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In the South African environment, the possibility of lack in the disaster response education and training fraternity was attempted to be mitigated with legislation. The National Disaster Management Framework (2005:162-169) states that national, provincial, and municipal organs of state need to plan, organize, and implement training programs relevant to their respective areas of responsibility. The South African Disaster Management Act (South Africa, 2002:19) encourages a broad-based culture of risk avoidance and the promotion of disaster management education and training throughout South Africa.
Aim:
As an organ of the state and a role-player in disaster management the Free State Emergency Medical Services (FS EMS) is responsible for making strategic decisions. Managers and supervisors are obliged to be trained and educated in disaster management. The study ascertained whether managers and supervisors are being trained and educated in disaster management as required by legislation.
Methods:
The project made use of quantitative data whereby fifty EMS managers and supervisors in the Free State Provincial Government (FSPG) were assessed by using a questionnaire.
Results:
The study found that 66% of the respondents did not receive training to equip them to fulfill their disaster management functions. The remaining 34% indicated that they did receive aspects of disaster management training.
Discussion:
Based on the quantitative scores for the different indicators, the research found that there are shortcomings in disaster management qualifications and training among the EMS supervisors and managers in the FSPG EMS. However, the findings make it clear that there are several positive aspects in the already established practice of disaster management education and training in the FS EMS. The results indicated that there is an opportunity for revision and improvement that will contribute and empower the FS EMS managers and supervisors to meet legislative requirements towards disaster management training and education.
The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.
Aim:
The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.
Methods:
A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.
Results:
Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.
Discussion:
Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.
As the second largest metropolitan area in Canada, Montréal has its share of risks for disasters and major incidents. In such events, the interoperability of emergency services is critical to effective interventions. As the emergency medical service (EMS) for the cities of Montréal and Laval, the Urgences-santé Corporation (USC) has close ties with several emergency partners on the territory, including police and fire departments. These different organizations have joined forces to develop a tabletop exercise program (TEP) to train operational managers to initiate a better-coordinated response on joint interventions.
Aim:
The TEP was designed to enhance interoperability in the field by improving communication and the understanding of the roles, responsibilities, methods of coordination and decision-making in each of the organizations involved. The aim is for all of USC’s operational managers to participate in at least one exercise of the TEP within the first year of the program.
Methods:
Selection criteria were established to gather, for each exercise, managers that are likely to work with one another on a real intervention. The TEP was also designed in such a way that its implementation would require few resources and yield minimal impact on regular operations.
Results:
After four pilot exercises to fine-tune the approach, the program was launched on October 5, 2018. We have now run eight exercises, each involving one or more USC supervisor. The response has been very favorable from the participants as well as their directors.
Discussion:
In the short term, the TEP helps managers understand their counterparts’ key issues, and has already yielded improvements in our joint interventions. In the longer term, the program will help identify specific training needs to better equip responders.
The Rohingya refugee crisis in Bangladesh continues to overburden humanitarian resources and undermine the health and security of over 900,000 people. Spatial, sector-specific information is required to better understand the needs of vulnerable populations, such as women and girls, and to target interventions with improved efficiency and effectiveness.
Aim:
The aim of this study was to create a gender-based vulnerability index and explore the geospatial and thematic variations in the gender-based vulnerability of Rohingya refugees residing in Bangladesh by utilizing pre-existing, open-source data.
Methods:
Data sources included remotely-sensed REACH data on humanitarian infrastructure, UN Population Fund resource availability data, and the Needs and Population Monitoring Survey conducted by the International Organization for Migration in October 2017. Gaps in data were addressed through probabilistic interpolation. A vulnerability index was designed through a process of literature review, variable selection and thematic grouping, normalization, and scorecard creation. Pareto ranking was employed to rank sites based on vulnerability scoring. Spatial autocorrelation of vulnerability was analyzed with the Global and Anselin Local Moran’s I applied to both combined vulnerability index rank and disaggregated thematic ranking.
Results:
Twenty-four percent of settlements were ranked as most vulnerable, with 30 highly vulnerable clusters identified predominantly in the Upazila of Sadar. Five settlements in Dhokkin, Somitipara, and Pahartoli were categorized as less vulnerable outliers amongst highly vulnerable neighboring sites. Security- and health-related variables appear to be the largest drivers of gender-specific vulnerability in Cox’s Bazar. Clusters of low security and education vulnerability measures are shown near the refugee ingress point near Gundum.
Discussion:
The humanitarian space produces tremendous amounts of data that can be analyzed with spatial statistics to better target research and programmatic intervention. The critical utilization of these data and validation of vulnerability indexes is required to improve the international response to the global refugee crisis.
The 2017 Montreal Half-Marathon was held on September 24th despite a record-breaking, out-of-season heatwave. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), was tasked with coordinating and delivering prehospital response for over 15,000 runners at a time when the province’s paramedics were on strike.
Aim:
USC’s mission was to ensure runner safety under extreme conditions with limited staffing. In conjunction with the event’s medical teams, we implemented a new approach that oriented patients to the event’s clinic with the aim of limiting ambulance transports off-site and thus optimizing resources by promoting a “treat and release” principle.
Methods:
Emergency response was organized around the event’s clinic, which offered a level of care comparable to proximate emergency departments, including mass-cooling capacities. This capacity allowed us to modify provincial protocols, and thus prioritize treating patients on-site instead of transporting them to a hospital. Consequently, the prehospital response on the course could be assured with only 15 ambulances (staffed by managers) and a single team deployed at the event’s clinic, acting as transport officers. Heatstroke identification protocols were reinforced for the safety of the runners and spectators.
Results:
A total of 1,071 participants received medical attention, including 24 who were treated for a heat-related incident. On the course, 32 were evaluated by paramedics and 20 were transported to the event’s clinic. Only 7 patients were transferred from the clinic to a hospital, of which only one was for a heat-related incident. No deaths resulted from the race.
Discussion:
By anticipating and preparing for the extreme heat, the coordinated prehospital response safely reduced off-site transports, minimizing treatment delays for patients, and maximizing the use of on-site resources. We attribute this success to a strong collaboration with the race organizers, the presence of an on-site clinic, and an increase in prehospital resources.
Recent mass shooting events remind us of the importance of hospitals’ preparedness to manage a large number of patients in a short period of time. While prehospital systems triage for field interventions and priority of transport, they were not designed to triage for the scarce resources of a hospital. Therefore, upon arrival to hospital, clinicians must then quickly determine how to best assess and provide life-saving interventions based on their limited resources.
Methods:
In collaboration with the Greater New York Hospital Association (GNYHA), the Center for Disaster Medicine at New York Medical College piloted an interactive and intensive eight-hour course at four New York State hospitals that covered critical areas such as: current literature on Mass Casualty Events and Triage, review of hospital emergency management, hospital-based triage principles, a MCI exercise in the emergency department, a surge capacity tabletop exercise, and use of ultrasound. While targeted towards physicians to foster team-based care and learning, nurses, physician assistants, and hospital administrators also participated in the pilot course.
Results:
Sixty persons from four hospitals participated in the pilot phase. Preliminary findings post-training reveal the following: 58% of participants expressed greater confidence in distinguishing between emergency department triage and triage during disasters; 59% of participants expressed greater confidence in performing initial triage of victims; 49% of participants expressed greater confidence in describing the use of ultrasound-guided triage; and 95% of participants reported an enhancement in their ability to perform their clinical role.
Discussion:
Preliminary findings reiterate the ongoing need for hospitals to provide training to their staff in the unique aspects of hospital triage and surge management using tools specifically designed in order to be prepared for the rapid influx of a large number of patients. A multipronged training model is a positive approach to help hospitals prepare for large-scale disasters.
Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have onsite medical care to help reduce the impact on local healthcare systems. Historically, the literature suggests that patient transfers offsite are frequently related to complications of substance use. However, there is a gap in understanding as to why patients are transferred to a hospital when an onsite medical team, providing a higher level of care (HLC), is present.
Aim:
To better understand the causes that necessitate patient transportation to the hospital during festivals that have onsite physician-led coverage.
Methods:
De-identified patient data from a convenience sample of four, large-scale Canadian festivals (over two years) were extracted. Patient encounters that resulted in transfers to hospital, by ambulance, non-emergency transport vehicle (NETV), or self-transportation were analyzed for this study.
Results:
Each festival had an onsite medical team that included physicians, nurses, and paramedics. During 34 event days, there were 10,406 patient encounters, resulting in 156 patients requiring transfer to a hospital. A patient presentation rate of 16.5/1,000 was observed. The ambulance transfer rate was 0.12/1,000 of attendees. The most common reason for transport was musculoskeletal injuries (54%) that required imaging.
Discussion:
The presence of onsite teams capable of treating and releasing patients impacted the case mix of patients transferred to a hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required imaging. Results suggest that a better understanding of the specific effects onsite medical teams have on avoiding off-site transfers will aid in improving planning for music festivals. Findings also identify areas for further improvement in care, such as onsite radiology, which could potentially further reduce the impact of music festivals on local health services.
Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.
Aim:
To review the past disaster responses of our hospital.
Methods:
The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.
Results:
Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.
Discussion:
For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.
Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.
Aim:
To assess the impact of the 2018 Japan heatwave on community emergency medical service.
Methods:
Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.
Results:
The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.
Discussion:
The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.
Sri Lanka Army is a valuable resource for the country as a capacity factor in disaster situations. Sri Lanka Army has established Search and Rescue teams (SAR teams) in all 25 districts.
Aim:
To describe the knowledge, attitudes, and practices of SAR teams regarding search and rescue as a response to disasters.
Methods:
A descriptive cross-sectional study was carried out from October to December 2017. Five platoons were selected randomly from high and medium risk district categories, and all five platoons were selected from the low-risk category. The total sample size was 465. A pre-tested self-administered questionnaire was employed.
Results:
The median age was 28 years. 3.2% were officers, 96.8% were soldiers, the majority (80.4%) were educated up to G.C.E. (O/L), and 62.4% were married. 52.9% of the population had undergone SAR training during the past three years in Sri Lanka, and none had undergone training outside of the country. Overall knowledge regarding search and rescue as a response to disasters seem to be good (57.2% received higher than a score of 75%). 93.8% has desirable positive attitudes. 73.5% had participated in search and rescue operation as a response to disasters. Overall practices seemed to be poor, (71.3% of the population received lower than a score of 75%). A statistically significant association was observed with a level of education (p = 0.001), designation (p = 0.004), and knowledge on search and rescue as a response to disasters. Level of education, designation, and SAR training had no significant association with attitudes on search and rescue as a response to disasters. A statistically significant association was observed with designation (p = 0.021) and practices.
Discussion:
Search and rescue drills should be carried out regularly. Knowledge of search and rescue as a response to disasters should be incorporated into training programs for officers and soldiers.
The mental health challenges encountered by paramedics have received much attention in recent years. This attention has particularly focused on high rates of stress, depression, anxiety, and post-traumatic stress disorder. This heightened awareness of the high incidence of mental illness, which has at times tragically resulted in the suicide of serving and former paramedics, is stimulating the address of mental health within the paramedic profession. It is now time to call on paramedic educators to prepare student paramedics for the mental health challenges associated with a career in the emergency medical services.
Aim:
To explore the preparedness of student paramedics for the mental health challenges of the paramedic profession and identify the coping strategies used by veteran paramedics to successfully meet these challenges.
Methods:
Twenty semi-structured interviews with veteran paramedics from Australia and New Zealand were conducted.
Results:
Advice from veteran paramedics was comprised of three key themes: support, health, and the profession.
Discussion:
The findings of the study indicate that the preparation of student paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. The advice offered by veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the personal experiences of the veteran paramedics. These experiences are highly credible and sharing them offers an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion in the undergraduate paramedic curriculum should be prepared to facilitate knowledge translation and to encourage the development of conscious coping strategies by student paramedics during their learning phase. Further research is needed to raise awareness in this area, with a specific focus on preparing paramedic students to cope with mental health challenges related to undergraduate degree programs, and how they feel about commencing their career as a paramedic.
Social isolation and death alone in the prefabricated temporary housing after a disaster has been a social concern. The importance of social ties among the community has been suggested and several reports pointed out the positive effect of “group allocation” which preserves pre-existing local social ties compared to the “lottery allocation”.
Japan Red Cross Society recommended “group allocation” as a better option than “lottery allocation” on their guidelines. However, many municipalities carried out “lottery allocation” for temporary housing arrangement after the Great East Japan Earthquake (GEJE).
Aim:
To collect the information about the accelerating factors and bottlenecks when practicing the “group allocation”.
Method:
In-depth interview was conducted between August and November 2013. Interviewees were the professionals of disaster management, individuals who were involved in arranging the prefabricated housing and the residents. This research was supported by the Ministry of Education, Culture, Sports, Science, and Technology in Japan.
Results:
This study found the municipality which carried out “group allocation” had characteristics such as: (1.) the staff in charge of housing arrangement had the information about the positive effect of “group allocation”, and (2.) pre-existing community leaders were able to gather residents’ opinions, and citizens were involved in the decision making to some content.
Discussion:
Although this study is based on the experience of a limited number of key persons, it would be useful to give the insight about the possible bottleneck for the practitioners who will be in charge of housing arrangement under the disaster setting in future. Also, the relevancy and evidence about “group allocation” should be carefully examined in the context of preventing social isolation as well as various long-term effects. It would be essential that the knowledge and experience will be accumulated and shared between municipalities in a usable and comparable format.
In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.
Aim:
To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.
Methods:
A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.
Results:
ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.
Discussion:
Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.
Clinicians working in emergency departments (ED) play a vital role in the healthcare response to chemical, biological, radiological, nuclear, and explosive (CBRNe) events. However, ED clinicians’ individual and workplace preparedness for CBRNe events is largely unknown.
Aim:
The aim of this research was to explore Australian ED nurses and doctors’ perceptions of individual and workplace preparedness related to CBRNe events.
Methods:
The study populations were Australian nurses and doctors who work in EDs. Data was collected via a survey with 43 questions requiring binary responses or a rating on a Likert scale. The survey consisted of questions relating to the participant’s previous disaster training, perceived likelihood of a CBRNe event impacting their ED, perceived level of knowledge, perceived personal preparedness, perception of ED preparedness, and willingness to attend their workplace. Data were analyzed using descriptive and inferential statistics.
Results:
There were 244 complete responses, 92 (37.7%) doctors and 152 (62.3%) nurses. When comparing doctors and nurses, there was a statistical difference between gender (p = < 0.001), length of employment (p = < 0.001), and role in the ED (p = < 0.001). Doctors and nurses had a similar level of previous training except for practical training in mask fitting (p = 0.033). CBRNe events were considered separately. Perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness were significant predictors of willingness to work in all CBRNe event. Perceived likelihood of a CBRNe event impacting their ED was not a predictor of willingness.
Discussion:
This research contributes to an overview of the current status of Australian ED clinicians’ preparedness for CBRNe response. To increase the willingness of ED doctors and nurses attending their workplace for a CBRNe event, strategies should focus on enhancing individuals perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness.
Prolonged conditions of chronic stress have the potential to cause mental health difficulties and disrupt developmental processes for children and adolescents. Natural disasters disproportionately affect low-resource areas, yet little is known about the interaction between trauma exposure, chronic stressors, and mental health.
Aim:
To determine the rates of post-traumatic stress disorder (PTSD), depression and anxiety among adolescents affected by earthquakes in China and Nepal, and examine the specific roles of trauma exposure and chronic stressors across the three mental health outcomes.
Methods:
A school-based, cross-sectional study of 4,215 adolescents (53% female, ages 15-19 years) was conducted in disaster-affected areas of southern China and Nepal. Participants completed a series of translated and culturally adapted standardized assessments. Mixed effects logistic regression analyses were conducted for each mental health outcome.
Results:
The overall rate of PTSD was 22.7% and was higher among Nepalese participants (China: 19.4% vs. Nepal: 26.8%, p<0.001), but did not differ between genders (China: p=0.087 and Nepal: p=0.758). In both countries, the level of trauma exposure was a significant risk factor for PTSD, depression, and anxiety (China: OR’s 1.09-1.18 and Nepal: OR’s 1.08-1.13). Chronic stressors significantly improved the model and further contributed to mental health outcomes (China: OR’s 1.23-1.26 and Nepal: OR’s 1.10-1.23). Multilevel risk and protective factors across all mental health outcomes will be presented.
Discussion:
While there are limited opportunities to protect adolescents from disaster exposure, there is significant potential to address the effects of ongoing economic insecurity, domestic violence, and school cessation that are likely to worsen mental health outcomes. Programs that identify chronic stressors for adolescents in disaster-affected settings, and work to address poverty and violence, will have cascading effects for mental health, development, and security.
Clinical diagnostics in sudden-onset disasters (SOD) has historically been limited. With poor supply routes, lack of a cold chain, and challenging environmental conditions, many diagnostic platforms are unsuitable.
Aim:
We set out to design, implement, and evaluate a mobile diagnostic laboratory accompanying a type II emergency medical team (EMT) field hospital.
Methods:
Available diagnostic platforms were reviewed and selected against infield need. Platforms included HemoCue301/WBC DIFF, i-STAT, BioFire multiplex RT-PCR, Olympus BX53 microscopy, ABO/Rh Grouping, and specific rapid diagnostic tests (RDT). This equipment was trialed in Katherine, Australia and Dili, Timor-Leste.
Results:
During the initial deployment, validation of FilmArray rt-PCR multiplex tests was successful on blood culture, gastrointestinal, and respiratory panels. HemoCue301 (n = 20) haemoglobin values were compared on Sysmex XN 550 (r = 0.94). Analysis of HemoCue WBC DIFF samples had some variation when compared to Sysmex XN 550, (neutrophils r = 0.88, lymphocytes r = 0.49, monocytes r = 0.16, eosinophils r = 0.70, basophils r = 0.16). i-STAT showed non-significant differences for CHEM4 (n=10), CG8 (n = 10), and TnI (n = 5) against Vitros 250. A further trial of BioFire rt-PCR testing in Dili, Timor-Leste diagnosed 117 causative pathogens on 168 FilmArray test cartridges.
Discussion:
This mobile laboratory represents a major advance in SOD. Setup of the service was quick (<24hr) and transport to site rapidly. Training was simple and performance consistent. Future deployment in fragmented health systems after sudden onset disasters with EMT2 will now allow broader diagnostics.
Sendai Framework for Disaster Risk Reduction 2015-2030, for the first time, describes how disaster affects the health of people. Japan is prone to natural hazards, but at the same time, Japan has achieved one of the highest life expectancies (LE) in the world. After experiencing many disasters, Japan seems to have achieved resilience against disasters. Thus, we tested a hypothesis that high LE correlates with low disaster risk.
Methods:
We compared LE from the World Health Organization's (WHO) Global Health Observatory and the Index for Risk Management’s (INFORM) disaster risk index, or World Risk Index (WRI), of each country using JMP software. INFORM risk index varies from 0-10, while WRI varies from 0-1, where a higher value means higher disaster risk in both systems. INFORM risk index considers hazard and exposure, vulnerability, lack of coping capacity, and lack of reliability. WRI considers exposure, susceptibility, lack of coping capacity, and lack of adaptive capacity, including logarithmized LE as a part of adaptive capacity.
Results:
The overall INFORM risk index was negatively correlated with LE (p<0:0001). Although natural hazard did not correlate with LE (p=0.7), the human hazard, vulnerability, and lack of coping capacity negatively correlated with LE (p<0.0001, respectively). Health-related indicators, which confirm the vulnerability and lack of coping capacity, were negatively correlated with LE. Cluster analysis of LE and INFORM risk of six categories resulted in four clusters of countries, suggesting that health development and disaster risk reduction are independent determinants. WRI also correlated with LE, but there are many outliers compared to the INFORM risk index.
Discussion:
High LE can be a good complementary indicator of low disaster risk. Strategies to achieve better health that contribute to high LE are also effective and important strategies for disaster risk reduction.
The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.
Aim:
To clarify the gap between medical supplies and demand.
Methods:
Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.
Results:
The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.
Discussion:
Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”
There is currently no standardized approach to collecting mass gathering health data, which makes comparisons across or between events challenging. From 2013 onward, an international team of researchers from Australia and Canada collaborated to develop a Minimum Data Set (MDS) for Mass Gathering Health (MGH).
Aim:
The process of developing the MDS has been reported on previously at the 2015 and 2017 World Congresses on Disaster and Emergency Medicine, and this presentation will present a final MDS on MGH.
Methods:
This study drew from literature, including the 2015 Public Health for Mass Gatherings key considerations, previous event/patient registry development, expert input, and the results of the team’s work. The authors developed an MDS framework with the aim to create an online MGH data repository. The framework was populated with an initial list of data elements using a modified Delphi technique.
Results:
The MDS includes the 41 data elements in the following domains: community characteristics, event characteristics, venue characteristics, crowd characteristics, event safety considerations, public health considerations, and health services. Also included are definitions and preliminary metadata.
Discussion:
The development of an MGH-MDS can grow the science underpinning this emerging field. Future input from the international community is essential to ensure that the proposed MDS is fit-for-purpose, i.e., systematic, comprehensive, and rigorous, while remaining fluid and relevant for various users and contexts.
The Canterbury Primary Response Group (CPRG) was formed following the threats of severe acute respiratory syndrome (SARS) and avian influenza worldwide. The possible impact of these viruses alerted health care professionals that a community-wide approach was needed to manage and coordinate a response to any outbreak or potential outbreak. In Canterbury, New Zealand, the CPRG group took the responsibility to coordinate and manage the regional, out of hospital, planning and response coordination to annual influenza threats and the possible escalation to pandemic outbreaks.
Aim:
To outline the formation of a primary health and community-wide planning group, bringing together not only a wide range of health providers, but also key community agencies to plan strategies and responses to seasonal influenza and possible pandemic outbreaks.
Methods:
CPRG has developed a Pandemic Plan that focuses on the processes, structures, and roles to support and coordinate general practice, community pharmacies, community nursing, and other primary health care providers in the reduction of, readiness for, response to, and recovery from an influenza pandemic. The plan could reasonably apply to other respiratory-type pandemics such as SARS.
Results:
A comprehensive group of health professionals and supporting agencies meet monthly (more often if required) under the chair of CPRG to share information of the influenza-like illness (ILI) situation, virus types, and spread, as well as support strategies and response activities. Regular communication information updates are produced and circulated amongst members and primary health providers in the region.
Discussion:
Given that most ILI health consultations and treatments are self or primary health administered and take place outside of hospital services, it is essential for providers to be informed and consistent with their responses and knowledge of the extent and symptoms of ILI and any likelihood of a pandemic.