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The use of tourniquets by the civilian population has been deemed a critical aspect of the initial response during an active shooter situation. Tourniquet deployment in public-access must be accompanied by education. Studies indicate that the act itself is not an intuitive process and enclosed instructions may be inadequate. However, civilians for diverse reasons may not avail themselves of accepted training programs.
Aim:
To develop an alternative means of “Just-In-Time” education to enable a naïve responder to apply a commercial tourniquet efficaciously.
Methods:
A video (~40 seconds long) was created highlighting the actual application of a C-A-T® (Combat Application Tourniquet) on a human model. It was uploaded to YouTube on a public channel. A QR® code was generated using https://www.qr-code-generator.com, embedding the link for the YouTube® video. An appropriately-sized QR® code was printed and applied with packaging tape (Scotch®) to the exterior wrapping of a C-A-T® device. The C-A-T® with code was then accessed with the iPhone®.
Results:
With the iPhone® camera app activated and focused on the C-A-T’s QR® code, a request popped-up to open “YouTube.com” in Safari. When pressed, the full-screen video appeared immediately with audio of excellent quality.
Discussion:
The use of a QR® code and its video link is a feasible option to provide “Just-In-Time” training to a naïve civilian population who are responding to an active shooter situation. This offers the naïve responder two options of immediate education: the enclosed instructions and the QR® code. Redundancy in communications is essential in any emergency response. An important limitation of this innovation is the inability to obtain Internet® access and therefore, the availability of the enclosed instructions is still critical. Research to prove that this innovation will allow the application of a tourniquet to proceed expeditiously with few errors is currently underway.
Disaster Medical Response is a challenging field where opportunities for advancement are welcomed. Small Unmanned Aerial Vehicle (sUAV) technology (i.e., drones) has made enormous strides in the past few years and is poised for utilization in the early disaster response phase.
Aim:
To discuss current uses of UAVs, proposed utilization and logistical details, technological advancements, current deficits, and training.
Methods:
Our Foundation, Luman Medical, is working in the field of UAV integration for small to large scale disaster response. The concept is to equip first responders with small, relatively inexpensive, programmable drones that come equipped with hardware and software that are easy to use for inexperienced as well as skilled sUAV pilots.
Discussion:
These UAVs could increase ease and speed of deployment for early assessments of disaster area mapping, thermal imaging, ingress and egress routes, the discovery of survivors, communications, and delivery of supplies. Drone technology offers a new and growing type of tool in the disaster response arena. It is our hope to explore an integration that is easy, safe, and affordable to augment and enhance existing disaster response planning.
An inland earthquake is expected to occur in Tokyo in the near future, and disaster preparedness and response measures have been put in place by the government of Japan and local authorities.
Methods:
Japan Disaster Medical Assistant Teams (DMATs) conducted two large-scale drills for the first time in preparation for a Tokyo inland earthquake, in collaboration with the following participants: the Tokyo Metropolitan Government, disaster base hospitals in Tokyo, three Staging Care Units (SCUs), and neighboring prefectures. One of the scenarios was a north Tokyo Bay earthquake affecting the Tokyo wards and had 142 Japan DMATs participation. Another scenario was Tama inland earthquake affected mid-west of Tokyo and 110 DMATs participated. The drill included headquarters operation, affected hospital support operation, patient transportation within the area and to the wider region, SCU operation, collaboration with associated organizations, and logistics operation.
Results:
Post-drill assessments identified the following areas that need to be addressed: review of Japan DMAT implementation strategies; improvement of SCUs; establishment of a patient air transportation framework; securing means of patient transportation; improvement of communication systems; strengthening of disaster response of all hospitals in the Tokyo Metropolis; and preparations for survival in the event of isolation caused by the disaster.
The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.
Aim:
To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.
Methods:
A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).
Results:
A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p < 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).
Discussion:
The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.
In the past five decades, the region of Latin America and the Caribbean (LAC) has been subject to several types of terrorist attacks, with most committed by local terrorist organizations. However, there have also been attacks by international terrorist groups. Internationally, terrorist attacks are increasing in both frequency and complexity. Significant concerns exist regarding the use of Chemical Warfare Agents (CWAs) in civilian settings. Asphyxiants (e.g. cyanide), opioids (e.g. fentanyl), and nerve agents (e.g. sarin) represent some of the most lethal CWAs. To date, there is very little published data on their use in the LAC region despite the fact that the recent attacks in Syria have sparked international interest in the use and regulation of CWAs.
Aim:
To improve civilian health service preparedness in response to CWAs attacks by describing the types of agents historically used within the LAC region.
Methods:
Information was extracted and analyzed from the open-source Global Terrorist Database hosted by the University of Maryland, regarding CWA-LAC from January 1, 1970, to December 31, 2017.
Results:
During the forty-seven year period reviewed, there were 29,846 terrorist attacks in the LAC region, with 63.6% occurring in the southern region. Twenty-nine CWA attacks were reported, with the most common agents being tear gas (37%) and cyanide (29.6%). The most frequent targets were religious figures/institutions (22.2%), law enforcement (18.5%), and government agencies/personnel (18.5%).
Discussion:
Cyanide is one of the most prevalent agents used for chemical weapons attacks in the LAC region. Preparedness should be enhanced for CWA terrorist attacks, especially those involving cyanide, given its life-threatening nature, prevalence, and the existence of reversal agents. First responders, physicians, and nurses should be aware of this potential hazard and be trained to respond appropriately. Additionally, regional stockpiles of antidotes should be considered by governmental bodies within the LAC region.
Vehicles stranded in rising water account for the majority of swiftwater rescues (SWR) during urban and small stream flash flooding. Multiple simultaneous SWR incidents are commonplace during severe storms. Historically, SWR teams have pursued a “reach, throw, row, go” strategy. However, reach and throw attempts are usually futile. Boat operations and/or in-water rescue attempts can be technically complicated, time-consuming, and a drain on rescuer resources.
Aim:
To design an ideal SWR modality for use during urban and small stream roadway flooding.
Methods:
SWR objectives, strategy, and tactics were mapped against various transportation modalities to develop the safest solution for urban and small stream flood response.
Results:
High water vehicles (HWV), such as the “deuce and a half” 6 × 6 military truck, represent a new standard for SWR practicality and safety as they can reduce rescuer time in-water. HWVs are heavy and high enough to be stable on roadways in most flash flooding conditions. A properly designed emergency response package includes a fording kit, multi-directional floodlights for nighttime operations, public safety radios, and a siren that doubles as a public address system to coach victims as a rescue is initiated. Deployable ladders enable rescuer egress from and victim access to a covered lighted cargo bed that holds PPE, throw bags, and rescue rings; a deployable “boat in a bag” for victims who require ferrying; and a heated seating area where medical evaluation can be conducted while staying dry.
Discussion:
SWRs are dangerous resource-intensive incidents which account for more rescuer morbidity/mortality than all other technical rescue sub-types combined. These incidents will increase in frequency and severity worldwide due to climate change and overdevelopment. If rescue conditions are still tenable, HWVs are the most efficient and effective platform for conducting SWR from flooded roadways while decreasing safety risks to first responders and victims.
Disasters are part of the Australian landscape. Bushfires, floods, cyclones, and drought reoccurring consistently across the continent. Primary Health Networks (PHNs) and general practitioners (GPs) are scattered across Australia and are inevitably involved when disasters strike their local communities. Limited guidance exists to guide their systematic involvement within the broader disaster response system. In October 2013, large bushfires swept through the NSW Blue Mountains. The response was unusual in its inclusion of NSW general practice networks within the response system, most crucially the local (now) Nepean Blue Mountains Primary Health Network (NBMPHN).
Methods:
The lessons learned by GPs and NBMPHN during the fires highlighted the need for GP preparedness to improve recovery outcomes. This led to the development of a living discussion document “Emergency management: the role of the GP,” created with input from the various GP groups. More recently, a PHN emergency preparedness guide aimed at strengthening communication and formalizing the role of the PHNs and GPs before, during, and after a natural disaster.
Results:
Clarity and implementation of a process for disaster preparedness have enabled a more proactive and coordinated approach to local emergency management with a distinct role for both the PHN and local GPs when responding to a natural disaster.
Discussion:
This presentation discusses lessons learned and the preparedness strategy now in place in the Nepean Blue Mountains PHN region, and launches the emergency preparedness guide that can be used and adapted by GPs and other PHNs across Australia.
On March 11, 2011, the Great East Japan Earthquake struck the northeastern coast of Japan with the magnitude nine. Ishinomaki medical zone was affected most severely with 328 evacuation shelters and approximately 50,000 evacuees. The Ishinomaki Zone Joint Relief Team gathered information directly from all evacuation shelters using assessment sheets. Based on this assessment data, various measures were carried out for environmental improvement of the shelters. To prepare for the next major disaster, a software program called Rapid Assessment System of Evacuation Center Condition - Gonryo and Miyagi (RASECC-GM) was developed, which computerizes the whole process, including entering, tabulating, and managing of shelter assessment data.
Aim:
To verify the feasibility, usability, and accuracy of RASECC-GM, a verification test was performed using mock shelter data on October 23-26, 2018, to coincide with Logistics Training Course of Medical Logistics for Disasters held by Iwate Medical University.
Methods:
On October 22, 2018 at four simulated disaster relief and health care branches, participants at each branch were asked to enter two mock shelter data items, submit a closed shelter request, and register a new shelter using RASECC-GM, respectively. The next day participants were asked to enter two mock shelter data items per branch while offline and upload the data to the server when next online. The uploaded data was checked for accuracy and whether it could be viewed on the management screen. After the test, a questionnaire survey was given to participants to verify the feasibility and usability of RASECC-GM.
Results:
It was confirmed that RASECC-GM functioned almost correctly. All participants answered that input operation was easy to understand, and 90.9% of participants could input without a mistake and did not feel stress when inputting data.
Discussion:
RASECC-GM appeared to be useful to shelter assessment, but further improvements are needed for practical use.
Research on events and mass gatherings is hampered by a lack of standardized and central reporting of event data and metrics. While there is work currently being done on report standardization, this will require a plan for recording, storing, and safeguarding a repository of event data. A global event data registry would further the work of standardized reporting by allowing for the collection and comparison of events on a larger scale.
Aim:
To characterize the considerations, challenges, and potential solutions to the implementation of a global event data registry.
Methods:
A review of the academic and grey literature on the current understanding and practical considerations in the creation of data registries, with a specific focus on an application to mass gathering events.
Results:
Findings were grouped under the following domains: (1) stakeholder identification and consultation, (2) research goals and clinical objectives, (3) technological requirements (ie hosting, format, maintenance), (4) funding (budget, affiliations, sponsorships), (5) ethics (privacy, protection, jurisdictions), (5) contribution facilitation (advertising, support), and (6) data stewardship and registry access for researchers.
Conclusion:
This work outlines key considerations for undertaking and implementing an event data registry in the mass gathering space, and compliments ongoing work on the standardization of data collected at mass gathering events. If practical and ethical considerations are appropriately identified and managed, the creation of an event data registry has the potential to make a major impact on our understanding of events and mass gatherings.
Those residing in supervised facilities including nursing homes, mental health facilities, group homes, and penal institutions for health, legal, or security reasons present unique challenges in a disaster.
Methods:
A review of the literature and after action reports on supervised and institutionalized populations in disasters.
Results:
Recommendations for supervised, institutionalized populations in a disaster include: (1.) preplanned agreements for specialized transportation if needed; (2.) reciprocal agreements between similar facilities (nursing home with another nursing home, prison with other prison, dialysis centers, etc.) for resource sharing; (3.) arrangements for sharing and emergency privileging of personnel in institutions that are not their primary workplace; (4.) just-in-time training for appropriate volunteers; and (5.) accommodations for family members if personnel are to be available during a disaster.
Individuals in some institutions need a personalized disaster plan with pertinent data: next of kin with contact information, medical records, care providers and care plan to accompany a mobilized individual. Long-term care and housing may be needed if the institution is nonfunctional. Dealing with medical and behavioral issues is secondary to the disaster. Chronic issues must be considered as well.
Discussion: Caring for specialized, institutional individuals is complex and difficult. Comprehensive pre-disaster planning can mitigate the effects of the disaster.
Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined or operationalized in the international literature.
Aim:
This study seeks to contribute to the alignment of knowledge of disaster preparedness in hospitals based on a systematic review and analysis of definitions and operationalizations.
Methods:
A systematic search was conducted in five databases: Scopus, Pubmed, Web of Science, Disaster Information Management Research Centre, and Safetylit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text were excluded, as were articles on pre-hospital care.
Results:
Of the 39 included publications, 14 defined disaster preparedness in hospitals and 26 operationalized the concept. Although the definitions differed, they also reflected similar elements. Based on an analysis of the operationalizations, 12 different components could be identified that generally were not studied in relation to each other. Moreover, where publications primarily focused on structure and process aspects of disaster preparedness, 4 articles described the preferred outcome.
Discussion:
This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining the elements of the definitions and the components operationalized disaster preparedness could be conceptualized in a more comprehensive and complete way. A framework was developed that can guide future disaster preparedness research.
This descriptive study explored barriers and difficulties faced by an international disaster relief team from China, which took part in two types of international disaster relief missions.
Methods:
Data was collected since the founding of the Chinese international disaster relief team, including information on team composition, operational hours, and average number of patients rescued and treated by staff per day, etc.
Results:
Overall, thirteen disaster relief missions utilizing the Chinese disaster relief team occurred in eight countries. All the operations were divided into two kinds of models: Urban Search and Rescue mission, and Emergency Medical service. The first model consisted of search, rescue, and emergency medical services on site. The ratio of medical staff on the team accounted for 18.8%. According to the six international health-based operations, the team was deployed ten days following the disaster, with an average working time of 17.8 days, and benefiting around 6,812 wounded and sick persons per operation. Compared with these two models, medical-based operations deployed more staff after the disaster and had a longer window of operation. The beneficiaries of medical-based operations are ten times greater than those of rescue-based operations. The differences are distinct.
Discussion:
Missions will better meet the needs of international relief by enhancing organizational coordination among medical teams around the world, and by contributing to the communication between teams. They will further benefit from technical capacity building, regional coordination trainings, formatting the standard of teaming building, and evaluation of the work.
Emergency service workers perform physical work while being subjected to multiple stressors and adverse, volatile working environments for extended periods. Recent research has highlighted sleep as a significant and potentially modifiable factor impacting operational performance.
Aim:
This presentation would (a) examine the existing literature on emergency service workers’ sleep quantity and quality during operations, (b) synthesize the operational and environmental factors that impact sleep (e.g., shift start times, shift length, sleeping location, smoke, noise, heat), and (c) assess how sleep impacts aspects of emergency service workers’ health and safety, including mental and physical health and performance.
Methods:
This presentation would be based on a narrative review conducted by the authors which used a systematic search strategy of health-related databases. Articles that were not relevant, duplicate or from non-peer-reviewed sources were excluded.
Results:
Sleep is restricted during emergency service deployments, particularly when shifts have early start times, are long duration, and/or when sleeping in temporary accommodation (e.g., tents, vehicles). Shortened sleep impairs cognitive but not physical performance under simulated emergency services conditions.
Discussion:
Depending on the organization and jurisdiction, these findings warrant re-evaluation of existing policies, formalization of beneficial but currently ad-hoc practice, or provide support for current procedures. Work shifts should be structured, wherever possible, to provide regular and sufficient recovery opportunities (rest during and sleep between shifts), especially in dangerous working environments where fatigue-related errors have more severe consequences. For agencies to continue to defend local communities against natural hazards, strategies should be implemented to improve and manage emergency service workers sleep and reduce any adverse impacts on work.
Brazil has 200 million descendants of African, Portuguese, Indigenous, German, Italian, and other peoples who have built their identities. The Federal Constitution was rewritten in 1988 to include a Social Protection System. Between 2000 and 2016, the federal government was governed by the Workers’ Party. This party invested in the creation of inclusive public policies and affirmative actions built through collective processes of citizenship that guaranteed better living conditions for the population. In one decade, it went from being underdeveloped to developing. In 2016, the elected president of the Workers’ Party was withdrawn from power through impeachment. In the next election, right-wing conservatives excluded speech, attacked minorities (e.g. LGBT population), and defended the traditional family.
Aim:
To understand the retreat of Brazilian public policies in a country that set public social policies, compensatory policies, and affirmative actions guaranteeing citizenship of men and women.
Methods:
Qualitative research with analysis and reflection on the regression of universalist public policies and affirmative policies with the creation of quotas.
Results:
The creation of affirmative actions was guaranteed. Vacancies in public tenders for the black population led to the establishment of 50% quotas for blacks in universities, and the creation of a universal health system, or universal expanded health indicators. The federal government created a group of SUS analysis by reducing actions.
Discussion:
Social inequality in Brazil is one of the worst in the world. 16 million people live below the poverty line (OXFAM, 2017). In recent decades, the population that was expanding and strengthening access to services, health, education, and social assistance network has seen a reduction of public policies. The importance of research that points to this reduction of rights is fundamental for documenting what has already been achieved.
On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.
Methods:
A field perspective and experience feedback from the Emergency Medical Response.
Results:
The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.
Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.
Discussion:
Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.
Komfo Anokye Teaching Hospital Emergency Department (KATH ED) is a tertiary referral center in Ghana. Anecdotally, patients seeking care at KATH ED do not actively participate in research initiatives.
Aim:
To find out why patients presenting to KATH ED do not enroll in research studies that are conducted in the department.
Methods:
The study was a cross-sectional survey of patients presenting to the ED for one month in June 2017. A semi-structured questionnaire was presented to patients presenting to KATH ED from 8:00-20:00 each day. Patients who were interviewed were all patients presenting to the ED for care, including those who had refused to enroll in the ongoing ACESO study. Patients had to be conscious, alert, and with conditions that did not require immediate management.
Results:
35% of the interviewees (91/260) had been approached to enroll in research studies at some point in the past. 13.5% had refused to enroll in a research study. 45.7% of those who refused to enroll admitted that they were afraid to enroll in a study; 28.6% had inadequate information and 22.9% perceived enrolling in a study would delay their treatment. The Akan language (73%) was most commonly used by research assistants then English (26%), and finally Hausa (1%) to interact with patients. There was a significant association between educational background and explaining a study to a patient before they enrolled. Males were more willing to enroll in an ongoing study compared to females. All age groups correlated significantly with being approached to enroll in a research study and similarly all age groups also correlated with refusing to enroll in a research study
Discussion:
Patients are paramount to hospital research. Efforts must be made to ensure that patients concerns and needs are addressed to ensure increasing participation.
After accidents of Fukushima Daiichi power plant, the Japanese Government distinguished some medical institutions corresponding to the nuclear disaster by roles and functions. Nuclear Regulation Authority is managing these medical institutions. The Nagasaki University was designated as two centers for “the advanced radiation emergency medical support” and “nuclear emergency medical support”. We established “Headquarters for Nuclear Disaster Response and Preparedness in Nagasaki University” (NDRP) and prepared for emergency ordinarily. The staff of headquarters are mainly concentrating their power on the network construction and joint training with each facility. We are improving the dispatch system of nuclear emergency medical assistance team, but some problems were found through the experiences of some trainings.
Aim:
To stimulate discussion and listen to opinions from several facilities.
Methods:
The dispatch system of nuclear emergency medical assistance team imitated the system of Japan Disaster Medical Assistance Team (DMAT). Specifically, activity days of all teams are limited, and all teams should come under the command of the head of support acceptance medical institution of a disaster area. Particularly the main duties of the dispatch team, which is sent from the nuclear emergency medical support center, are unification and adjustment of the team activities from other facilities. Some other duties include offering appropriate medical care to patients at the disaster area and support of patients’ transportation from the hospital at the disaster area to “advanced radiation emergency medical support center” or “nuclear emergency medical support center.”
Discussion:
In training the many facilities that participated, we realized that we couldn’t proceed with each activity quickly and smoothly without support from the nuclear emergency medical assistance teams from outside the boundaries of disaster areas. We need to clarify the problems that are obtained from trainings and improve the current system corresponding to a nuclear disaster with efficiency.
Natural disasters confront individuals, communities, and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters, it is pertinent to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community.
Aim:
The presentation will highlight the effectiveness of interventions post-disaster, and continued adverse outcomes five years post-event.
Methods:
An evaluation of literature related to the psychosocial impact of natural disasters, treatment efficacy, and government strategies to confront the social and psychological impact of natural disasters for the period 1983 – 2016 was undertaken.
Results:
Epidemiological studies following natural disasters, despite the use of differing psychological measures, demonstrate significant psychological morbidity – anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%), and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy capability.
Discussion:
The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social, and economic consequences of these events have resulted in the development and implementation of government policies to confirm the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions, with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance of developing strategies to ensure effectively evaluated psychosocial interventions are available across at-risk communities.
During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.
Aim:
To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.
Methods:
A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.
Results:
Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.
Discussion:
This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.
Aim:
To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.
Methods:
There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).
Results:
Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.
Discussion:
This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.