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Complex emergencies (conflicts or disasters caused by natural events) do not recognize borders. The connection between conflict and trauma regarding psychosocial development and well being has long been established as emergencies expose and exacerbate existing individual and societal problems.
Methods:
An extensive literature search, including nongovernmental organizations'“grey” literature, was performed. Articles were analyzed for key contributions, available programs, and mental health measurement indicators.
Results:
Analysis revealed that the emergency mental health services are not integrated into emergency relief response and/or are insufficient. Provision of early mental health interventions reduces the burden on a country's health facilities and/or relief responses. In order to achieve integrated physical and mental health services (a key World Hearth Organization goal) alternative strategies are proposed.
Conclusions:
Establishing a referral network among relief organizations stimulates collaboration and sharing of best practices. The recent publication of the Inter-Agency Standing Committee (IASC) Guidelines offers concrete strategies for ensuring that emergency care is effective, inclusive, and culturally appropriate. Training relief workers in the use of psychological first aid and mental health needs assessments provides opportunities to raise awareness about these guidelines. The training sessions reinforces cooperation established by the referral network. With greater appreciation of the necessity to integrate emergency mental health services, relief workers become advocates for change within their own organizations, and together, within the political arena. With concrete guidelines to assist them in articulating specific funding priorities to politicians and measurement indicators to ensure accountability, advocating for changes will be more meaningful and persuasive.
Following the response to the devastating 2004 tsunami, Medical Teams International's (MTI) Emergency Medical Services (EMS) program has worked directly with the Government of Sri Lanka to develop a comprehensive EMS system. In September and October 2008, a delegation of eight Sri Lankan EMS instructors visited Oregon and Washington for advanced instructor training in EMS skills and observation of local and governmental EMS agencies. The delegation participated in > 1,300 hours of combined classroom education and direct provider observation experiences. Following the visit, the delegation was given a 10-question post-event survey to measure their perception of the effectiveness of this type educational exchange.
Methods:
A Web-based survey tool was utilized to elicit responses from the participants. Questions consisted of open-ended and ranked questions. The survey period was 30 days and there was a 60% response rate.
Results:
The participants felt this opportunity was useful and beneficial to the ongoing development of the EMS system in Sri Lanka. Additionally, participants indicated that the classroom experience was the most important aspect of the visit. An unanticipated response was that the participants were impressed with the concept of collaborative teamwork and unity that exists within US fire departments and EMS agencies.
Conclusions:
Future exchange programs should focus more on classroom experiences and less on ride-along type experiences. Additionally smaller groups may allow for greater one-on-one peer education opportunities. This exchange provided participants with opportunities that are not currently available in Sri Lanka. The participants in this exchange will utilize the knowledge from this exchange for many years to come.
The Pan-American Trauma Society (PTS) developed a Trauma and Emergency Ultrasound Course (USET) in response to the requirement for trauma ultrasound training for low- and middle-income countries. The objective of this study was to evaluate the efficiency of this course.
Methods:
Pre- and post-course tests were used. An interval estimation of proportions was calculated at 95% CI. Theoretical and practical pre- and post-course knowledge were assessed with the Wilcoxon Signed Rank test at a 0.05 level of statistical significance.
Results:
Between 2005 and 2007, 114 students, including general surgeons, emergency medicine physicians, anesthesiologists, critical care physicians, and residents of these specialties, were trained in seven countries (Uruguay, Peru, Mexico, Venezuela, Aruba, Colombia, and Ecuador). The difference on complete knowledge ranked scores before and after the course was statistically significant (p <0.001). After the course, almost all participants (97.4%) demonstrated complete knowledge in final evaluation.
Conclusions:
The USET course is an effective approach for trauma ultrasound training. Specific training programs for trauma care providers that work in low- and middle-income countries are necessary and could be performed with low-cost training programs.
In an effort to create uniformity in job-critical knowledge and skill sets among hospital emergency coordinators throughout Georgia, yielding improved emergency preparedness and interagency cooperation, the Georgia Department of Human Resources Division of Public Health and the Medical College of Georgia's Center of Operational Medicine created the Certified Hospital Emergency Coordinator (CHEC) Program.
Methods:
A focus group of emergency management, public health, and emergency medicine experts was convened. Twenty-seven critical and important tasks, skills, and areas of knowledge imperative to professionals were identified. Based on these, two novel courses were developed. The completion of these and other established courses available through the US government and the National Disaster Life Support Foundation, in addition to job experience, form the basis of the newly created three-level certification program.
Results:
Approximately 125 hospital emergency managers from all regions of Georgia have been trained thus far, and another four courses are scheduled for 2009 with an average of 30 students per course expected. Attendance at both the Basic and Level II courses has created valuable interpersonal relationships, professional familiarity, and a common educational baseline amongst the state's hospital emergency coordinators.
Conclusions:
Georgia's CHEC program represents a novel approach to training and preparedness at the hospital level. Coordination between public health and academia has allowed for the sharing of knowledge and resources in an unprecedented way. This has created enhanced preparedness throughout the state and has emboldened interpersonal and interagency cooperation within the realm of emergency management.
Although 15 years have passed since the Tokyo subway attack, it was the preparations for the Kyushu-Okinawa G8 summit (2000) five years thereafter that catalyzed the development of countermeasures and policy against chemical, biological, radioactive, nuclear, or explosive (CBRNE) threats in Japan.
Report: No substantial progress was made for five years after the subway attack. Preparedness for the Kyushu-Okinawa G8 Summit included promulgation of the Civil Protection Law (2004), which codified the responses to CBRNE terrorist attacks, and consequendy, the effectiveness with which the countermeasures against CBRNE terrorism acts could be deployed at a national level. Countermeasures included the establishment of a CBRNE task force, syndromie surveillance programs, and the stockpiling of antidotes, antitoxins, and antibiotics. Decontamination facilities were introduced throughout Japan.
Conclusions:
Preparedness for the summit facilitated recognition of the need for medical countermeasures against CBRNE threats to protect healthcare providers in Japan. In the 15 years since the Tokyo Subway Attack, the measures implemented in the last five years have been most effective. However, future challenges include the promotion of civilian awareness, inter-agency collaboration, and increasing the mutual-aid capacity of local communities.