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Considerable morbidity, mortality, and costs are associated with household emergency situations involving natural hazards and fires. Many households are poorly prepared for such emergency situations, and little is known about the psychosocial aspects of household emergency preparedness.
Problem:
The aim of this study is to promote a better understanding of homeowners' experiences and perceptions regarding household emergency situations and related preparedness practices.
Methods:
A brief survey was administered and three focus group sessions were conducted with homeowners (n = 16) from two metro Atlanta homeowners'associations.The survey inquired about basic demographic information, personal experience with a natural hazard or fire, and awareness of preparedness recommendations. The focus group discussions centered on household emergency preparedness perceptions and practices.
Results:
Participants defined household emergency preparedness as being able to survive with basic supplies (e.g., water, flashlights) for 48 hours or longer. While most participants had sufficient knowledge of how to prepare for household emergency situations, many did not feel fully prepared or had not completed some common preparedness measures. Concern about protecting family members and personal experience with emergency situations were identified as strong motivations for preparing the household for future emergencies.
Conclusions:
The focus group findings indicate that most participants have prepared for household emergency situations by discussing the dangers with family members, stockpiling resources, and taking a CPR or first-aid class. However, to the extent that behavior is influenced, there is a gap between maintaining preparedness levels and internalizing preparedness recommendations. Prevention efforts in Georgia should focus on closing that gap.
On 11 September 2001, terrorists hijacked two passenger planes and crashed them into the two towers of the World Trade Center (WTC) in New York City. These synchronized attacks were the largest act of terrorism ever committed on US soil. The impacts, fires, and subsequent collapse of the towers killed and injured thousands of people.Within minutes after the first plane crashed into the WTC, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, initiated one of the largest public health responses in its history. Staff of the CDC provided technical assistance on several key public health issues. During the acute phase of the event, CDC personnel assisted with: (1) assessing hospital capacity; (2) establishing injury and disease surveillance activities; (3) deploying emergency coordinators/liaisons to facilitate inter-agency coordination with the affected jurisdictions; and (4) arranging rapid delivery of emergency medical supplies, therapeutics, and personal protective equipment. This incident highlighted the need for adequate planning for all potential hazards and the importance of interagency and interdepartmental coordination in preparing for and responding to public health emergencies.
There are many patient assessment challenges in the prehospital setting, especially the estimation of external blood loss. Previous studies of experienced paramedics have demonstrated that external blood loss estimation is highly inaccurate. The objective of this study was to determine if undergraduate paramedic students could accurately estimate external blood loss on four surfaces commonly found in the prehospital environment.
Methods:
This prospective, observational, blinded study used a convenience sample of undergraduate students studying at Monash University during 2006. Students were provided with four clinical vignettes using four different surfaces and varying simulated blood amounts.
Results:
Accurate estimation occurred with the vinyl simulation (100 ml), with a mean value of the estimations of 98 ml (95% Confidence Interval (CI) 84–113 ml). Carpet and concrete surfaces were both associated with large under-estimations.The carpet simulation (1,000 ml) had a mean value for the estimations of 347 ml (95% CI 320–429 ml). The concrete simulation (1,500 ml) had a mean value for the estimations of 885ml (95% CI 771–999 ml). Conversely, the clothing simulation (500 ml) emphasized over-estimation, with a mean value for the estimations of 1,253 ml (95% CI 1,093–1,414 ml). There was no relationship between increased accuracy and clinical experience, exposure, educational qualifications, or age of students.
Conclusions:
External blood loss estimation by undergraduate paramedic students generally is too inaccurate to be of any clinical benefit. Particularly, absorbent and impermeable surfaces precipitated inaccuracies by undergraduate paramedic students.
In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city.
Problem:
The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake.
Methods:
A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims.
Results:
The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 ±2.7 and 0.9 ±1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 ±10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 ±13.5 hours after escaping the rubble.
Conclusions:
These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.
The effectiveness of humanitarian response efforts has long been hampered by a lack of coordination among responding organizations. The need for increased coordination and collaboration, as well as the need to better understand experiences with coordination, were recognized by participants of a multilateral Working Group convened to examine the challenges of coordination in humanitarian health responses. This preliminary study is an interim report of an ongoing survey designed by the Working Group to describe the experiences of coordination and collaboration in greater detail, including factors that promote or discourage coordination and lessons learned, and to determine whether there is support for a new consortium dedicated to coordination. To date, 30 key informants have participated in 25-minute structured interviews that were recorded and analyzed for major themes. Participants represented 21 different agencies and organizations: nine non-governmental organizations, eight academic institutions, two donor organizations, the US Centers for Disease Control and Prevention, and the World Health Organization.
Common themes that emerged included the role of donors in promoting coordination, the need to build an evidence base, the frequent occurrence of field-level coordination, and the need to build new partnerships. Currently, there is no consensus that a new consortium would be helpful.
Addressing the underlying structural and professional factors that currently discourage coordination may be a more effective method for enhancing coordination during humanitarian responses.
After Hurricane Katrina struck the Gulf Coast of the United States on 29 August 2005, it became obvious that the country was facing an enormous national emergency. With local resources overwhelmed, governors across the US responded by deploying thousands of National Guard soldiers and airmen. The National Guard has responded to domestic disasters due to natural hazards since its inception, but an event with the magnitude of Hurricane Katrina was unprecedented. The deployment of >900 Army National Guard soldiers to St. Bernard Parish, Louisiana in the aftermath of the Hurricane was studied to present some of the operational issues involved with providing medical support for this type of operation. In doing so, the authors attempt to address some of the larger issues of how the National Guard can be incor- porated into domestic disaster response efforts. A number of unforeseen issues with regards to medical operations, medical supply, communication, preventive medicine, legal issues, and interactions with civilians were encoun- tered and are reviewed. A better understanding of the National Guard and how it can be utilized more effectively in future disaster response operations can be developed.
To assist field workers in program evaluation and to explicitly discuss program strengths and weaknesses, a practical method to estimate the effectiveness of public health interventions within the existing program capacity was developed. The method and materials were tested in seven countries (Afghanistan, Zimbabwe, Tanzania, Uganda, Guatemala, the Philippines, and Ghana). In this method, four core components are assessed using a questionnaire: (1) the efficacy of the intervention; (2) the level of existing human resources (i.e., quality of recruitment, training, and continuing education); (3) the infrastructure (i.e., supplies, salary, transportation, and supervision); and (4) the level of community support (i.e., access and demand). Using the assessment tool provided, program staff can determine if all necessary elements are in place for a successful program that can deliver the specific intervention. Based on the results of the assessment program, weaknesses can be identified, explicitly discussed, and addressed.The usefulness of this tool in humanitarian relief may be twofold: (1) to assess the design and implementation of effective programs; and (2) to highlight the inevitable need for capacity building as the disaster situation evolves.
Information is needed to support humanitarian responses in every phase of a disaster. Participants of a multilateral working group convened to examine how best to meet these information needs. Although information systems based on routine reporting of diseases are desirable because they have the potential to identify trends, these systems usually do not deliver on their promise due to inadequate organization and management to support them.
To identify organizational and management characteristics likely to be associated with successful information systems in disaster settings, evaluations of the Integrated Disease Surveillance and Response (IDSR) programs in 12 participating countries were reviewed. Characteristics that were mentioned repeatedly in the evaluations as associated with success were grouped into nine categories: (1) human resources management and supervision; (2) political support; (3) strengthened laboratory capacity; (4) communication and feedback (through many mechanisms); (5) infrastructure and resources; (6) system design and capacity; (7) coordination and partnerships with stakeholders; (8) community input; and (9) evaluation. Selected characteristics and issues within each category are discussed.
Based on the review of the IDSR evaluations and selected articles in the published literature, recommendations are provided for improving the shortand long-term organization and management of information systems in humanitarian responses associated with disasters. It is suggested that information systems that follow these recommendations are more likely to yield quality information and be sustainable even in disaster settings.
Prehospital and community hospital healthcare providers in the United States must be prepared to respond to burn disasters. Continuing education is the most frequently utilized method of updating knowledge, skills, and competence among healthcare professionals. Since preparedness training must meet multiple educational demands, it is vital to understand how participants'work and educational experience and the program's content and delivery methods impact knowledge acquisition, and how learning influences confidence and competence to perform new skills.
Purpose:
The purpose of this exploratory, convenience sample study was to identify healthcare provider characteristics and continuing education training content areas that were predictive of self-reported improvement in competence after attending a mass-casualty burn disaster continuing education program.
Methods:
Logistic regression analysis of data from a post-training evaluation from nine, one-day continuing education conferences on mass burn care was used to identify factors associated with improved self-reported competency to respond to mass burn casualties.
Results:
The following factors were associated most closely with increased self-reported competency: (1) prehospital work setting (odds ratio (OR) = 3.06, confidence interval (CI) = 0.83–11.30, p = 0.09); (2) 11 or more years of practice (OR = 0.31, CI = 0.09–1.08, p = 0.07); and (3) practice in an urban setting (OR = 0.01, CI = 0.18–0.82, p >0.01). Confidence items included: (1) ability to implement appropriate airway management modalities (OR = 2.31, CI = 1.03–5.17, p >0.04); (2) manage patients with electrical injuries (OR = 4.86, CI = 1.84–12.85, p >0.001); (3) identify non-survivable injuries (OR = 2.24, CI = 0.93–5.43, p = 0.07); and (4) recognize special problems associated with burns in young children or older adults (OR = 2.14, CI = 0.87–5.23, p = 0.10). The final model explained 89.9% of the variability in self-reported competence.
Conclusions:
Interventions used to train healthcare providers for burn disasters must cover a broad range of topics. However, learning needs may vary by practice setting, work experience, and previous exposure to disaster events. This evaluation research provides three-fold information for continuing education research: (1) to identify content areas that should be emphasized in future burn care training; (2) to be used as a model for CE evaluation in other domains; and (3) to provide support that many factors must be considered when designing a CE program. Results may be useful to others who are planning CE training programs.
As the humanitarian health response industry grows, there is a need for technical health expertise that can build an evidence base around outcome measures and raise the quality and accountability of the health relief response.We propose the formation of technical support units (TSUs), entities of health expertise institutionalized within humanitarian non-governmental organizations (NGOs), which will bridge the gap between the demand for evidencebased, humanitarian programming and the field capacity to accomplish it. With the input of major humanitarian NGOs and donors, this paper discusses the attributes and capacities of TSUs; and the mechanisms for creating and enhancing TSUs within the NGO management structure.
This paper is an attempt to review the advances and shortfalls in data collection and use of health data that have occurred during health emergencies in recent decades for the opening session of the Humanitarian and Health Conference at Dartmouth University in September of 2006.
Methods:
Examples of various kinds of successes and failures associated with health data collection are given to highlight advances with an effort to emphasize multi-agency efforts reviewed by outside scholars.
Results:
Health data, particularly surveillance data, have allowed relief workers to set priorities for life-saving humanitarian programs. The main guidelines widely utilized such as those of the US Centers for Disease Control and Prevention, Médecins sans Frontières, and the Sphere Project have considerable similarity due to the consistency of data collected in various crises. Moreover, difficult to see problems and successes have been revealed by coherent surveillance efforts. Yet, these data collection efforts can not show significant improvements in the quality of humanitarian aid in recent years. Moreover, health data often do not appear to have meaningful influence on the prioritizing of relief resources globally or on those political issues that trigger emergencies.
Conclusions:
The field of humanitarian relief is relatively nascent. Methods for documenting basic health measures on the local level have been developed and general health priorities have been documented. Some technical improvements in monitoring still are needed but decision-making is most often limited by the lack of data rather than the problems with data. The ability of health data to influence spending global priorities, legal or political actions undertaken by international organizations, remains very limited.
Vicarious traumatization is now a well-known entity and may have negative influences on those that are involved in rescue efforts in any disaster or traumatic events. Healthcare workers work with trauma survivors and witness an immense array of gruesome and ghastly images. This work has the potential to cause those engaged in rescue efforts to become affected subconsciously.
Job-related stress may cause psychological symptoms in care providers who provide support and listen to the survivors' account of trauma. A therapist working in disaster situations may become a victim of psychological anguish—undermining their physical and mental well-being as well as their profession, adversely affecting their traumatized patients, and leading to a counter-productive therapist-survivor relationship.
This significant theme of secondary trauma must be recognized in relief workers at early stages and must be addressed at an individual as well as organizational level. The key may lie in turning to social supports, adapting positive coping mechanisms, and subsequently seeking mental health consultation. Further research is required in this area to determine the best resolution.
Morbidity and mortality due to acute but treatable conditions remain high in the developing world, as many significant barriers exist to providing emergency medical care.This study investigates these barriers in a rural region of Ethiopia.
Hypothesis:
The limited capacity of frontline healthcare workers to diagnose and treat acute medical and surgical conditions represents a major barrier to the provision of emergency care in rural Ethiopia.
Methods:
Health providers at a convenience sample of 16 rural health centers in the state of Tigray, Ethiopia completed a questionnaire designed to assess the availability of diagnostic and treatment modalities, the proximity and methods of transportation to referral facilities, and health providers' level of comfort in diagnosing and treating a variety of representative emergency medical conditions.
Results:
Thirteen (81%) providers had only a very basic level of medical training, and seven (44%) lacked access to any diagnostic equipment.While most providers could offer oral rehydration solution (ORS), anti-pyretic medications, and antibiotics, none of the providers could offer blood transfusions or any form of surgery. Ten (63%) respondents stated that their patients had to travel >10 km from the health center to a referral hospital, with only a minority of patients having access to motorized transport. For the seven emergency conditions assessed, a majority of providers felt comfortable diagnosing these conditions, though fewer felt comfortable treating them.
Conclusion:
There is a significant need for both health worker training and improvements in transportation infrastructure in order to increase access to emergency medical care in rural areas of the developing world.Low-cost interventions that improve human capacity in a context-appropriate manner are warranted as transportation and hospital network capacity expansions are considered.
The effectiveness of humanitarian programs normally is evaluated according to a limited number of pre-defined objectives. These objectives typically represent only selected positive expected impacts of program interventions and as such, are inadequate benchmarks for understanding the overall effectiveness of aid.This is because programs also have unexpected impacts (both positive and negative) as well as expected negative impacts and expected positive impacts beyond the program objectives.The authors contend that these other categories of program impacts also should be assessed, and suggest a methodology for doing so that draws on input from the perspectives of beneficiaries. This paper includes examples of the use of this methodology in the field. Finally, the authors suggest future directions for improving this type of expanded assessment and advocate for its widespread use, both within and without the field of disaster response.
The Suwa Onbashira Festival is held every six years and draws approximately one million spectators from across Japan. Men ride the Onbashira pillars (logs) down steep slopes.At each festival, several people are crushed under the heavy log. During the 2004 festival, for the first time, a medical care system that coordinated a medical team, an emergency medical service, related agencies, and local hospitals was constructed.
Objective:
The aims of this study were to characterize the spectrum of injuries and illness and to evaluate the medical care system of this festival.
Methods:
The festival was held 02 April–10 May 2004. The medical records of all of the patients who presented to an on-site medical tent or who were treated at the scene and transported to hospitals over a 12-day period were reviewed.The following items were evaluated: (1) the emergency medical system at the festival; (2) the environmental circumstances; and (3) patient data.
Results:
All medical usage rates are reported as patients per 10,000 attendees (PPTT). A total 1.8 million spectators attended the festival during the 12-day study period; a total of 237 patients presented to the medical tent (1.32 PPTT), and 63 (27%) were transferred to hospitals (0.35 PPTT). Of the total, 135 (57%) suffered from trauma—two were severely injured with pelvic and cervical spine fractures; and 102 (43%) had medical problems including heat-related illness.
Conclusions:
Comprehensive medical care is essential for similar mass gatherings. The appropriate triage of patients can lead to efficient medical coverage.
Disaster preparedness and response have gained increased attention in the United States as a result of terrorism and disaster threats. However, funding of hospital preparedness, especially surge capacity, has lagged behind other preparedness priorities. Only a small portion of the money allocated for national preparedness is directed toward health care, and hospitals receive very little of that. Under current policy, virtually the entire funding stream for hospital preparedness comes from general tax revenues. Medical payers (e.g., Medicare, Medicaid, and private insurance) directly fund little, if any, of the current bill. Funding options to improve preparedness include increasing the current federal grants allocated to hospitals, using payer fees or a tax to sub- sidize preparedness, and financing other forms of expansion capability, such as mobile hospitals. Alternatively, the status quo of marginal preparedness can be maintained. In any event, achieving higher levels of preparedness likely will take the combined commitment of the hospital industry, public and private payers, and federal, state, and local governments. Ultimately, the costs of pre- paredness will be borne by the public in the form of taxes, higher healthcare costs, or through the acceptance of greater risk.