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Simulation is often employed to test mass casualty and disaster response planning within hospitals, but it is resource intensive and needs to achieve high-quality recreation of scenarios to be effective. The delivery of large-scale interdisciplinary team and system simulation requires consideration of physical safety, system integrity for real patients, simulation team communication, and effective dissemination of outcomes.
Aim:
To describe challenges and potential solutions for effective delivery of disaster simulations, drawn from simulation service experience at Gold Coast Hospital and Health Service (GCHHS).
Methods:
This case study reviews strategies used to deliver a large-scale multi-team in-hospital disaster and trauma simulation, involving more than 75 participants drawn from paramedic/ambulance, emergency, trauma service, anesthetics, perioperative, surgical, and hospital administrative teams.
Results:
Issues reviewed include simulation delivery team composition and briefing, safety strategies, matching simulation methodology to exercise objectives, the use of real-time communications technologies and apps for real-time communication and performance tracking, and leveraging the simulation experience for observers by narrated Facetime stream. Following the simulation, a debriefing was conducted with participants to address performance, communication and interfaces, strengths and weaknesses, and overall opportunity for improvement. Facility-wide dissemination of messages through standardized reporting, infographics, and video vignettes were also reviewed.
Discussion:
Simulation is an engaging way to assess protocols and practices for disaster response within a tertiary hospital, and effectiveness can be enhanced through the strategic use of contemporary techniques and technologies.
Emergency services are not the only source of information that the public uses when considering taking action during an event. There are also environmental cues, information from the media, or actions by peers that can influence perceptions and actions. When cues from different information sources are in conflict, it can cause uncertainty about the right protective action to take.
Aim:
Our research responds to concerns that conflicting cues exacerbate community non-compliance with emergency warnings.
Methods:
The sample consisted of 2,649 participants who completed one of 32 surveys.
Results:
The findings from this project confirmed emergency services agencies’ suspicions that conflicting cues can affect information processing and risk perceptions, and therefore prevent people from taking appropriate protective action. The results were reasonably consistent across fire and flood scenarios, suggesting the problem of conflicting cues is not hazard-specific. When presented with consistent cues, participants were more likely to evacuate, perceive risk about the event, share information with friends, family, and peers, find emergency warnings to be effective, and comprehend information. When faced with conflicting cues, participants were more likely to seek out additional information. It affected their information processing and self-efficacy. The results did not change for people of different ages, native language, country of birth, or post-hazard experience. This is contrary to most emergency literature research findings, which show that individual differences play a role in impacting propensity to take protective action. However, there does appear to be a significant gender effect. These results require further exploration.
Discussion:
These findings may be used to assist emergency services agencies to tailor community warnings during time-critical situations, and develop ways to mitigate ambiguity caused by conflicting cues to encourage protective action in order to save lives and properties.
Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.
Methods:
This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).
Results:
There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).
Discussion:
Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.
The treatment of patients in the triage category “expectant” is not in the focus of the prehospital disaster medicine. The aim is to save as many lives as possible in situations with very limited resources. It is necessary to allocate the life-saving interventions to those who have the chance to survive, but there is a human right of best assistance even for those who are expected to die.
Aim:
In Germany, it is possible to use the triage category “expectant” in overwhelming disasters, so there should be preparedness for those patients, who receive this categorization. A survey was conducted to find out what the needs are of those patients.
Methods:
An online-survey was submitted to German medical incident commanders and palliative care physician in function of expert groups via their national associations.
Results:
219 physicians participated. The majority confirmed a necessity to treat those patients and to be prepared. Currently, in most of the areas, there is no preparation. The main needs are the treatment of pain, dyspnoea, fear, and loneliness. Following the “Dying person’s bill of rights” (1), the most relevant rights are:
To be treated as living human being until I die
To be free from pain
To express the feelings and emotions
To die in peace and dignity
Discussion:
Palliative care should be part of disaster medicine planning. It is not too difficult to prepare a special group of helper for the care of dying patients. Medical incident commanders and palliative care physicians agree in the majority about the necessity, so SOPs can be implemented to teach non-medics. The medics will be needed for the first aim of disaster medicine.
Music and sporting events are mass gatherings with unique risks related to participation. “All-ages” events, which include participants below the age of majority (18 in many jurisdictions), have been observed to have an over-representation of patient presentations in the youth category. Peer helpers may lower the barrier to seeking on-site care. Youth (peer-aged) volunteerism provides opportunities for exposure to new environments, skills, and mentorship. Medical volunteerism may promote personal satisfaction through prosocial behavior (i.e., helping others), community engagement and immersion into a potential health professions career path.
Methods:
We conducted an observational pilot feasibility study with feedback forms and semi-structured interviews. The pilot program paired youth with parents/guardians/responsible adults as health care volunteers at special events.
Results:
Youth/adult dyads volunteered for a variety of events in Canada during the 2018 event season. All participants in the “Juniors Program” completed at least a Standard First Aid course, including orientation to personal safety and confidentiality. Each pair worked in one of two areas: first aid or Festival Health (the harm reduction space at music events) providing peer-to-peer and “all-ages” support. Post-event feedback from the dyads revealed many positive experiences and universally called for more opportunities.
Discussion:
A strong volunteer base is an asset to any community. In this pilot study, the volunteer experiences were supervised by a team of credentialed health care professionals. The authors report on qualitative feedback in themes based on patient perspective, volunteer perspective, team perspective, and event management perspective. More research is needed to measure the outcomes of the Junior’s Program. More Investigation is needed to determine not only the long-term benefits of participation on event medical teams, but also to identify factors that shape a positive experience for youth, their parents, and the event participants that they support.
Currently, Technical Advisors of the World Health Organization’s (WHO) Emergency Medical Teams (EMT) Secretariat are conducting standardized verification work for international emergency medical teams in various countries and organizations. However, a uniform and standard training course for an International EMT is lacking.
Aim:
To design a training course model based on knowledge structure, teaching, and evaluation methods for an International EMT.
Methods:
The first and second level catalogue defined as chapters and sections for the International EMT training curriculum were drafted based on literature and summaries of fragmentary experience. The teaching syllabus with the method of teaching and evaluation was initially outlined. The expert consultation form was designed and validated. Experts from International EMTs from various countries were consulted and investigated. The Delphi method was used, and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts.
Results:
A total of 25 experts were consulted. By 2 rounds of consultation with a Kendall coordination coefficient W value of 0.210 and chi-square value of 78.61 (p<0.05), consensus about the knowledge structure for the curriculum was achieved, which consisted of 6 chapters: (1) introduction of International EMT, (2) Disaster medicine, (3) Global health, (4) Care in austere condition, (5) Medical technology, (6) Field training, with the weights of 0.1415, 0.1584, 0.1536, 0.1827, 0.1728, and 0.1909, respectively, and 32 sections. Teaching methods for different knowledge modules were determined, which included lecture, demonstration, discussion, drills, and tabletop simulation. The evaluation methods were affirmed via a quiz, written examination, skill test, and teamwork test assessed by intra-group and inter-group evaluation.
Discussions:
Through scientific investigation of experts from International EMTs, a training course model for International EMT was established.
Pediatric trauma is one of the leading causes of child mortality and morbidity and is a major challenge for healthcare systems worldwide. Treatment of pediatric trauma requires special attention according to the unique needs of children, especially in children affected by severe trauma who require life-saving treatments. It is essential to examine the preparedness of Emergency Departments (EDs) for admitting and treating pediatric casualties.
Aim:
To develop a model for admitting and treating pediatric trauma casualties in EDs.
Methods:
Seventeen health professionals were interviewed using a semi-structured qualitative tool. A quantitative questionnaire was distributed among general and pediatric EDs’ medical and nursing staff. Following the qualitative and quantitative findings, another round of interviews was performed to identify constraints, to construct a “Current Reality Tree,” and develop a model for admission and management of pediatric casualties in EDs. The model was validated by the National Council for Trauma and Emergency Medicine.
Results:
Lack of uniformity was found regarding age limit and levels of injury of pediatric patients. Most study participants believe that severe pediatric casualties should be concentrated in designated medical centers and that minor and major pediatric casualties should be treated in pediatric rather that general EDs. Pediatric emergency medicine specialists are preferred as case managers for pediatric casualties. Significant diversity in pediatric-care training was found. Based on qualitative and quantitative findings, a model for the optimal admitting and managing of pediatric casualties was designed.
Discussion:
To provide the best care for pediatric casualties and regulate its key aspects, clear statutory guidelines should be formulated at national and local levels. The model developed in this study considers EDs’ medical teams and policy leaders’ perceptions, and hence its significant contribution. Implementation of the findings and their integration in pediatric trauma care in EDs can significantly improve pediatric emergency medical services.
The Emergency Medical Team (EMT) Strategic Advisory Group of the World Health Organization has endorsed the EMT Minimum Data Set (MDS) as the standard methodology for EMT daily report. The MDS had been developed on a similar methodology called J-SPEED which developed in Japan. Thus, lessons learned from the J-SPEED can be applied to the MDS.
Aim:
To review previous J-SPEED activations and to extract lessons learned.
Methods:
Cases of the J-SPEED activation at the Kumamoto earthquake in 2016, West Japan Heavy Rain in 2018, and Hokkaido Earthquake in 2018 were reviewed.
Results:
The first large-scale activation of the J-SPEED at the Kumamoto earthquake revealed a significant burden in aggregations of submitted paper forms at the EMT Coordination Cell (EMTCC). To strengthen this function of the EMTCC, electronic system and human capacity development have been identified as key issues. To fulfill this gap, a smartphone app so-called J-SPEED+ has been developed. Also, the J-SPEED offsite analysis support team, which is a team to support analysis of data from outside of an affected area has been established. These two functions contributed to significant improvement of J-SPEED data flow at the West Japan Heavy Rain and Hokkaido Earthquake. These two responses reinforced the necessity of strengthening the capacity of J-SPEED onsite coordinator working at the ETMCC, and national education and training for all EMTs.
Discussion:
In order to strengthen the mechanism to run the J-SPEED, nationwide training for all EMTs, onsite coordinators, and the off-site analysis support team have been established. The authors regard this structural approach as a requirement for other countries to run the MDS.
Proper use of personal protective equipment (PPE) is essential when facing emerging infectious diseases. Proper training methods can promote the use of the PPE correctly.
Aim:
To explore the effect of the training method of sequential operation training on medical staff to master PPE penetration and removal skills, and to study the memory attenuation after training.
Methods:
Fifteen medical staff with no experience of PPE operation in a hospital were trained to wear PPE in accordance with WHO standards by illustration and sequential operation method. The training included 30 minutes of theoretical teaching and 60 minutes of practical exercises. At the end of the training and 1 week after the training, the training objects were evaluated for PPE operation. A 2.5 x 2.5 cm fluorescent agent was applied on 6 parts, such as hands, chest, abdomen, and knees, to simulate contamination. After taking the PPE off, the parts of the whole body and the inner layer of clothing that were fluorescently contaminated were recorded. The whole operation process was recorded by video to evaluate whether the operation was correct. The error rates of two operations and the contamination position and frequency were compared.
Results:
The error rate of the operating PPE after training was 18.6%, rising to 31.9% after 1 week (Z=16.0, P<0.05). After the training, the average number of contaminated PPE removal was 1.96±1.56, which rose to 2.96±2.03 one month later. The difference was statistically significant (Z=8.92, P<0.05). The main vulnerable sites are the wrist, chest, abdomen, and left calf.
Discussion:
Illustrative sequential operation training is an important means to improve the way for medical staff to wear PPE, but it must be completed more than once to ensure that medical staff can firmly master the skills of wearing and removing PPE.
Because of the rapid progress of multiple trauma patients, the early mortality rate is high. Therefore, early assessment of the severity and prognosis of multiple injuries is crucial for timely treatment and improvement of prognosis. So we need to find parameters related to mortality and severity of multiple trauma.
Aim:
To find out parameters related to mortality and severity of multiple trauma.
Methods:
This was a single center, trauma registry based, observational cohort study. Data were collected from consecutive patients with multiple trauma who presented to the emergency department of a tertiary referral hospital between April 2015 and December 2016. The main outcomes studied were 28-day in-hospital mortality, 24-hours mortality, emergency operation rate, and ICU admission rate.
Results:
444 patients were eventually included in the study, including 337 males (75.9%) and 107 females (24.1%). The 28-day survival group consisted of 381 patients (85.8%) and the death group accounted for the other 14.2%. Multivariate logistic regression analysis showed that heart rate, peripheral oxygen saturation, lactic acid, partial pressure of carbon dioxide, plasma albumin, hematocrit, and Glasgow score were independent risk factors for 28-day mortality. The area under the ROC curve (AUC) of the above indicators was 0.669, 0.547, 0.868, 0.512, 0.740, 0.627, and 0.815, and the AUC value of lactate was the maximum.
Discussion:
When the body suffers from severe trauma, it loses a lot of blood and reduces the circulating blood volume, which leads to absolutely insufficient hemoglobin content and hypoxia of tissue cells. The plasma lactate content increases at this time. Therefore, lactate can be used as an important prognostic parameter for patients with multiple trauma. In addition, we can use lactate to revise the existing trauma score to enhance its effectiveness.
An estimated two billion people are currently affected by war, with civilian populations increasingly exposed to the hazards of armed conflict. While the effect of explosive remnants of conflict is well documented, the impacts of the toxic remnants of war on civilian health are less well understood.
Methods:
This study was a scoping review examining the human health impacts of exposure to toxic remnants of war. Toxic remnants of war refer to any toxic or radiological substances arising from military activities. In this study, however, the focus was limited to the health effects of exposure to toxic substances and explosive by-products from munitions fired, dropped, or abandoned during conflict. The following databases were searched: Embase PubMed, Scopus, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of studies that met the inclusion criteria.
Results:
Common toxicants reported on were Tetrachlorodibenzo-p-dioxin TCDD, white phosphorus, depleted uranium, lead, mercury, and sulfur mustard. Common health effects included respiratory diseases as well as cutaneous, cardiovascular, reproductive, and congenital effects. Posttraumatic stress disorder, depression, anxiety, cognitive impairments, and decreased quality of life were also commonly reported. The evidence base, however, is mixed with heterogeneity in study design and outcome measures. Lack of baseline data and inadequate exposure models make establishing an adverse causal relationship between an agent and a disease challenging.
Discussion:
Civilian exposures to toxic remnants of conflict remain understudied and under-addressed. The study suggests assessment of the human health impacts of toxicants should be part of a post-conflict response, especially given the potential long-term intergenerational effects. The current lack of recognition of the human health impacts of toxic remnants of conflict also limits the amount of global resources assigned to post-conflict decontamination.
Housing has always been a source of stress for people in Hong Kong (HK), especially to those living in sub-optimal settings. About 210,000 people are forced to live in subdivided flats in HK. Most of these flats cannot meet health standards set by the UN even for prisoners, in terms of the floor space, climatic conditions, lighting, air quality, and ventilation. Fire and public safety equipment are lacking. Most believed that the substandard environment has a negative impact on one’s mental health.
Aim:
To investigate how the living condition in a subdivided flat affects a person’s mental health.
Methods:
104 households living in the subdivided flats in Kwai Tsing, one of the 18 Districts of HK, were surveyed by HKJCDPRI’s Collaborating Partner, HKSKH Lady MacLehose Centre in February 2017; while a follow-up study with purposive sampling was conducted in October 2017 to interview 10 households on their mental health status. A mixed Methods was used combining the quantitative Results of the WHO Quality of Life-BREF scale and Depression Anxiety Stress Scale 21, and qualitative Results of face-to-face interviews.
Results:
80% of 104 households surveyed suffered from mental distress. The follow-up study revealed that seven of them displayed signs of depression and/or anxiety, while two were diagnosed with a mental disorder. Distress is proven to associate with the environmental and health risks, including fire and disease outbreak, as well as chronic issues resulting from poor indoor air quality and extreme weather.
Discussion:
Low level of perception and preparedness among HK people is making these public health risks more apparent. The already desperate housing and land policy don’t seem to offer any help in the near future. Public educations efforts need tremendous enhancement, to engage, mobilize and empower individuals and communities, to actively plan and prepare for future shocks.
In the first months of 2018, there was an increase in the number of cases of fever possibly related to toxoplasmosis in the city of Santa Maria, Brazil, reaching significant values. Toxoplasmosis is an autoimmune acute infection usually asymptomatic in 80-90% of immunocompetent adults. In this outbreak, the intensity of the symptoms presented warrants attention.
Objective:
To report cases of the toxoplasmosis outbreak in the city of Santa Maria, Brazil.
Methods:
This is a cross-sectional study using data on the outbreak of toxoplasmosis in Santa Maria published in bulletins by the Municipal Health Department of Santa Maria, Rio Grande do Sul, Brazil.
Results:
The outbreak of toxoplasmosis in Santa Maria was confirmed on April 19, 2018. Until June 14, 2018, 510 cases were confirmed. According to the most recent bulletin released by the State Health Department on June 8, 2018, 441 occurrences are people residing in Santa Maria. Five are residents of the districts and seven cases are patients residing in neighboring counties. In a bulletin published on May 25, 2018, 1,116 cases were reported to state epidemiological surveillance by the end of May. Of these, 766 cases were still suspected (fever, headache and/or myalgia accompanied by lymphadenopathy, weakness, arthralgia, or change in vision. In the other 460 cases, there was laboratory confirmation of acute toxoplasmosis, of which 35 were pregnant, with two fetal deaths (36 and 28 weeks), and two abortions. There are also 212 cases still pending laboratory confirmation.
Discussion:
The results of this research show that the current outbreak of toxoplasmosis in the city of Santa Maria, Brazil, is the largest reported in Brazil and appears to be the largest in the world. The notification to authorities by physicians was very important for the identification of this outbreak.
The Project for Strengthening the Association of Southeast Asian Nations (ASEAN) Regional Capacity on Disaster Health Management (ARCH Project) is the project under the collaborative framework between the National Institute for Emergency Medicine, Thailand, Ministry of Public Health, and Japan International Cooperation Agency. The project aims to strengthen disaster health management focusing on the International Emergency Team (I-EMT) operation and coordination in ASEAN by using various mechanisms, for example, regional collaboration meeting, regional collaboration drill, training, etc.
Aim:
The study aims to evaluate the outcomes which ARCH Project’s activities have been facilitating to strengthen the ASEAN disaster health management.
Methods:
A comparative study is utilized to see the improvement of the ASEAN disaster health management of the current situation and the project’s outputs compared to the previous survey in 2015.
Results:
Recent ASEAN disaster health management has been strengthened in three distinctive dimensions: (1.) national capacity of each ASEAN Member States is being strengthened through the project’s training courses; (2.) the ASEAN I-EMT coordination platforms have been set up to the extent that the progress of developing the toolkits such as the Standard Operating Procedures for the Coordination of EMT in ASEAN is at its eighty percent, while the Database of the EMT and their Minimum Requirements and Qualifications are now at its ninety percent; and (3.) Standard reporting forms (medical record and health need assessment form) for all ASEAN member state (AMS) has been developed and fully completed.
Discussion:
The ARCH Project has been facilitating the strengthening of the ASEAN disaster health management through its capacity building endeavors and the creation of collaborative mechanisms for operations and coordination. These activities should be maintained either under the existing or newly created mechanisms in order to build a sustainable collaborative framework.
Compared to high-income countries, low and middle-income countries (LMICs) bear the heaviest brunt of road traffic incidents (RTIs), which is a serious public health and development burden. Like other LMICs, Uganda has been experiencing a worryingly high burden of RTIs and their associated impacts with the highest number of all the total registered RTIs in Uganda registered in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected.
Aim:
To aid in better planning of EMS for the victims of RTIs by using risk mapping of RTIs in the GKMA.
Methods:
A mixed methodological approach involving a systematic review, Delphi panel technique, retrospective data analysis, and a cross-sectional method.
Results:
With Uganda progressing forward as envisaged in its “Vision 2040,” the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth. This has significantly increased RTIs, which puts pressure on the pre-hospital emergency care for those affected unless necessary actions are taken.
Discussion:
Therefore, the road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that cause them, particularly in the GKMA which experiences the highest number of RTIs and Uganda as a whole. The WHO “Safe System Approach” is desirable for this purpose as it represents the most appropriate approach because it is broad enough to comprehensively manage any of the ongoing dynamics (political, socio-cultural or economical) that are known to contribute to RTIs.
The Japanese Association for Disaster Medicine (JADM) Disaster Medical Coordination Support Team (DMCST) was formed in 2016 when Japan experienced Kumamoto earthquake to support other disaster medical assistance teams in terms of headquarter operation logistics.
Aim:
Introducing medical association-based disaster medical support team.
Methods:
JADM DMCST was formed by an association member who had experience in disaster medical headquarter operation and logistic support. Disaster medical headquarter tends to have a gap between acute phase and sub-acute phase due to an alternation of disaster medical assistance team. To keep disaster medical management at medical management headquarter, experienced manpower requires. JADM DMCST provided assistance to fill those gaps.
Results:
For 2016 Kumamoto Earthquake, 107 members responded as a JADM DMCST, 78 members responded for 2018 West Japan Torrential Rain Disaster. Most of the members responded to the medical headquarter of affected prefecture’s, city’s, and medical region’s headquarters. Members provided logistic support in headquarter operation, gathered medical needs information, helped medical team dispatch coordination, gathered evacuation shelter information, provided heat stroke support for evacuees, assisted deep vein thrombosis management, provided AED delivery operation, and helped statistical information analysis based on WHO standards.
Discussion:
JAMD DMCST could provide medical management support at each headquarters without time span restrictions which the most of disaster medical assistance team has. Since all members were experienced in disaster medical management, they could connect and keep providing medical assistance to the affected people. At the time of disaster, disaster medical management headquarter is always short handed due to a large amount of incoming information. All this information was managed by the support team. Although JADM DMCST contributed to support headquarter management, each member had to pay for his/her transportation, hotel, food and any devices required for headquarter operations. Therefore, improving member’s responding condition is next problem to solve.
Psychosocial needs related to disaster are increasingly identified as a significant concern for both communities and responders. In response to the needs of travelers suddenly unable to leave Vancouver immediately after 9/11 in the United States, a network for the provision of volunteer mental health response at the time of a disaster was developed through the Provincial government within British Columbia (BC). Starting from less than 20 individuals primarily located within the Vancouver area, Disaster Psychosocial Services (DPS) now encompasses a network of over approximately 200 providers throughout the Province.
Aim:
To showcase a successfully functioning DPS program modeled after a volunteer-based mental health network, the evolution undergone, its present operational framework, and future goals.
Methods:
In response to the observed need for trained psychosocial intervention, we developed a framework for recruitment, education, deployment, and support of a volunteer network of mental health professional and paraprofessional providers.
Results:
This approach has been found to be effective, significantly increasing our volunteer base and opportunities for deployment.
Discussion:
This presentation will detail the grassroots development of BC’s DPS Program as well as the current model in practice. It will provide an overview of how BC’s DPS network of providers was stimulated and managed; issues related to volunteer management, including the selection of volunteers; methods of specialized training; and deployment. Multiple settings in which DPS is now utilized with increasing regularity will be described, including Emergency Operations Centers, Reception Centers, and Town Hall Meetings. Lastly, there will be a focus on the lessons learned, as well as future goals highlighting a focus on culturally-sensitive support, specifically with respect to British Columbia’s indigenous populations for building community resiliency and knowledge across the province.
This study profiles climate change as an emerging disaster risk in Oceania. The rationale for undertaking this study was to investigate climate change and disaster risk in Oceania. The role of this analysis is to examine what evidence exists to support decision-making and profile the nature, type, and potential human and economic impact of climate change and disaster risk in Oceania.
Aim:
To evaluate perceptions of climate change and disaster risk in the Oceania region.
Methods:
Thirty individual interviews with participants from 9 different countries were conducted. All of the participants were engaged in disaster management in the Oceania region as researchers, practitioners in emergency management, disaster health care and policy managers, or academics. Data collection was conducted between April and November 2017. Thematic analysis was conducted using narrative inquiry to gather first-hand insights on their perceptions of current and emerging threats and propose improvements in risk management practice to capture, monitor, and control disaster risk.
Results:
Interviewees who viewed climate change as a risk or hazard described a breadth of impacts. Hazards identified included climate variability and climate-related disasters, climate issues in island areas and loss of land mass, trans-nation migration, and increased transportation risk due to rising sea levels. These emerging risks are reflective of both the geographical location of countries in Oceania, where land mass due to rising oceans has been previously reported and climate change-driven migration of island populations.
Discussion:
Climate change was perceived as a significant contemporary and future risk, and as an influencing factor on other risks in the Oceania region.
Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Aim:
Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Methods:
The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.
Results:
This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.
Discussion:
DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Spontaneous delivery is a completely physiological phenomenon. Occupational obstetric care in a hospital environment focuses on supporting the mother, the smooth progression of the baby, and the treatment of the newborn child. Occupational activities play a rather supportive and assisting role. The obstetrician and the midwife are ready to respond immediately in the hospital environment to any complications or sudden emergencies. During a birth outside of the hospital environment, there are a number of influences that can cause complications in an unprepared environment without professional assistance, endangering the condition of both the child and the woman.
Methods:
The educational concept of PARABORN focuses on situations outside the hospital environment. It is generalized and adaptable to varying geographic, economic, and cultural-political conditions of the target providers, particularly to rescue and paramedic teams. Educational concepts are specialized, interactive courses. The course includes a theoretical and practical block. In the theoretical part, the participants acquire knowledge of urgent obstetric conditions in an out-of-hospital environment including an overweight birth, bleeding, premature delivery, or a complicated delivery (non-standard position, umbilical cord prolapse, etc.). In the practical block, participants acquire the skills of acute interventions as well as methods of communication in these emergency situations. Practical training takes the form of case studies and can be tailored to the real geographic and cultural conditions in which the intervention units operate such as remote terrain, conflicts zones, etc.
Discussion:
The knowledge of the cultural and political environment is a necessary prerequisite for managing the urgent situation. Paramedics, as first responders, should have adequate training to manage maternity situations in an out-of-hospital environment where a hospital environment is not available or accessible either by choice or circumstance.