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Behavioral health needs of first responders often receive less attention than those of survivors. Fire, police, medical, and other personnel frequently witness direct loss of life, assaultive violence, and other stressors during disasters. Evidence indicates a greater incidence of psychiatric sequelae among disaster workers. What role do emergency management authorities have in addressing the needs of such personnel?
Aim:
To evaluate integration of first responder behavioral health needs among a metropolitan healthcare coalition, the Chicago Healthcare System Coalition for Preparedness and Response (CHSCPR).
Methods:
CHSCPR developed a Behavioral Health Annex providing uniform guidance on behavioral health integration into emergency operations with attention to first responders. An electronic Behavioral Health Capability Survey of coalition members was performed in March 2017 to assess implementation of these recommendations. Qualitative and quantitative responses were recorded.
Results:
Fifteen of thirty-five institutions responded, including academic and private community hospitals. Many reported no services. Where services existed, most facilities endorsed use of employee assistance programs or external vendors for staff support. 4/15 (26.7%) reported proactive strategies to mitigate stress such as information sheets on healthy coping. Measures for family support of affected emergency personnel were varied and typically outsourced to online resources, or reported as “in development.”
Discussion:
Findings suggest that recognition of emergency personnel behavioral health needs is lacking in city-wide disaster planning with greater emphasis on post-disaster needs than preventative efforts. Increased awareness of risk for psychological decompensation among first responders, and inclusive efforts to mitigate this risk, are warranted in future disaster planning.
As a subtropical urbanized city in Southeast Asia, Hong Kong is prone to frequent typhoons. With an increasing number of severe typhoons, usual preparedness measures should be explored to assess their adequacy to safeguard health and wellbeing. Typhoon Mangkhut (2018) serves as an example of the successes and limitations of community preparedness for a severe typhoon.
Aim:
To explore how Hong Kong residents prepared for Typhoon Mangkhut and whether their usual preparedness measures provided enough protection.
Methods:
A population-based randomized telephone survey of Hong Kong residents (n=521) was conducted soon after Typhoon Mangkhut’s landing. Only residents aged 18 or above and understood Cantonese were included. Socio-demographic factors, types of typhoon and general preparedness, risk perception, and impacts from the typhoon were asked. Descriptive characteristics and univariate analysis were used to describe the patterns and associations.
Results:
8.6% of respondents felt their home was at high risk of danger during typhoons although 33.4% reported some form of impact from Mangkhut. Over 70% reported doing at least one typhoon specific preparedness measure. Among those who practiced at least one typhoon specific preparedness measure, 37.2% (p=0.002) were affected by the typhoon.
Discussion:
Despite the high adaptation of preparedness measures, warranted by the frequent typhoons, Hong Kong residents were not adequately prepared for a severe typhoon. While the early warning system and evacuation of flood-prone areas mitigated some of the impact, unexpected effects such as flying air conditioners, roadblocks affecting employment, swaying buildings, and loss of power supply were not accounted for. Future preparedness for natural disasters which will become more extreme due to climate change and needs to account for unforeseen risks.
Personal protective equipment (PPE) is a necessary item in the period of unknown and high risk emerging infectious disease. It is not only the necessary requirement of strict isolation but also the last line of defense to protect medical staff.
Aim:
To determine the frequency and sites of contamination of personnel during the process of using Chinese PPE.
Methods:
Recruit 56 health care workers (HCWs) who worked in front-line clinical to test PPE issued by the Chinese Center for Disease Control for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion. Then the frequency and sites of contamination of personnel were recorded after removal of contaminated PPE. The method of visual observation was used to determine contamination.
Results:
The frequency of easily contaminated parts included: left hand and wrist (7 times), left calf (7 times), front chest center, left and right chest (6 times each), and left abdomen (5 times). Mistakes in the process of wearing PPE included: clothing touching the ground (20.00%), N95 air mask tightness not checked (13.33%), glove air-tightness not checked (4.44%), protective clothing zipper not checked (4.44%). Mistakes in doffing PPE included: clothes touching the ground or the inner surface is polluted (20.00%), the wrong method of removing N95 mask (14.44%), touching the pollution goggles mirror with hands (12.22%), incomplete washing steps, insufficient time and frequency of hand hygiene (11.11%).
Discussion:
It is necessary to carry out training on PPE donning and doffing for Chinese medical workers.
Medicine is one of the most important areas of higher education. It is important that undergraduate students are well educated and have theoretical knowledge, but also have good clinical skills after graduating from medical training.
Aim:
To understand whether the training objectives of the emergency medical internship was completed or not and to find the relationship between young doctors’ self-confidence and what they can do via using Rosenberg self-esteem scale (RSES). In addition, an objective was to consider which learning methods are more useful based on the feedback.
Methods:
This survey study was performed in 2018 at Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey with the students who completed an emergency department rotation in the 2017-2018 education term. The questionnaire was composed by the researchers. It consisted of three parts which were included demographic information and education methods in emergency medicine of internships, questions about knowledge goals and learning goals for basic medicine applications, and RSES to assess young doctors’ self-confidence.
Results:
96 young doctors with the mean age of 25.22 ± 1.216 years(minimum 23 and maximum 30 years) were in the study5. 3 (55.2%) of which were female. All young doctors were evaluated with RSES4. (4.2%) of which were low self-confidence and 32 (33.3%) of which were high self-confidence. The best useful learning methods were clinical application of interaction with patients (n=828. 5%) and invasive procedures performed on patients (n=727. 5%).
Discussion:
The more you practice, the more you learn. Practice-based education is an important factor in a young doctor’s life. Besides, the higher self-confidence you have, the more you can. Young doctors with high self-esteem see themselves as qualified to perform applications even in complicated situations. However, more studies are needed to find out whether they could really perform or not.
The Red Cross and Red Crescent Health Information System (RCHIS) combines the functionality of an Electronic Medical Record (EMR), Health Information System (HIS), as well as Human Resource and stock management system. Its purpose is to facilitate patient quality of care, early warning for outbreak detection, accountability/reporting, and resource management. Short-term, emergency medical teams and support staff responding to acute clinical needs in a humanitarian context are the intended end users.
Aim:
To explain the functional design principles and usability testing protocol implemented in initial RCHIS design and development phases to ensure technological fit within the humanitarian medical context.
Methods:
RCHIS development followed the patient-user journey, with each patient/staff interaction encapsulated by a microservice. The integration of multiple microservices enabled RCHIS to mimic various patient journeys. The functional scope of each microservice was designed by medical end-users and was further used for access management. The value and variable design, including validation rules, were led by health informaticians and existing medical standards. Intuitiveness and ease of use guided User Interface design, with targeted medical end-user feedback collected on a twice-monthly basis in addition to early design workshops, field immersion, and post-development pilot testing.
Results:
Support and implementation of RCHIS were not inherently guaranteed. As such, the process of co-designing with end users had the primary benefit of ensuring effective scope and technological fit given the humanitarian context, but also the secondary benefit of improving internal acceptability and advocacy.
Discussion:
The added value of digital health records as a quality assurance mechanism is well documented. However, the increased workload and reduced employment satisfaction affiliated with the rise of EMRs illustrated a need to re-evaluate current design and use within clinical settings. The design and development approach taken for RCHIS is one attempt to improve human-computer interaction in the clinical setting.
An expert government committee in Japan decided to revise the chance of a Nankai Trough earthquake in the next 30 years from 70% to between 70 and 80% in 2017. If a mega-earthquake occurs, medical institutions in disaster regions are required to perform self-contained activities during the super-acute phase. Human damage varies depending on whether medical functions can be sustained, particularly in rural areas and isolated islands. Here we examined actual situations.
Aim:
To identify the issues of a disaster medical system in rural areas and isolated islands that need solving.
Methods:
Regarding disaster preparedness planning, we conducted a survey on 10 hospitals undesignated as disaster key hospitals of remote area medical care bases (survey group), and 69 hospitals designated as disaster key hospitals (control group) in three prefectures in the Tokai region (Aichi, Mie, and Shizuoka).
Results:
We received responses from four hospitals in the survey group and 52 hospitals in the control group. The hospitals in the survey group responded that they could accept 74 severe casualties and 85 moderate casualties. We identified problems such as insufficient stockpiling of fuel, water, and oxygen, and lack of a prioritized lifeline supply contract.
Discussion:
It was predicted that human damage would be relatively minor given smaller populations in rural areas and isolated islands in the Tokai region. However, the number of patients would exceed their acceptance capacity. Moreover, the system for sustaining infrastructure is not adequate for providing medical services. Thus, it was indicated that these regions would be isolated in terms of disaster measures. It is imperative to establish a disaster medical system in rural areas and isolated islands that lack adequate disaster medical systems to manage Nankai Trough earthquakes.
Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.
Aim:
To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.
Methods:
Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.
Results:
209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.
Discussion:
Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.
The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.
Aim:
Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.
Methods:
A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.
Results:
It was found that the use of ePCR:
1. Allowed for collection of relevant data to assist in future planning of MGEs
2. Aids the overall coordination of first aid delivery at MGEs
- faster relaying of patient information to event commanders
- reduction of paperwork
- improved ability to locate first aid crews using GPS tracking
3. Received positive feedback from first aiders, event organizers, and patrons
4. Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our members
Discussion:
These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.
A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.
Aim:
To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.
Methods:
An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.
Results:
Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.
Discussion:
While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.
Hunger is a global problem and has increased in recent years. In Latin America, hunger continues in high numbers. Although the level of hunger is relatively low compared to other regions, this increase in Latin America is mainly explained by the economic slowdown in South America. Also, climate changes are already weakening the production of the main crops in tropical and temperate regions.
Aim:
Report the numbers of hunger in Latin America.
Methods:
A cross-sectional study with reports of the World Health Organization’s hunger figures, September 2018.
Results:
The number of hungry people in the world has increased for the third consecutive year and affects 821 million people, according to a report released by UN agencies. This corresponds to one in nine people in the world. In Brazil, the figures indicate that more than 5.2 million people spent a day or more without consuming food by 2017, which corresponds to 2.5% of the population. In Latin America and the Caribbean, hunger has also increased and affects some 39 million people.
Discussion:
Hunger is a catastrophic problem in Latin America. Involving professionals in food and nutrition to try to reduce these numbers appears to be a good strategy because just as the doctor treats the disease, the involvement of other specialists to address the cause of the problem can bring long-term benefits. A social project for this purpose that mobilizes chefs and nutritionists is in progress in Brazil.
One lesson learned from the 2015 Nepal earthquake was the need for a more coordinated effort between hospitals to improve disaster response. To improve the coordination, the concept of a hub and satellite system was introduced.
Aim:
Describe the implementation of a hub and satellite system in the disaster management plan to improve coordination and communication between hospitals and the health system during a disaster.
Methods:
A standard hospital disaster management plan was developed and validated with governmental and non-governmental agencies. Twenty-five hub hospitals within Nepal were identified. Smaller hospitals surrounding hub hospitals were identified as satellite hospitals. A plan was made to address communication and coordination between hub-satellite hospitals and ministry of health involving resource sharing, capacity analysis, and development of deployment teams in each hub. An output-based workshop was planned. Each hospital’s existing plans were evaluated before the workshop with a checklist containing essential components of disaster management. Each hospital was oriented and allowed to fill up a standardized template of a disaster management plan, after which their disaster management plan was reevaluated. The newly developed plan was then tested with a tabletop exercise function. The trainings were conducted from September 2017 to October 2018.
Results:
Disaster management plans were made in 110 hospitals, including nine hub hospitals and 101 satellite hospitals in three of seven provinces in Nepal. Evaluation of a pre-workshop score for the existing disaster plan was 18/32, and the score of the disaster plan post-workshop was 30/32 on average. The average score for hospitals for the tabletop exercise was 68.2% (53.8% to 84.6%).
Discussion:
A hub-satellite system-based disaster management plan has been developed and implemented in more than 100 hospitals in Nepal. Workshops for these hub and satellite hospitals improved their communication, coordination, and planning to improve disaster preparedness and future response.
Recently, the risk of flood disasters due to concentrated heavy rains has been increasing in Japan. While some cases of hospital evacuation have been reported, standards for hospital evacuation have not been established and regional administrative evacuation plans do not include medical facilities.
Aim:
To clarify the timeline for in-hospital vertical evacuation during a flood disaster.
Methods:
A timeline was set for vertical evacuation as criteria of the hospital’s emergency response based on the Arakawa River Downstream Timeline, which is an estimate of the time until river flooding based on the water level of the Arakawa River located near the facility. The timeline was calculated backward from 0 hours to when the river floods. A drill was held for verification.
Results:
The timeline was based on the water level of the Arakawa River and objective evidence of risky transfer of critical patients; therefore, the decision to evacuate was made when the water level reached a dangerous level (-3 hours). However, this did not provide enough time to evacuate patients in all hospital departments simultaneously, resulting in a shortage of human resources. There was a planned shutdown of the electronic clinical record system at 0 hours to avoid water damage and evacuation of its server, but three hours were not enough to prepare patient clinical summaries.
Discussion:
There is a need for greater and earlier preparation for evacuation to reduce or discharge patients who can leave the hospital when a flood disaster is predicted. Only in-hospital vertical evacuation was considered because it is very risky to transfer critical patients without an evacuation order from government or municipal officials. In fact, over 10,000 patients would need to be evacuated in the region if the Arakawa River floods. Therefore, a regional plan is indispensable for such large scale and simultaneous hospital evacuations.
Emergency medical teams (EMTs) have helped to provide surgical care in many recent sudden onset disasters (SODs), especially in low- and middle-income countries (LMICs). General surgical training in Australia has undergone considerable change in recent years, and it is not known whether the new generation of general surgeons is equipped with the broad surgical skills needed to operate as part of EMTs.
Aim:
To analyze the differences between the procedures performed by contemporary Australian general surgeons during training and the procedures performed by EMTs responding to SODs in low- and middle-income countries (LMICs).
Methods:
General surgical trainee logbooks between February 2008 and January 2017 were obtained from General Surgeons Australia. Operating theatre logs from EMTs working during the 2010 earthquake in Haiti, 2014 typhoon in the Philippines, and 2015 earthquake in Nepal were also obtained. These caseloads were collated and compared.
Results:
A total of 1,396,383 procedures were performed by Australian general surgical trainees in the study period. The most common procedure categories were abdominal wall hernia procedures (12.7%), cholecystectomy (11.7%), and specialist colorectal procedures (11.5%). Of note, Caesarean sections, hysterectomy, fracture repair, specialist neurosurgical, and specialist pediatric surgical procedures all made up <1% of procedures each. There were a total of 3,542 procedures recorded in the EMT case logs. The most common procedures were wound debridement (31.5%), other trauma (13.3%), and Caesarean section (12.5%). Specialist colorectal, hepato-pancreaticobiliary, upper gastrointestinal, urological, vascular, neurosurgical, and pediatric surgical procedures all made up <1% each.
Discussion:
Australian general surgical trainees get limited exposure to the obstetric, gynecological, and orthopedic procedures that are common during EMT responses to SODs. However, there is considerable exposure to the soft tissue wound management and abdominal procedures.
Mass gatherings attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted to identify those variables that are associated with increased medical usage rates.
Aim:
To identify studies that developed and/or validated a statistical regression model predicting patient presentation rate (PPR) or transfer to hospital rate (TTHR) at mass gatherings.
Methods:
Prediction modeling studies from 6 databases were retained following systematic searching. Predictors for PPR and/or TTHR that were included in a multivariate regression model were selected for analysis. The GRADE methodology (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence.
Results:
We identified 11 prediction modeling studies with a combined audience of >32 million people in >1500 mass gatherings. Eight cross-sectional studies developed a prediction model in a mixed audience of (spectator) sports events, music concerts, and public exhibitions. Statistically significant variables (p<0.05) to predict PPR and/or TTHR were as follows: accommodation (seated, boundaries, indoor/outdoor, maximum capacity, venue access), type of event, weather conditions (humidity, dew point, heat index), crowd size, day vs night, demographic variables (age/gender), sports event distance, level of competition, free water availability, and specific TTHR-predictive factors (injury status: number of patient presentations, type of injury). The quality of the evidence was considered as low. Three studies externally validated their model against existing models. Two validation studies showed a large underestimation of the predicted patients presentations or transports to hospital (67-81%) whereas one study overestimated these outcomes by 10-28%.
Discussion:
This systematic review identified a comprehensive list of relevant predictors which should be measured to develop and validate future models to predict medical usage at mass gatherings. This will further scientifically underpin more effective pre-event planning and resource provision.
Children represent a particularly vulnerable population in disasters. Disaster Risk Reduction refers to a systematic approach to identifying, assessing, and reducing risks of disaster through sets of interventions towards disaster causes and population vulnerabilities. Disaster Risk Reduction through the education of the population, and especially children, is an emerging field requiring further study.
Aim:
To test the hypothesis that an educational program on Disaster Risk Reduction can induce a sustained improvement in knowledge, risk perception, awareness, and attitudes toward preparedness behavior of children.
Methods:
A Disaster Risk Reduction educational program for students aged 10-12 was completed in an earthquake-prone region of Jordan (Madaba). Subject students (A) and control groups of similarly aged untrained children in public (B) and private (C) schools were surveyed one year after the program. Surveys focused on disaster knowledge, risk perception, awareness, and preparedness behavior. Likert scales were used for some questions and binary yes/no for others. Results were collated and total scores averaged for each section. Average scores were compared between groups and analyzed using SPSS.
Results:
Students who had completed the Disaster Risk Reduction program were found through Levene’s test to have statistically significant improvement in earthquake knowledge (5.921 vs. 4.55 vs. 5.125), enhanced risk perception (3.966 vs. 3.580 vs. 3.789), and improved awareness of earthquakes (4.652 vs. 3.293 vs. 4.060) with heightened attitudes toward preparedness behavior (8.008 vs. 6.517 vs. 7.597) when compared to untrained public and private school control groups, respectively.
Discussion:
Disaster Risk Reduction education programs can have lasting impacts when applied to children. They can improve students’ knowledge, risk perception, awareness, and attitudes towards preparedness. Further work is required to determine the frequency of re-education required and appropriate age groups for educational interventions.
Blockchain is a distributed ledger technology for storing and transmitting information (value) that is secure, verifiable, and auditable. Two specific use-case opportunities exist, identity management and payment systems.
Aim:
A secure and auditable solution for disaster refugee support.
Methods:
Gap analysis, literature search, and synthesis using existing technologies.
Results:
Strategy foundation: A blockchain identity management system that utilizes the Hyperledger Fabric framework; identification on a large scale, in a distributed model that provides immutable record capabilities to prevent fraud, with the ability to incorporate biometrics and DNA; deploy applications that will provide supply-chain capabilities; cryptocurrency for recipients and other relief functions for refugees/disaster victims; components such as consensus, membership services, and Smart Contracts; cloud-based, with redundancies in multiple vendors and additional complex government cloud requirements/certifications, leveraging NIST 800–53 by utilizing a hybrid public permissions architecture.
Discussion:
There are an estimated 68 million refugees worldwide at any time. Valid identification is needed by most refugees to qualify for government or international donor relief. That identification is crucial in getting refugees and victims access to the aid supply chain. Blockchain stores data on a large number of computer nodes connected over the Internet. Each node contains an identical copy that is time-stamped and protected by a cryptographic technique called hashing, and control is decentralized. This blockchain strategy will revolutionize the way the government manages the $30 billion in foreign aid to refugees. It will build upon the identities established to deploy applications that will provide supply-chain capabilities, cryptocurrency for recipients, and other relief functions for refugees/disaster victims. Stakeholders beyond government will also benefit tremendously. The distributed nature of our application will provide visibility to NGOs, nonprofits, host nation stakeholders, and other relief organizations. A single system that provides information to everyone involved will almost instantaneously change the face of relief.
Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.
Aim:
To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.
Methods:
A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.
Results:
The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.
Discussion:
Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.
Hospitals are required to maintain emergency preparedness 24/7. In order to maintain readiness, Israeli hospitals operate Emergency Committees comprised of medical, nursing, and administrative professionals who are responsible for capacity building including the development of plans, infrastructure, equipment, training, crisis management, and learning lessons. The Ministry of Health (MOH) and Home Front Command (HFC) conduct a comprehensive, structured evaluation of emergency preparedness in every hospital every two to three years.
Aim:
To assess the impact of a periodical evaluation on levels of emergency preparedness over time in a level one trauma center.
Methods:
Evaluation of emergency preparedness is conducted by approximately 12 evaluators from the MOH and HFC, encompassing mass casualty incidents (MCIs), mass toxicological/chemical incidents (MTEs), radiological and biological events, earthquakes and conflicts. Evaluations are based on objective parameters, relayed to hospitals prior to the evaluation. The hospital’s level of emergency preparedness is graded and improvements that must be implemented are delineated. The grades of four evaluations conducted from 2011 to 2018 were compared to identify trends in preparedness.
Results:
Mean levels of emergency preparedness in the 2018 versus 2011 evaluations presented an increase concerning all threats, including MCIs (92 vs. 90), MTEs (99 vs. 77, respectively), biological events (96 vs. 73, respectively), radiological events (91 vs. 79), earthquakes (87 vs. 60, respectively), and conflicts (95 vs. 74). The relative change in levels of preparedness was more noted concerning biological events and earthquakes.
Discussion:
A periodical evaluation by governing authorities seems to motivate the hospital’s administrations to invest efforts in building and maintain a high level of emergency preparedness. Systematic evaluations conducted bi-annually contributed to improved readiness for diverse emergency scenarios, including for threats that less frequently materialize.
The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.
Aim:
The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.
Methods:
Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.
Results:
Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.
Discussion:
Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.
Seoul is the third most densely populated area in the world except for the city-state. However, a national disaster plan has not yet been established.
Aim:
From September 2017, representatives of seven regional emergency medical centers in Seoul met monthly and decided to investigate basic data for the future establishment of surge capacity planning.
Methods:
Staff, supply, space, and systems for surge capacity were surveyed in seven hospitals. The additional surveyed data were as follows: hospital incident command system and actual operational experience; performance of disaster drill; safety and security plan; estimation of surge capacity in normal operating conditions and extreme operating conditions; alternative therapeutic spaces; back-up plan to call non-duty medical staff; decontamination equipment; contingency plan for stuff shortage; etc.
Results:
All the hospitals reported they have hospital incident command systems and held disaster drills every year, however, the two hospitals (28.5%) had no real experience of hospital incident command system activation. Five hospitals (71.4%) did not have a safety and security plan. They replied they can treat average 7.7 emergency patients (Korean Triage and Acute scale (KTAS) ≤ 3), 10 non-emergent patients (KTAS>4), 0.9 surgical patients and 0.7 unstable patients simultaneously in normal operating conditions. In extreme operating conditions, they replied they can treat average 26.4 emergency patients (KTAS ≤ 3), 54.3 non-emergent patients (KTAS>4), 37 surgical patients and 2.3 unstable patients simultaneously. The two hospitals (28.5%) had no alternative therapeutic spaces, no back-up plan to call non-duty medical staff and no contingency plan for stuff shortage. Three hospitals (42.9%) did not have decontamination equipment.
Discussion:
The survey revealed the basic data for surge capacity planning in Seoul. Data from hospitals other than regional emergency medical centers should be collected for the completion of disaster plans.