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Predisaster Drill Activities (PDAs) may act as predictors of preparedness, but have been studied inadequately. To address this gap, a descriptive study of PDAswas conducted at two large hospitals.
Methods:
A longitudinal study was conducted at two large academic hospitals (A: a tertiary care university hospital, and B: an urban, municipal, Level-1 Trauma Center) in Brooklyn, New York. Both were equipped with disaster plans. Over a period of five weeks preceding a full-scale drill of a simulated pandemic influenza outbreak, eight sequential public health alerts were issued. Hospital responses to pre-identified components were recorded: (1) training; (2) equipment; (3) communications; (4) incident command centers; (5) supplies; (6) staffing; (7) infection control measures; and (8) miscellaneous. A descriptive statistical analysis was performed.
Results:
The overall response rate to all die alerts for Hospital A was 67%, while that for Hospital B was 40% (p <0.009).The median delay in responding to alerts for Hospital A was six days (range = 0–19 days), and B was seven days (range = 0–21 days). Training was die most frequendy cited component (n = 20), however the median delays (days) were two (range = 0–13), and nine (range = 4–21) for hospitals A and B, respectively. Responses to communications, supplies and incident command center components were delayed or inadequate. Some additional unexpected responses such as supplemental meetings (n = 4) and additional infection control measures (n = 3) were elicited at both hospitals.
Conclusions:
There were disparate responses to identical triggers at similar sites. Pre-disaster Drill Activities may help identify emergency response preparedness gaps and augment available resources for optimal utilization.
In 2005, a seven-car commuter express train collided with an apartment building in Japan. The crash left 107 passengers dead and 549 injured. This paper highlights confined space medicine mat was provided for three survivors and introduces the current approach for training Japan Disaster Medical Teams (JDMATs) and/or rescue professionals.
Methods:
A retrospective analysis of confined space medicine provided after the train crash and a study of training of JDMATs and/or rescue teams.
Results:
Three medical teams and search-and-rescue teams rescued three survivors whose bodies were trapped in the tangled wreckage of the first car. The medical teams secured intravenous lines and provided oxygen and approximately 4L of fluid before extrication. A 46-year-old woman was extricated in 14 hours, a 19-year-old man in 16.5 hours, and an 18-year-old man 22 hours after the crash. All three worsened at the final moment of extrication. Their crush syndrome required resuscitation at the scene, and intensive care such as hemodialysis and limb amputation in hospitals. Two patients survived and one patient died on me fifth day due to multiple organ dysfunctions.
Now, the curriculum of the JDMAT training course includes lectures and introductory exercises with rescue teams to learn the importance and difficulties of confined space medicine at the scene.
Conclusions:
Confined space medicine was provided successfully after the train crash. Knowledge of confined-space medicine is essential to medical and rescue teams. Further education and training curriculum must be created.
There is a difference between prehospital providers' ability and willingness to respond to terrorist, public health emergencies, and disaster incidents.
Methods:
A nationally representative sample of the 203,465 basic and paramedic emergency medical service providers in the United States was surveyed to assess their ability and willingness to respond to terrorist incidents.
Results:
Emergency medical technicians were appreciably (10–20%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p <0.0001). Emergency medical technicians who received terrorism-related continuing medical education within the previous two years were nearly twice as likely (OR = 1.9, 95% CI 1.8, 2.0) to be willing to respond to a potential terrorist incident as those who indicated that they had not received such training.
Conclusions:
Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates.
The objective of this study was to determine providers' opinions of SALT Triage after receiving training and using it during a simulated mass-casualty incident.
Methods:
A survey was conducted of trainees in a disaster course. Trainees were given a-30 minute lecture on SALT (sort, assess, life-saving interventions, treatment and/or transport) Triage and then used it during a drill. After the drill, trainees were asked to complete the survey. Results were analyzed using descriptive statistics.
Results:
Thirty trainees (11 medical doctors (MDs), six registered nurses (RNs), eight emergency medical technicians (EMTs), one RN/EMTs, four other) participated in the course. Of these participants, 67% had prior drill experience (mean: 10 drills) and 37% had prior mass-casualty incident experience (mean: four experiences). Prior to the drill: 7% reported that they felt very confident using SALT Triage, 33% were confident, 30% were somewhat confident, and 30% were not confident. After the drill: none reported not feeling confident using SALT Triage, 27% were at the same level of confidence, 73% felt more confident, and none felt less confident. Before the drill: 52% of respondents felt SALT Triage was easier to use than their current disaster triage protocol, 44% felt it was similar, and 4% felt it was more difficult. After the drill: 67% did not change how easy they felt SALT Triage was to use, 26% thought it was easier to use, and 3% thought it was similar.
Conclusions:
Providers felt confident using SALT triage after a 30-minute training session and found it was similar or easier to use than their current triage protocol. Using SALT Triage during a drill improved confidence.