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The New Mexico-1 Disaster Medical Assistance Team (NM-1 DMAT) has responded to more disasters due to hurricanes than disasters from any other type of event. To assess whether defined patient needs may be applied to future hurricanes, the patient needs after Hurricanes Andrew and Iniki were compared. The study question was, “Did patient medical needs differ after these hurricanes?”
Methods:
Design: Retrospective cohort review. Subjects: All patients evaluated by NM-1 DMAT following Hurricanes Andrew and Iniki. Observations: Age, past medical history, chief complaint, diagnosis, diagnostic tests, treatments, triage level, and disposition. Age was analyzed using Student's t-test, other data were analyzed using the chisquare test.
Results:
A total of 1,056 patients were evaluated. Age distributions did not differ between events. More patients had co-morbidities after Hurricane Andrew. The only difference in chief complaint was that more patients complained of “cold” symptoms following Hurricane Iniki. The only differences in diagnoses were for upper respiratory infections, which were diagnosed more often after Hurricane Iniki. There were no differences in the administration of tetanus toxoid, antibiotics, or analgesics. Patients evaluated after Hurricane Andrew had more diagnostic tests performed and a higher illness/injury acuity. The proportion of the total number of patients conveyed to a hospital did not differ.
Conclusion:
Patient needs were similar after Hurricane Andrew and Hurricane Iniki and may be applicable for predicting the needs of patients for future hurricanes.
A number of organized and universally publicized, large-scale events take place each year in many parts of the world that involve a population at greater risk. Large gatherings provide a theater of operations for public health and more thought now is being given to these issues. The Olympic Games is the largest, single event that is concentrated into one significant geographical space that unfolds over a period of weeks and involves a transient population. From Atlanta to Sydney, a growing awareness of public health issues has occurred, and there is a clear recognition that much more preparation is necessary for all future events. Therefore, it is mandatory that we recognize that the Olympic Games, Athens 2004 is a potential venue for accidents as well as for purposefully precipitated acts leading to suffering, disability, and death. The organization and management of public health is a major hurdle for Athens 2004. At a minimum, hospital and emergency medical services must be in an optimal state of readiness, a network of public health laboratory services must be deployed, and human resources must be retooled.
The issues surrounding “life” continue to increase in number and complexity. Those of us in the health professions believe that once a life is established, we must do all that is possible to preserve it. For most of us, this is an absolute, regardless of circumstances and setting.
But, it is essential that we recognize that this value that we place on all life is not held universally. Members of some societies believe that the after-life is of greater value than is life in this earthly realm. For some, the “ultimate sacrifice” is relinquishing one's own life for a higher cause.
Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI.
Objective:
To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents.
Methods:
Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings.
Results:
A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communicationrelated issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Predeployment planning was the most important factor for future incident impact minimization.
Conclusions:
Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.