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Education of graduate students in international disaster relief (IDR) is important. The authors introduced this practical education in Saga University in Japan.
Methods:
The authors performed a mass casualty disaster exercise involving the simulated IDR from 06 October to 08 December 2008 (every Monday, for two hours/week, for a total of 12 hours). The exercise was designed to simulate the medical relief operation of the Indian Ocean tsunami that occurred in December 2004. Logistical functions also were involved. Thirteen students participated the exercise, and they were assigned to one of two groups. Each group included one Indonesian doctor who was a PhD candidate, while die remaining students were achieving a Masters in nursing. The official language used during the exercise was English. This study reports on the experience and evaluation of the students.
Results:
More than 90% of the students answered that this exercise was very instructive and interesting. They rated the simulation exercise very favorably and believed that the knowledge gained through the exercise would be beneficial in the near future.
Conclusions:
This kind of practical education is valuable in disaster medicine and disaster nursing training for graduate students in Japan.
A multi-disciplinary team was formed to review the Department of Emergency Medicine process in Singapore.
Methods:
The team set the current Department of Emergency Medicine performance as the baseline, and after analysis, met with management and agreed to work toward three main objectives: (1) reducing patient waiting time; (2) improving the staffing and workload; and (3) improving key patient concerns by reducing the number of steps in the process and increasing communication. A patient and information flow analysis chart was mapped to scrutinize the entire process and to identify opportunities for improvement. Triage before registration was identified as one of the key initiatives. This eliminates the need to register and wait before the first point of clinical contact (triage). Visits were made to other hospitals to gain fresh insights and current literature was studied to learn more about worldwide trends and improvements. Weekly meetings were held to craft the implementation plan. Presentations were made to the Department of Emergency Medicine staff and management to get feedback and buy-in.
Results:
Triage before registration would reduce the waiting time by approximately seven minutes for each patient (with potential for further savings with the streamlining of the triage process). Resuscitation and critical care patients who require more expeditious treatment also will be identified earlier, leading to a better clinical outcome. Triage before registration also results in patients that are seen earlier by a staff nurse who can order tests and treatment as the patient waits for consultation. The empowerment of nurses to initiate more tests and treatment before consultation will improve patient experience and reduce downstream delays. The Patient Care Assistant at the test/treatment station will reduce the workload of the triage nurse conducting additional tests and speed up the triage process. Patient flow is streamlined and congestion at the waiting area is reduced.
Conclusions:
Triage before registration significantly reduces overall waiting time and improves patient experience.
Sri Lanka has experienced a 24-year civil war with monthly terrorist incidents. Disaster drills, as a method of teinforcing collaboration and improved communication, can enhance military and civil response coordination and ultimately benefit the community and the injured victim.
Methods:
Two large-scale disaster drills occurred in Sri Lanka in 2008 with participation of military disaster response teams, civil hospitals, international non-governmental organizations (INGOs), the World Health Organization, American universities and hospitals, the local governments, Ministry of Health, non-governmental organizations, the Red Cross, and others. Training occurred in incident command, communication, clinical response, crowd control, evaluation, and the planning process. Civil and private prehospital care responders worked closely with the military during the drill. More than 400 participants gave active feedback and an educational video of the recorded drills was distributed for future training exercises.
Results:
Military and civil responders identified challenges and strengths and discussed improvements for future operations. In the days following the drill, participants responded to actual mass casualty incidents with improved skills, coordination and communication. Subsequent drills and task-force meetings were conducted. The INGOs supported follow-up activities and provided training materials. International partnerships were forged with military, civilian representatives, and disaster medicine specialists. Military and civil response teams had never performed a drill together before and felt it was invaluable for their coordination.
Conclusions:
The promotion of drills involving military, civil society, and communities should be encouraged to improve response, especially in countries with ongoing civil conflict and high terrorist activity. Drills can help military and civil partners reach a broader understanding of the others' role and methodology of response, which may improve the outcome and timeliness of a disaster response.
Traditionally, emergency care in Pakistan has not been a priority because of lacking primary care. Resources and trained personnel are scarce. Cultural barriers often supersede the urgency of medical conditions. Despite these challenges, the value of emergency care is gaining significance. The objective of this study is to explore the breadth of emergency medicine training in Pakistan, through an analysis of a teaching hospital with an emergency medicine residency. Aga Khan University Hospital in Karachi is a teaching institution with the only emergency medicine residency program in the region. It was started in 2000, led by US-trained physicians, and laid the foundation for emergency medicine in the country.
Methods:
A review and analysis of the curriculum and clinical duties will be conducted to illustrate the specific roles and training of emergency medicine physicians. A chart review of patients seen in the emergency department during a two-week period will be conducted to determine if the current training is appropriate for the patient population and diseases seen.
Results:
This study will provide a view of a curriculum in development and report on unique aspects of the program in relation to other established emergency medicine programs throughout the world. Furthermore, different roles emergency medicine physicians may play in this particular hospital setting will be identified.
Conclusions:
Aga Khan University Hospital is a pioneer in establishing emergency medicine as an official discipline in the region. Through an examination of how a program is developing in Pakistan, an invaluable look of how emergency medical care is gaining significance in developing nations will be provided. This will help other nations that are interested in developing such programs to do so.