury among victims of the disasters, it is also important to remain aware of the health impact on individuals and organizations providing assistance. The potential immune naïveness of relief workers may predispose them to contracting diseases which are normally not a concern for the local population. If significant numbers of relief workers are affected this can severely impact an organizations ability to provide assistance and may lead to a worsening of the situation. Even a simple surveillance program can provide early warning of potential problems in order to timely implement control measures which will prevent further illness and minimize mission impact.
The terms catastrophe and disaster have been frequently heard worldwide due to situations like earthquakes, floods and events provoked by man as the September 11th and Anthrax attack. Catastrophe means all situations where material and human resources available in a healthcare facility are not enough to assist a large number of victims admitted at the same time. Accreditation requires having a plan to manage effectively those situations, assessing safely as much victims as possible.
Objective
To describe the catastrophe plan and its management in a private hospital.
Methodology
Hospital Albert Einstein is located close to a huge soccer game stadium and near to the State Government Hall. This was the reason to have a plan focusing on casualties with a large number of victims. The literature was revised to choose the triage methodology. Triage to identify the priority of patients' assessment based on their condition, possibility of treatment and determining discharge for those without visible risk. Simulation was implemented, followed by debriefing to register lessons learned.
Results
An algorithm was developed with a crisis center and defining care and support areas in the organizations to manage the victims at Emergency Room and triage field. The plan was effectively deflagrated twice: 47 victims from a bus accident and 25 from a policeman strike. Debriefing was done in all opportunities and communication is the main issue; 15 simulations have been done for training purpose, with specific goals.
Conclusion
Hospital is a high risk environment itself for an internal or external incident depending on its localization. A disaster plan is necessary to improve everyone safety, to organize resources, to respond effectively to such situations and take the organization back to regular operation as soon as possible. Simulations are essential to guarantee staff competency and organization support and response to adverse situations.
Basic emergency care at primary, secondary and tertiary health care level in India is in its infancy. Lack of training in emergency care is an important factor. We designed AIIMS basic emergency care course (AIIMS BECC) to address the issue.
Objective
To improve the knowledge, skill and attitude of healthcare workers and laypersons in basic emergency care and to identify and train instructors.
Methods
Prospective study conducted over a period of one and half years. The target groups were medical, police, fire fighter, paramilitary forces, teachers, school children of India. Provider AIIMS BECC is of one day duration. The contents of the course are cardio-pulmonary resuscitation, chocking and special scenarios like trauma, electrocution, drowning, hypothermia, pregnancy, etc. Course was disseminated via lectures, audio-visual and hands on training. The participants were evaluated by pre and post test questions. Subjects had to score 80% to be successful and those who scored more than 90% were eligible for instructor course. The confidence levels at baseline and at the end of the course were evaluated in policecourses were evaluated on course clarity, course delivery and trainers quality on a likert scale (1 = worst, 5 = excellent).
Results
1614 subjects were trained. 99.81% became providers and 2.6% were trained as instructors. 83.1% were non-medical and16.9% were medical personals. 76.14% were police, paramilitary 0.8%, teachers 1.6%, students 2.1% and mixed groups were 2.6%. The average and modal increase in confidence level among police were 66.14% and 62.49%. Likert scale of ≥ 4 was observed in 90.7% in course clarity, 91.28% in course delivery and 95.26% in trainer quality.
Conclusion
Knowledge, skill and attitude of healthcare care and laypersons in providing basic emergency care improved by community emergency care initiative. Instructors were identified for further dissemination of the course. The confidence levels increased among police.
The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper management
of difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.
This Level-1 Trauma Center, with a service area covering a population of approximately four million people, treats approximately 80,000 patients per year. In 2010 it is anticipated that > 23,000 patients will be admitted, and > 850,000 patient encounters will occur within the network. This year was especially fruitful with the World Series, Dallas Cowboys, and other large crowd events simultaneously. The disaster plan prepares the hospital for the Super Bowl in February 2011, and its anticipated 250,000 extra people. The emergency preparedness program is a unique hybrid model integrating hospital accreditation guidelines, governmental guidelines, and regulations with the daily experiences at the trauma center. Emergency Preparedness is a program of the Trauma Department; this relationship provides a direct connection between the emergency preparedness program and direct execution of the plan. The emergency preparedness coordinator is responsible for directing the hospital command center at the time of a disaster requiring activation of the plan. The four phases of emergency planning: (1) Mitigation; (2) Preparedness; (3) Response; and (4) Recovery comprise the core of the plan. However, memoranda of understanding with local, regional, and state emergency operation professionals and organizations are enacted so depleted resources can be replenished. This integration provides for a flexible web that allows sharing of expertise and resources. Trauma Research is available for conducting measurable assessments of emergency preparedness drills and exercises, as well as actual disasters and emergencies where a paucity of research exists. Compliance with all relative agencies is important. A successful emergency preparedness plan directly incorporates daily experiences. This model allows for the continued provision of standards of care and continuity of service during disasters and emergency situations on a daily basis.
Efficient management of disasters has received increased attention globally. It has been realized by all countries in the world that no development is sustainable if human life is vulnerable to major Disaster risks. Disaster Preparedness and Response are the most important components of an effective Disaster Management strategy. The objective of Disaster Preparedness is to ensure that appropriate systems are in place and personnel are trained to provide immediate response to victims in the event of any Disaster. Medical response is one of the most critical, most important and of immediate requirement in any Disaster situation. The success or failure of any Disaster Management operations will depend to a great extent on the success achieved by the Medical and Health sector since most of the Deaths and illnesses caused by disasters are preventable health risks. Though Disaster Management is the responsibility of every organization and institution, the Health Sector has a key role to play, as it is the lead sector. Hence, health personnel play a very important role in reducing disaster risks. This paper briefly examines the role and responsibilities of Medical and Health personnel and provides an overview of Emergency medical preparedness for reducing disaster risks. The concept of Disaster Medicine in dealing with the public health management of Disasters and Emergency Medical Preparedness, including the Prevention, Response, Relief and Rescue operations of Health Management while addressing various issues like casualty area management and Hospital Management etc through various strategies and actions will also be discussed. The Impact of Disasters on Health and how they can be best managed to reduce the number of mortalities and morbidities resulting from Disasters will be examined. The need for ensuring Community Participation in Health Management and prevention of health risk through Immunization and vaccination, proper food & nutrition, maintenance of hygienic and sanitation, adequate system of garbage disposal, Vector control and Research and Epidemiological studies will also be discussed. Prof. Bhaskara Rao, Mulam, Specialist, Policy, Planning and Related Issues, SAARC Disaster Management Centre (SDMC), New Delhi
Disasters caused by natural and human-made hazards often result in mass-movement of populations. Within these movements, companion and production animals can have significant impacts on the internally displaced persons, refugees, and disaster managers. The humanitarian agency Sphere recently identified and highlighted the fact that animal welfare and protecting the livestock of rural communities (before and after disasters) is crucial to the survival of those disaster-impacted communities. Those who are faced with the decision to move will consider the impact and risk/benefit evaluation of housing, losing companion animals, or the loss of production animals necessary for food security and economic survival. Animal impacts also include the potential to spread zoonotic or animal transboundary diseases, raise security concerns within camps, loss of future breeding stock, feeding, housing, and maintaining accountability. Issues involved with animals and refugees in the evacuation decision process, during movement, and in ad hoc, developing, and mature refugee camps will be discussed.
Global warming is predicted to increase the number and severity of extreme weather events. (IPCC 2007) But we can lessen the effects of these disasters. “Critically important will be factors that directly shape the health of populations such as education, health care, public health prevention and infrastructure.” (IPCC 2007) A comprehensive approach to disaster risk reduction (DRR) has been proposed for climate change adaptation. (Thomalla 2006) DRR is cost-effective. One dollar invested in DRR can save $2-10 in disaster response and recovery costs. (Mechler 2005) Disasters occur as a result of the combination of population exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity to reduce or cope with the potential negative consequences.
Discussion
By reducing human vulnerability to disasters, we can lessen—and at times even prevent—their impact. Vulnerability may be lessened by: 1) reducing human exposures to the hazard by a reduction of human vulnerability, 2) lessening human susceptibility to the hazard, and 3) building resilience to the impact of the hazard. (Keim 2008) Public health disasters are prevented when populations are protected from exposure to the hazard. Public awareness and education can be used to promote a “culture of prevention” and to encourage local prevention activities. Public health disasters may also be mitigated through both structural and social measures undertaken to limit a health hazard's adverse impact. (IPCC 2007) Community-level public health can play an important part in lessening human vulnerability to climate-related disasters through promotion of “healthy people, healthy homes and healthy, disaster resilience communities.” (Srinivasan 2003)
The January 2010 earthquake affected many services in Haiti, including health care. After the disaster, top-down response from international sources seemed like the only solution. While the existing health system was fragile, opportunities likely existed for incorporating bottom-up approaches in the capital and other cities, such as Cap Haitien in the North.
Objective
The study aims to: (1) identify available local health-related resources; (2) examine how these were, or were not, utilized in response efforts; and (3) evaluate the level of coordination among health delivery groups, particularly preparedness and recovery.
Methods
This case study included 11 key informant interviews at two hospitals (six at Justinian and five at Milot) and an organizational analysis of cooperation among 16 health-related organizations operating in northern Haiti. Disaster preparedness and recovery data for the health-sector organizations were obtained using a validated survey instrument and the Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER) tool that uses the principles of Social Network Analysis (SNA) to elucidate the makeup of collaborative relationships.
Results
During the response phase, command-and-control approaches from international healthcare organizations had a roll given the numbers of people affected and the overwhelmed local response capabilities. Pre-disaster vulnerabilities limited response capacity. Even during response, opportunities existed for integrating established groups. Generally, this was not a model utilized by international organizations, although some examples were present.
Conclusions
The external infusion of money, priorities, and forces potentially may harm the current system, rather than build upon it. International aid provides free health services beyond treatment of earthquake-related injuries, taking the place of some service functions of the Haitian system. Eventually, this could erode aspects of the Haitian health system. Alternative models of aid may better incorporate and integrate existing structures. Disaster planning is linked intrinsically to strengthening the health system as a whole.
Selective non-operative management of abdominal visceral lesions is one of the most important and challenging changes that occurred in trauma patient care over the last 20 years. The main advantage of this type of management is the avoidance of unnecessary/non-therapeutic laparotomies. Trauma surgeons who deal with this type of treatment are worried of missed abdominal injuries. Modern diagnostic tools (spiral computed tomography, ultrasound, angiography, laparoscopy) allow trauma surgeons to accurately characterize the lesions to be addressed non-operatively. This presentation discusses the main elements of selective, non-operative management of principle solid visceral lesions (liver, spleen, and kidney). The advantages and limitations of the main diagnostic instruments used for evaluation of trauma patients allocated to non-operative management will be highlighted. Polytrauma patients in a Leve-1 trauma center over the last five years were selected and outcomes were analyzed. Pancreatic trauma remains an operative injury. However, surgeons must temper the enthusiasm for non-operative management of patients with solid organ injury, and exclude patients who would best be treated with surgery from this management scheme. Emergency care of the patients according the golden hour and team ability must be considered.
Le triage des victimes en nombre s'impose aujourd'hui comme une nécessité opérationnelle. Les deux actions complémentaires qui le caractérisent: catégorisation des blessés et dispensation des soins d'urgence sont universellement admis. Il a plusieurs buts: repérer les blessés les plus graves pour leur donner les soins dans les meilleurs délais, les regrouper par niveaux de soins afin d'y consacrer les sauveteurs-soignants correspondants, mieux gérer les flux de blessés et dans le même temps administrer les premiers soins. Le triage de victimes de catastrophes civiles, a longtemps été considéré en France comme un acte médical, réalisé par les seuls médecins placés à l'entrée du Poste Médical Avancé, où sont dispensés les soins d'urgence et la mise en condition des victimes, nécessaires à leur évacuation vers les structures d'accueil et de soins. Aujourd'hui, notamment sous l'influence anglo-saxone un triage préalable est effectué par les sauveteurs sur le terrain, afin de catégoriser les victimes du ramassage avant leur transfert sur le PMA: ce pré-triage, premier triage, est connu sous le nom de « Simple Triage And Rapid Treatment ». Une synthèse est nécessaire afin notamment que dans des conditions d'intervention internationalisées, les personnels de sauvetage et de soins d'urgence disposent d'une méthode à application universelle. Cela est rendu possible en soulignant l'aspect dynamique du triage qui se réalise et se complète d'étape en étape: sur le terrain au moment du ramassage par les sauveteurs, médicalisés ou non, au niveau du PMA ou du module de chirurgie vitale où seront pratiquées « damage control », réanimation et mise en condition d'évacuation, à la structure d'accueil ou sera réalisé le triage de vérification. Les critères retenus pour le triage des enfants, des brûlés, des victimes irradiées ou contaminées chimiques, les blessés psychiques viennent compléter les critères fonctionnels et lésionnels classiquement retenus.
The winter of 2009 brought the worst disaster caused by a natural hazard in the history of the state of Arkansas. An ice storm spanned the entire northern half of the state, leaving thousands without electricity, heat, transportation, health care, and in some cases, shelter, food, and water. In one county alone, > 13,000 power poles were destroyed. The infrastructure was severely damaged. In the University's arena, a shelter was opened by the Red Cross in partnership with the Medical Reserve Corps (MRC) to accept special needs victims and provide urgent primary care for shelter residents. The majority of patients presenting to the MRC had more than two illnesses. Examples included diabetes, renal disease requiring dialysis, hypertensive crisis, injuries from the storm, MRSA, respiratory syncytial virus, and mental illness ranging from depression to schizophrenia. Because the Red Cross did not consider ice storms as a reasonable cause for medication/medication supplies, these items were not replaced; this had health consequences of under-managed illness. Oxygen converters were preferred over oxygen tanks; however, the arena was on a generator and not all plug-ins had electricity. An ambulance company loaned the MRC a glucometer so blood glucose levels could be monitored. Those with mental illness required significant time from MRC providers. Largely, the MRC was nurse-managed with physicians or nurse practitioners available for sick call twice a day. Relationships became strained when the state placed a hold on the arena to secure it for a regional shelter. This put the university's financial stability in peril due to breech of contract with vendors scheduled to use the arena. The partnership between these three organizations does remain intact with formal memorandums of agreement now existing. They continue to work together in the community and jointly respond to regional disasters.
In the past decade, India has witnessed many lapses in crowd safety during mass gatherings. The high casualty rate in stampedes during traditional mass gatherings has prompted the study of these events. Wide variations exist in casualty rates for similar events, and key issues in healthcare services in these special situations were addressed in the Indian context.
Methods
From 2001–2010, Mass gathering data were collected from news items reported in the archives of newspapers, “The Times of India”, “The Hindu” and “The Indian Express”. The keywords used were: “stampede”, “mass gathering”, “mass-gathering events”, “mass-gathering incidents”, “crowd”, and “crowd management”. The study included triggers for the incident and the number of casualties (dead and injured) in each incident.
Results
In 27 separate mass gatherings in India, there were 936 dead and 540 injured casualties. The unique characteristics of mass gatherings in India included a predominance of old and vulnerable people in traditional mass gatherings, in contrast to the young and middle-aged groups who gather for music and sporting events elsewhere. Further, alcohol/substance abuse, brawls, and violent behavior were absent at traditional Indian mass gatherings. Non-traditional mass gatherings accounted for a lesser number of incidents in India, and were located in movie theatres and railway stations.
Conclusions
In a populous country like India, traditional mass gatherings predominate, and ensuring the health, safety, and security of the public at such events will require an understanding of crowd behavior, critical crowd densities, and crowd capacities in the Indian context. However, planning for mass gatherings can be developed using the existing body of knowledge of mass-casualty preparedness, food safety, and health promotion.
The year 2010 brought an unprecedented public health response to the novel H1N1 influenza pandemic. Included in that response were colleges and universities across the globe. At universities not associated with medical centers, medical directors of student health looked to nursing faculty or nurse practitioner directors of student health for leadership. From the day novel H1N1 was formally declared a public health emergency, Arkansas State University utilized a nurse faculty member with expertise in homeland security as its Incident Commander. A portion of the nurse's time was dedicated to managing the incident. The nurse was positioned to provide guidance and lead the response with an understanding of university structures as well as business and academic continuity. From the beginning, the nurse utilized the Incident Command System to manage the response. Portions of the University's Incident Command structure were activated and Incident Command meetings were held no less than every two weeks. A tabletop exercise was developed specifically for a university setting and to give University officials practice at pandemic management. The nurse's clinical focus and pre-established relationships with disaster response and public health officials allowed critical access to important resources that the University would have otherwise gone without. She guided the University through redefining their pandemic plan, including assisting residence life in establishing alternative housing for sick students. An on-line reporting system was developed that was utilized by faculty, students, staff, and other concerned constituents. A public awareness campaign on the campus was instituted and 1,000 posters were posted around campus encouraging sick students to stay home and/or seek medical care. The World Health Organization, (US) Centers for Disease Control and Prevention, and Department of Education guidelines were monitored and implemented. Two mass-immunization clinics were held on the campus with > 7,000 immunizations provided.
Mass casualty incidents (MCIs), requiring Trauma critical care, are increasingly likely. The ability to scale operations up i.e. ‘surge capacity’, is vital for ensuring scarce resources are used efficiently. The number of intensive care unit (ICU) beds is one of the key resources and indicators of a hospital's capacity and thus a vital area to target when assessing a systems ability to surge its Trauma ICU capabilities.
Objective
The study attempted to assess whether ICU facilities at major hospitals in large Australian cities would be able to respond to an event on the magnitude of the Madrid tragedy. This is the first report to measure Australia's major hospitals intensive care trauma surge capacity using Madrid as a standard.
Methods
In this prospective, cross-sectional analysis, we conducted a survey of major urban ICU trauma centres in the 8 state and Territory Capital cities of Australia. 14 Trauma Centre ICU's were targeted. The study was composed of two parts, A & B. Part A of the study consisted of an online survey, Part B, consisted of a follow-up telephone questionnaire. Full Ethics approval was sought and obtained.
Results
There were 8 replies to the survey giving a 57% participation rate. At the time of this snap-shot survey the total number of Physically available ICU beds throughout the 8 Level I trauma centres was 52.5. All hospitals had at least 3 spare beds. This ranged from 3 to 10 beds. After accounting for the flux in beds post admissions & discharges there was a 21% increase in bed availability, which was further increased by a magnitude of 28% to an average of 10.125 beds, if all elective surgical procedures were cancelled. When using the Madrid ICU surge (29 new ICU patients) as a gold standard against which to compare, it was found the largest trauma ICU in Australia could have managed 62% of this surge. On average the 8 trauma centres would have handled only 34.75% of the Madrid ICU surge.
Conclusions
In the event of a major traumatic disaster on the scale of the Madrid atrocity, few if any of Australia's major trauma centres have the capacity to cope with the requisite surge. More research and novel ways of addressing this challenge are needed.
On January 12th 2010 an earthquake of 7.0 magnitude struck Haiti. The region suffered an estimated 230,000 fatalities with approximately 250,000 injured and more than one million people who lost their houses. The government of Israel dispatched a military task force consisting of 230 people. 121 of them were medical personnel from the IDF Medical Corps. The force's primary mission was to establish a field hospital in Haiti and to give medical support to as many people as possible. We left Israel about 50 hours after the Earthquake and the field hospital started operating at Porte-Au-Prince 89 hours after the earthquake.
Materials and Methods
During our 10 days of operating, 1111 patients were treated at our hospital. 363 of them were pediatric patients (younger than 18 years). 272 pediatric patients were treated by the pediatric division, 79 (29%) were hospitalized and 57 (21%) required surgery.
Results
There were 16 deliveries, 5 Neonates, 244 Operations and 17 Intra-hospital deaths. We noticed a change of pattern of the hospital activity, regarding the cause of the admission after the sixth day. On the ninth day most of the patients who came to our hospital were due to a non-traumatic cause. At the pediatric department, the common treatments included wound debridement and dressing, I.V. rehydration and antibiotic treatment, and a neonatal unit, the sole one in the inflicted area. Operations when needed were done by the orthopedic team and the pediatric surgeon.
Conclusions
Operating a field hospital for a population inflicted by natural disaster is a complex mission and since pediatric care has its own unique, challenging characteristics, operating a pediatric division in such a field hospital is a continuous challenge, which includes preparedness in uncertainty and the necessity to have dynamic treatment strategy according to the unique circumstances.