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Mock Code Training is an exercise designed to develop competency in emergency responsiveness. The objectives for this educational intervention were: (1) demonstrate basic airway maneuvers (2) demonstrate basic life support-cardiopulmonary resuscitation (BLS-CPR); (3) demonstrate when and how to call a Code; (4) recognize life-threatening cardiac arrhythmias; (5) initiate relevant cardiac monitoring; and (6) initiate relevant resuscitation based on algorithms.
Methods:
Drills were conducted monthly on various inpa-tient and outpatient nursing units at the University of Wisconsin Hospital and Clinics. The following data was collected: (1) chime sounded; (2) basic patient assessment; (3) universal precautions; (4) compressions; (5) automated external defibrillator (AED) arrival; (6) unit emergency cart arrival; (7) oxygen administration; (8) code team arrival; (9) Advanced Cardiac Life Support (ACLS) Guidelines; (10) presence of recorder; (11) monitor initiation; (12) advanced airway; (13) intravenous (IV) access; (14) medications; (15) and time resuscitation ended.
This paper reports on an Australian experience with the MicroSim software used for the preparation of undergraduate, inter-professional paramedic nurses. The paramedic nurse course focuses on preparing graduates for practice in rural communities where there are opportunities to enhance the productivity and skill retention of the local emergency health workforce.
Methods:
The students were introduced to the software during their second year of a four-year, double-degree programs to enhance their ability to conduct primary and secondary surveys and respond in a timely and clinically appropriate manner. Their responses were required to be relevant to the nursing, paramedic, and inter-professional preparation for nursing as reviewed by the course thus far. The students were assessed as individuals and teams and were invited to describe observations of their own responses and those of the broader inter-professional team.
Results:
Aggregate results will be reported. The students were highly enthusiastic about their participation and assessment, and the method continued its third year in 2009. Examples of student responses to cardiac and trauma clinical scenarios will be demonstrated as two of the most frequent presentation types to the emergency department calls to the ambulance service.
Conclusions:
The combination of the use of interactive software and teamwork in simulations that paramedic nurses may experience in rural Victoria was highly successful in promoting confidence, competence, communication, critique, and team-building in this already high achieving group of students.
Mental stress management of medical staff in an international medical cooperation (IMC) is important for effective activities.
Methods:
The authors examined the mental stress of of IMC medical staff that was experienced throughout three activity periods. The activity periods included: (1) “Period A”, from decision-to-participate to arrival in the field; (2) “Period B”, from arrival in the field to before going back home; and (3) “Period C”, after going back home to three months after going back home. Self-administered questionnaires were used to examine the type of mental care preferred by staff. Participants were 154 medical staff members who worked in a past IMC. The data of 89 medical staff members were analyzed. The period of data collection was between August 2007 and November 2008.
Results:
The results clarified that 66 (74.1%) staff felt stress during Period A, 69 (77.5%) during Period B, and 47 (52.8%) during Period C. Main stress factors during Period A included “difficulty of gathering information”, “schedule coordination”, and “rapid environmental changes”; In Period B, “ambiguity of information”, “unexpected circumstances”, and “human relationship”; and in Period C, “lots of works after return to the hospital”, “prepare the activities report”, and “lack of taking vacation after IMC”.
Conclusions:
Stress levels and factors gradually changed during activity periods in IMC activities. It is important to establish effective mental stress management systems for the future success of IMCs.
“Cultural Competency” is an increasingly important skill required by the humanitarian workforce. Reviews and evaluations of recent major international events criticize tiie lack of cultural competency skills among foreign aid workers. This paper reviews two frameworks in the international literature to propose a model for cultural competency education in the humanitarian workforce.
Methods:
The framework for disaster health, developed by the World Association for Disaster and Emergency Medicine (WADEM) Education Committee, and the Australian National Health and Medical Research Councils (NHMCR) “Cultural Competency in Health: A Guide for Policy, Partnership and Preparation” (2006) were used as frameworks for this review. A meta-review of the literature was conducted to identify cultural considerations in disaster management.
Results:
A definition of cultural competence was adopted from a range of theoretical models. Both the WADEM model, which includes the “Socio political, cultural context”, and the NHMRC model, which describes four dimensions for actions (systemic, organizational, professional, and the individual), identify key principles. Using these principles informed by the literature review, a model is proposed to foster culturally competent behavior incorporating all four dimensions.
Conclusions:
The model argues that “everyone” is responsible for culturally appropriate and responsive management. This review makes explicit the importance of cultural competency skills in the humanitarian workforce and provides a model, underpinned by contemporary frameworks, to address this challenge.
The response to hazardous materials or chemical, biological, radiological, nuclear (CBRN) incidents typically consists of: (1) cordons regulating access into and egress from designated zones; and (2) use of appropriate personal protective equipment. In most systems emergency medical services (EMS) will stay outside of the “hot zone”. The patient will be rescued by the fire service and, after some gross decontamination, handed over. As mass gatherings are regarded as high-risk events, this system was used in Vienna during the Euro08 and augmented by: (1) casualty decontamination units (seven parallel lines for stretcher decontamination, located before triage); (2) a rapid intervention group for medical care in the hot zone (25 medical personnel), responsible for triage, life support (airway, breathing, bleeding), and antidote therapy; and (3) a joint CBRN incident command for close cooperation with detection units.
Methods:
After a review of the available open-source literature, a risk analysis was performed and the tactical concept described above was developed with cooperation of all involved services. Special training was performed for all members of the aforementioned units.
Results:
As the concept was not tested by an actual emergency, the following observations can be made: (1) readiness of the units could be successfully maintained during the EURO08; (2) me chosen equipment was experienced as appropriate; (3) several minor cases corroborated the risk analysis; and (4) manpower and training requirements were considerable.
Conclusions:
While it is possible to perform medical care within the hot zone, concepts are rarely tested in reality and the necessary efforts raise the question of proportionality.
When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation.
This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic, and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder.
The creation of a medical incident response plan for the treatment of injured victims contaminated during a chemical incident challenges more man one of me rescue services involved in civil emergency response. Our main objective the was to create an incident management plan compatible with existing rescue service logistics and resources.
Methods:
Under the supervision of the Schutzkommission des Inneren and with delegates from emergency medical services, fire, technical rescue services, and the German Army, a consensus conference to investigate the general conditions necessary and the existing structure available for managing victims of chemical incidents, was created. Typical injury patterns and their treatment in respect to decontamination procedures were considered, the necessary structure for casualty treatment and decontamination areas were derived, and commercially available products were tested for their usefulness in this situation. Standard operating procedures and algorithms were developed to aid realization of the concept. The suitability of the personal protective equipment and the question, if under these conditions the procedures of advanced life support can be performed, was evaluated in a standardized simulator model. The necessary training for rescue personnel involved was defined. To validate the concept, an exercise was performed.
Results:
All persons present at a chemical incident are to be classified as being contaminated. Injured persons must be separated into triage categories, and life threatening conditions treated before being decontaminated. Decontamination at the incident scene is necessary to prevent the transportation of the contaminant away from the incident scene. The principles of the decontamination of injured persons are based on the following pillars: triage, early removal of clothing, management of personal belongings and valuables, basic life support, spot decontamination, management and sealing of open wounds, application of antidotes, and primary decontamination of ambulant and non-ambulant victims.
The cooperation and the definition of roles between fire services (decontamination) and emergency medical services (triage and treatment) are necessary.
The concept uses existing decontamination vehicles used for the decontamination of fire fighters, by expanding its inventory with medical equipment, and extra technical apparatus. Using a modular approach, the system can be easily augmented by further units to treat multiple numbers of victims. However, demands on all rescue services involved are high, and must be complemented with an equally high standard of training, especially where rescue services have to learn skills not akin to their standard duties. An implementation of the system covering all geographical areas with specialized units is not possible, therefore a risk analysis to optimally position limited resources has to be conducted. Legislative bodies must strive to allow for an uncomplicated integration and disposition of disaster management resources.
Mental health is a low priority in resource-poor settings and among vulnerable populations fighting for survival after disasters. The psychosocial situation in the conflict setting is more complicated than for victims of natural disasters because their baseline mental health status is unknown.
Methods:
Psychosocial evaluations from Indian disasters during the past 10 years were collated and analyzed for important mental health predictors. Social issues of food security, equity of safe water provision, and about distribution of disaster relief and aid also were evaluated.
Results:
Children were the most vulnerable group in India. Post-traumatic stress disorder (PTSD) usually was a transient response to disasters, and lasted for an average of 90 days. Residual sadness was the only persisting PTSD symptom (84%). Underlying depression was the most important predictor for residual PTSD. Interventions facilitated through natural groups (language and ethnic groups) were easier to facilitate and yielded better results. While spiritual healing workshops had a definite role, relief being provided along religious lines was more controversial. Of 98% whose homes had been destroyed, 89% had their homes relocated/rebuilt within 24 months, and 51% had resumed their previous occupation. However, only 30% recovered economically after natural disasters. The healthcare providers, funders, and relief agencies were hesitant in their response in the setting of complex emergencies, as they are unsafe work environments, at the personal and political level. Mental health interventions were more complex and outcomes less predictable in the conflict setting as compared to natural disasters.
Conclusions:
Systematic mental health surveillance post-disaster must be included in the general post-disaster assessment. There is a need for supportive education, training of mental health workers, and development of region specific social and psychological questionnaire for validated use in India.
Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities.The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfi ll their roles.This review will explore these themes by highlighting important findings and areas of uncertainty.
People with disabilities largely have been excluded from emergency preparedness plans. Emergency Preparedness for Persons with Disabilities was developed to help assist such persons to deal with a variety of emergency situations.
Methods:
Phase I focused on healthcare professionals who care for such persons. An eight-hour, basic, core course includes triage, transfer and transport, personal protection, patient decontamination, equipment decontamination, developing an office emergency plan, evacuation, communications, and emergency contacts. Modules for non-medical office staff include communications, staffing, personal protection, and Internet access to helpful sites.
Phase II focused on the person with disability and his/her caregivers—health professionals (visiting nurse or Home Health Aide) and families. Training modules include home preparations, preparedness kit development, and evacuation.
Results:
Methods of evacuation and transportation of patients in vertical and horizontal situations were tested. Training staff noted a lack of familiarization of triage methods, patient and staff accountability, and equipment that could be used in case of an evacuation. Training modules were modified following evaluation of the above.
Conclusions:
Professionals and persons with disabilities can benefit from receiving emergency preparedness training. The experience and materials presented can accomplish this task. This training can serve as a model for rehabilitation professionals and the populations they serve.