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The human resources crisis in humanitarian health care parallels that seen in the broader area of health care. This crisis is exacerbated by the lack of resources in areas in which humanitarian action is needed—difficult environments that often are remote and insecure—and the requirement of specific skill sets is not routinely gained during traditional medical training. While there is ample data to suggest that health outcomes improve when worker density is increased, this remains an area of critical under-investment in humanitarian health care. In addition to under-investment, other factors limit the availability of human resources for health (HRH) in humanitarian work including: (1) over-reliance on degrees as surrogates for specific competencies; (2) under-development and under-utilization of national staff and beneficiaries as humanitarian health workers; (3) lack of standardized training modules to ensure adequate preparation for work in complex emergencies; (4) and the draining of limited available HRH from countries with low prevalence and high need to wealthier, developed nations also facing HRH shortages.
A working group of humanitarian health experts from implementing agencies, United Nations agencies, private and governmental financiers, and members of academia gathered at Hanover, New Hampshire for a conference to discuss elements of the HRH problem in humanitarian health care and how to solve them. Several key elements of successful solutions were highlighted, including: (1) the need to develop a set of standards of what would constitute “adequate training” for humanitarian health work; (2) increasing the utilization and professional development of national staff; (3) “training with a purpose” specific to humanitarian health work (not simply relying on professional degrees as surrogates); (4) and developing specific health taskbased competencies thereby increasing the pool of potential workers.
Such steps would accomplish several key goals, such as: (1) more confidently ensuring that individuals hired for a given post would have the capacity to function at a commonly understood level of training; (2) greatly increasing the potential number and types of workers available for humanitarian work;(3) increasing the efficiency of human resources utilization in humanitarian projects; and (4) recognition that humanitarian work is a multi-disciplinary endeavor: these goals will contribute to ensuring that humanitarian health workers have a minimum training in broader humanitarian action, making them more effective team members in the field.
Efforts were made to highlight some promising pilot programs for human resource development in humanitarian work, to identify a future vision for humanitarian health as a profession, and to develop a human resources strategy for achieving that vision.
This paper focuses on the dilemma that humanitarian non-governmental organizations (NGOs) face in their efforts to gain access to populations caught up in current wars. Narrow and broad concepts of humanitarian protection are discussed and it is argued that despite high levels of professionalism, the space for humanitarian action has constricted sharply since the events surrounding the attacks of 11 September 2001. Increasingly, aid workers are now being viewed with suspicion as agents of the great powers and assertions of humanitarian neutrality are not heeded or rejected. Non-governmental organizations have evolved a range of options to address this problem, but there is an urgent need to work collectively to find more durable and coherent solutions.
Presently, there is no shortage of methods for collecting data on populations requiring assistance from humanitarian health interventions. However, utilizing a working group, the authors of this paper have looked at these methods through a critical lens and found that there is need for improvement upon existing systems of data collection and analysis. The authors concluded that efforts to standardize the methods of data collection are needed to achieve universal uniformity, and that more funding should be allocated to analyze the data collected.
During humanitarian response efforts, the mass media serves as the primary informational intermediary informing donors, policy makers, and the nonaffected public. A lack of professional standards within the current culture of journalism, the politics of media ownership, and media manipulation by governments has distorted reporting on humanitarian crises, with possible detrimental effects on response efforts. Humanitarian response organizations must assume a proactive, leading role in the management and sharing of information with each other as well as with donors, policy makers, and the public. This will require working with the media as partners, as well as exploring innovative methods of mass communication. A multi-stakeholder, cooperative communication initiative could help improve media involvement, and harness the media as a credible and knowledgeable communication tool for response efforts. A professional publication dedicated to the discipline of humanitarian relief also could optimize efforts, communicate the perspectives of beneficiaries, and manage the underutilized resource of the general public.
Too often during major emergencies, those with specialty skills are perceived as unnecessary and are left sitting on the sidelines. Sometimes, they are not even considered. When they are utilized, they often are assigned menial tasks that, understandably, do not encourage a willingness to “buy in” to a response.
The aim of the study is to evaluate the self-administered Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria-based inventory for the screening of post-traumatic stress disorder. Due to its low sensitivity (57%) and high specificity (88%), it could be useful as a second step of a screening procedure in combination with other validated, self-report instruments. The clinical implications of the findings and the limitations of the study are discussed.
Increasingly, disasters and disaster response have become prominent issues in recent years. Despite their involvement, there have been almost no investigations into the roles of physiotherapists in emergency disaster responses.Additionally, physiotherapists are not employed in emergency disaster response by many of the principal non-governmental organizations supplying such care, although they are included in military responses in the United States and United Kingdom, and in Disaster Medical Assistance Teams in the US.This paper, based on a small qualitative study, focuses on the potential role and nature of input of physiotherapists in disaster response.
Methods:
A qualitative approach was chosen due to the emergent nature of the phenomenon. Four physiotherapists, all of whom had been involved in some type of disaster response, agreed to participate. Semi-structured telephone interviews were used to explore participants' experiences following disaster response, and to gain ideas about future roles for physiotherapists. Interviews were recorded, transcribed, and later analyzed using coding and categorization of data.
Results:
Four main themes emerged: (1) descriptions of disasters; (2) current roles of the physiotherapist; (3) future roles of physiotherapists; and (4) overcoming barriers. Although all four physiotherapists had been ill-prepared for disaster response, they took on multiple roles, primarily in organization and treatment. However, participants identified several barriers to future involvement, including organizational and professional barriers, and gave suggestions for overcoming these.
Conclusions:
The participants had participated in disaster response, but in ill-defined roles, indicating a need for a greater understanding of disaster response among the physiotherapy community and by organizations supplying such care. The findings of this study have implications for such organizations in terms of employing skilled physiotherapists in order to improve disaster response. In future disasters, physiotherapy will be of benefit in treating and preventing rescue worker injury and treating musculoskeletal, critical, respiratory, and burn patients.
The landmark Humanitarian Response Review, commissioned by the United Nations Emergency Relief Coordinator in 2005, has catalyzed recent reforms in disaster response through the Inter-Agency Standing Committee. These reforms include a “cluster lead” approach to sectoral responsibilities and the strengthening of humanitarian coordination. Clinical medicine, public health, and disaster incident management are core disciplines underlying expertise in disaster medicine. Technical lead agencies increasingly provide pre-deployment training for selected health personnel. Moreover, technical innovations in disaster health sciences increasingly are disseminated to the disaster field through multi-agency initiatives, such as the Standardized Monitoring and Assessment of Relief and Transitions (SMART) initiative.
The hallmark qualification of competency to render an informed opinion in the health specialties remains specialty board certification in North American healthcare traditions, or specialty society fellowship in British and Australasian healthcare traditions. However, disaster incident management training lacks international consensus on hallmark qualifications for competency. Disaster experience is best characterized in terms of months of fulltime, hands-on field service. Future practitioners in disaster medicine will see intensified efforts to define competency benchmarks across underlying core disciplines as well as key field performance indicators.Quantitative decisionsupport tools are emerging to assist disaster planners and medical coordinators in their personnel selection.
International mass gatherings can cause great challenges to local healthcare system and emergency medical services (EMS). Traditionally, planning has been based on retrospective reports of previous events, but there still is a need for prospective studies in order to make the process more evidence-based. The aim of this study was to analyze the success of medical preparedness, ambulance patient characteristics, emergency care, and the use of pre-hospital resources during the 2005 World Championship Games in Athletics in Helsinki, Finland.
Methods:
The study was a prospective, observational study conducted within the Helsinki EMS. Data from all emergency calls at the sport venues and Games village between 05 and 14 August 2005 were collected. Data from the organizations responsible for the health care and first aid of spectators and accredited persons (e.g., athletes, coaches, the press, very important persons and personnel working in the Games area) also were collected. The Institutional Review Board of Helsinki University Central Hospital approved the study plan.
Results:
A total of 479,000 persons visited the Games. The ambulance call incidence at the Olympic Stadium was 0.50 per 10,000 people and 0.7 per 10,000 when the Games Village was included. The overall need for ambulance transportation to the emergency department was 0.52 per 10,000. No patients needed cardiopulmonary resuscitation or other immediate, life-saving procedures on-site. First aid was provided to 554 spectators (0.17per 10,000 people). The three medical organizations cared for 1,586 patients of which 25 (1.6%) were transported to a hospital by an ambulance. The number of patients needing transportation and the overall patient loadfor the healthcare system was well-anticipated. Accredited persons sought health care a total of 1,009 times.The number of patients treated was associated closely with the number of spectators (p = 0.05). The number of ambulance calls in the city increased 5.9 % as compared to the corresponding time period in the five previous years.
Conclusions:
The medical preparedness and resources for the Games proved to be sufficient. The EMS personnel were able to provide quality emergency care. This prospective study provided new, detailed data for the medical aspects of mass gatherings and confirmed many previous observations.
The objective of this study was to estimate the burden of cancer in counties affected by Hurricane Katrina using population-based cancer registry data, and to discuss issues related to cancer patients who have been displaced by disasters.
Methods:
The cancer burden was assessed in 75 counties in Louisiana, Alabama, and Mississippi that were designated by the Federal Emergency Management Agency as eligible for individual and public assistance. Data from the National Program of Cancer Registries were used to determine three-year average annual age-adjusted incidence rates and case counts during the diagnosis years 2000–2002 for Louisiana and Alabama. Expected rates and counts for the most-affected counties in Mississippi were estimated by direct, age-specific calculation using the 2000–2002 county level populations and the site-, sex-, race-, and age-specific cancer incidence rates for Louisiana.
Results:
An estimated 23,549 persons with a new diagnosis of cancer in the past year resided in the disaster-affected counties. Fifty-eight percent of the cases were cancers of the lung/bronchus, colon/rectum, female breast, and prostate. Eleven of the top 15 cancer sites by sex and black/white race in disaster counties had >50% of cases diagnosed at the regional or distant stage.
Conclusions:
Sizable populations of persons with a recent cancer diagnosis were potentially displaced by Hurricane Katrina. Cancer patients required special attention to access records in order to confirm diagnosisand staging, minimize disruption in treatment, and ensure coverage of care. Cancer registry data can be used to provide disaster planners and clinicians with estimates of the number of cancer patients, many of whom maybe undergoing active treatment.
In stressful situations such as the management of major incidents and disasters, the ability to work in a structured way is important. Medical management groups initially are formed by personnel from different operations that are on-call when the incident or disaster occurs.
Objective:
The aim of this study was to test if performance indicators for staff procedure skills in medical management groups during simulations could be used as a quality control tool for finding areas that require improvement.
Methods:
A total of 44 management groups were evaluated using performance indicators in which results could be expressed numerically during simulations.
Results:
The lowest scores were given to documentation and to the introduction of new staff members. The highest score was given the utilization of technical equipment.
Conclusions:
Staff procedure skills can be measured during simulations exercises. A logging system may lead to enhancing areas requiring improvement.
No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat. The purpose of this study was to assess medical decisionmaking capabilities of law enforcement personnel under these circumstances.
Methods:
Web-based surveys were administered to all sworn officers within the county jurisdiction.Thirty-eight key actions were predetermined for nine injured officer scenarios, with each correct action worth one point.Descriptive statistics and t-tests were used to analyze results.
Results:
Ninety-seven officers (65.1% response rate) responded to the survey. The majority of officers (68.0%) were trained to the first-responder level. Overall mean score for the scenarios was 15.5 ±3.6 (range 7–25). A higher level of medical training (EMT-B/P versus first responder) was associated with a higher mean score (16.6 ±3.4, p = 0.05 vs. 15.0 ±3.6, p = 0.05).Tactical unit assignment was associated with a lower score compared with nonassigned officers (13.5 ±2.9 vs. 16.0 ±3.6, p = 0.0085).No difference was noted based upon previous military experience. Ninety-two percent of respondents expressed interest in a law enforcement-oriented advanced first-aid course.
Conclusions:
Tactical medical decision-making capability, as assessed through the nine scenarios, was sub-optimal. In this post 9/11 era, development of law enforcement-specific medical training appears appropriate.
Open-source information consists of a range of publicly available material, includingvarious periodicals, news reports, journal publications, photographs, and maps. Although intelligence agencies regularly use open source information in developing strategically important intelligence, the disaster community has yet to evaluate its use for planning or research purposes. This study examines how open-source information, in the form of Internet news reports and public access disaster databases, can be used to develop a rapid, 72-hour case report.
Methods:
Open-source information was extrapolated from several news reports on a terrorist bombing that occurred in Russia on 05 December 2003, using a self-devised “data” collection sheet, and background information collected on the nature of similar disasters using three public access databases.
Results:
The bulk of health-related information was collected in the first 13 hours after the event, including casualty demographics, immediate dead, total dead, admitted, and treated-and-released. The complex and prolonged rescue of casualties was identified, as well as the presence of unexploded ordnance. This incident also was identified as the first publicly reported suicide terrorist bombing of a commuter train.
Conclusions:
Open-source information has the potential to be a helpful tool in reconstructing a chain of events and response. However, its use must be validated further and used appropriately. Standards for collection and analysis also must be developed.