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The term “profession” to describe the people who carry out emergency management (EM) in Australia continues to gain momentum. Many emergency managers see themselves and are seen by others as professionals, yet little evidence exists to confirm this proposition. Unlike other professions, there is no peak body or overarching organization in Australia to help the diverse group of emergency managers to identify standards of performance and to lobby decision-makers on their behalf.
Aim:
This study identifies criteria that define a profession and considers how the emergency management sector in Australia reflects them.
Methods:
A literature review and review of established professions informed criteria of what constitutes a profession. Using these criteria, a survey was conducted to identify the demographic profiles of Australian emergency managers, their perception of the criteria of a profession, and their attitudes towards professionalization of their sector. Semi-structured interviews were conducted with a representative sample. Ethics approval was obtained.
Results:
A set of criteria for an EM context in Australia was created. 859 emergency managers in Australia were surveyed using an online questionnaire. No common profile emerged from the survey in terms of age, gender, background, expertise, skills, or experience. Likewise, no clear career path, no clearly defined standard training, no universal standards of performance, and no statutory certification to qualify an emergency manager as a professional were revealed. Participants variously identified some of the necessary criteria of a profession, but no uniformity emerged.
Discussion:
This unique study concludes that the sector is not yet in a position to regard emergency management as a profession. Recommendations suggest steps be taken in the short- and long-term to facilitate the establishment of EM as a profession and identifies further research to inform the journey towards professionalizing the emergency management sector.
Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.
Aim:
To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).
Methods:
A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.
Results:
Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).
Discussion:
There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.
Pharmaceutical services for public health emergencies, such as the Zika virus (ZIKV) epidemic, are relevant for service effectiveness in the Brazilian health system. Pharmacists can act strategically in risk reduction. However, official guidelines do not consider pharmaceutical services when approaching health emergencies.
Aim:
To identify and understand primary healthcare pharmacist interventions in risk reduction for the recent ZIKV epidemic in Brazil.
Methods:
The study took place in Campo Grande, Mato Grosso do Sul, in November 2017. A semi-structured questionnaire was developed, including general issues related to knowledge of Zika, risk communication, and the pharmacist's role in patient care for ZIKV disease. The instrument was pre-tested. Primary healthcare center (PHC) pharmacists were subsequently interviewed. Aspects related to knowledge, risk reduction measures, and role were categorized and analyzed. The project received approval from the Institutional Review Board (IRB) at the Sergio Arouca National School of Public Health.
Results:
Forty-two of the 48 PHC pharmacists in Campo Grande were interviewed. Risk reduction measures were cited by most interviewees. Among these strategies, 92% were collective measures, such as making information available for the population (30%) and for the health workers (8%), and vector control strategies (43%). Use of mosquito nets was the most cited individual risk-reduction strategy. Only one pharmacist cited risk for pregnant women and suggested birth control as a strategy. Another pharmacist pointed to ZIKV “treatment.” No interviewee mentioned measures related to preparedness of pharmaceutical services.
Discussion:
PHC pharmacists do not place themselves at the frontline of risk reduction for the ZIKV epidemic. In the face of potential hazards and consequences of this disease, action by pharmacists is deemed critical. This study highlights pharmacist's misconceptions and lack of focused knowledge, pointing to the need for training and capacity-building in order to increase quality of care and positive management of future epidemics.
Muhammadiyah, the Indonesia non-governmental organization (NGO), has more than 300 hospitals. It is one of the forerunners of the Safe Hospital Initiative in Indonesia beginning in 2008. Muhammadiyah realized that hospital strengthening must be done in collaboration with community strengthening. From 2016 to 2018, Muhammadiyah ran a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED) that was carried out through strengthening two hospitals and their surrounding communities in Palangka Raya, Central Kalimantan, and Bima, West Nusa Tenggara (NTB). This program was funded by the Australian Government and is in line with the Safe Hospital Comprehensive Framework of the World Health Organization (WHO).
Aim:
To strengthen hospitals and the surrounding communities to prepare for emergencies and disasters.
Methods:
HPCRED completed 92 activities in two areas consisting of the following: 10 training, 26 workshops, 12 exercises, four monitoring and evaluation meetings, and seven technical sessions/seminars. The exercises consisted of tabletop exercises, skill drills, command post exercise, and full-scale exercise.
Results:
There were positive changes in the hospitals and communities particularly on disaster management, policy, procedures, staff and community skills, knowledge, and behavior. The integration and collaboration between the hospital surrounding communities were established and can be examined by documents, agreements, and activities done together between the hospital and community during and after the program.
Discussion:
Before the program, hospitals were not ready to face disasters. PKU Bima Hospital collapsed during a flash flood in December 2016. The community, to save housing from water, hollowed the hospital wall out causing water entrance into the hospital. It meant there were no communication and coordination between the hospital and its community. HPCRED not only made them communicate and coordinate but also collaborate and cooperate to reduce risks and response disasters such as responding Lombok Earthquake in July 2018.
The elderly have the highest rates of morbidity/mortality in a disaster and are therefore the most vulnerable. 50% of deaths in Hurricane Katrina were ≥75 years old. In the California wildfires, most deaths were people in their 70s and 80s living in areas with unreliable communication services (without cell phone service, etc.), and were uninformed of the disaster or unable and/or unwilling to evacuate. Issues include social isolation and limited technology skills (may not receive messages).
Methods:
A review of the literature and after action reports from multiple disasters.
Results:
Augmented services are needed for persons with decreased mobility (impaired access to transportation and shelters); impaired senses; dependence on devices/technology, comorbidities requiring medications/equipment/oxygen, special feedings, sanitary/hygiene needs increased susceptibility to environmental extremes (heat, cold), inability to do ADLs (need for caregivers), increased susceptibility and increased morbidity/mortality with infections, illnesses, trauma; exacerbation of underlying conditions/illnesses when in crowded transportation vehicles and shelters. Additional stress may precipitate or exacerbate coping skills especially in those with dementia, delirium, or mental health illnesses.
Discussion:
Recommendations include the following:
1. Communications: messages in various forms: closed captioning, TTY deaf phones, use of family, friends, neighbors, officials for notification in addition to mass communication notices, house-to-house notification.
2. Medical: Medical/Special Needs Shelters to provide medical care (dialysis, etc.), cache of common medications (diabetic and BP medications) and devices (BP monitoring, glucometers), oxygen, wound care supplies, potable and non-potable water, special diets/formulas, feeding tubes, catheter care, diapers and other hygiene supplies.
3. Independence: Health care professionals to assist with medical and psychiatric needs. Caregivers to assist with ADLs.
4. Supervision: Those with dementia, delirium, mental health conditions may need supervision.
5. Transportation: Need for ambulances, wheelchair vans, specially equipped buses/vans in addition to “usual” school buses/vans with access to water, food, and sanitation if traveling long distances.
Nurses’ broad knowledge and treatment skills are instrumental to disaster management. Roles, responsibilities, and practice take on additional dimensions to their regular roles during these times. Despite this crucial position, the literature indicates a gap between their actual work in emergencies and the investment in training and establishing response plans.
Aim:
To explore trends in disaster nursing reflected in professional literature, link these trends to current disaster nursing competencies and standards, and reflect based on the literature how nursing can better contribute to disaster management.
Methods:
A systematic literature review, conducted using six electronic databases, and examination of peer-reviewed English journal articles. Selected publications were examined to explore the domains of disaster nursing: policy, education, practice, research. Additional considerations were the scope of the paper: local, national, regional, or international. The International Nursing Councils’ (ICN) Disaster-Nursing competencies are examined in this context.
Results:
The search yielded 171 articles that met the inclusion criteria. Articles were published between 2001 and 2018, showing an annual increase. Of the articles, 48% (n = 82) were research studies and 12% (n = 20) were defined as dealing with management issues. Classified by domain, 48% (n = 82) dealt with practical implications of disaster nursing and 35% (n = 60) discussed educational issues. Only 11% of the papers reviewed policy matters, and of these, two included research. Classified by scope, about 11% (n =18) had an international perspective.
Discussion:
Current standards attribute a greater role to disaster-nursing in leadership in disaster preparedness, particularly from a policy perspective. However, this study indicates that only about 11% of publications reviewed policy issues and management matters. A high percentage of educational publications discuss the importance of including disaster nursing issues in the curricula. In order to advance this area, there is a need to conduct dedicated studies.
Despite the influential Hyogo and Sendai Frameworks, risk remains poorly understood in the emergency preparedness sector. Hazard assessment and risk management are usually considered before events. An alternative view considers risk as a cascade of potential consequences throughout an event. The 2014 fire in the Victorian rural community of Morwell included a three-phased event: a small bush fire, from which embers ignited a persistent fire in a disused open cut brown coal mine fire. The consequent air pollution precipitated a public health emergency in the nearby community of 15,000 people.
Aim:
To examine this event as a case study to investigate concordance with accepted definitions and key elements of a cascading event.
Methods:
Selected literature informed a risk cascade definition and model as a framework to examine the key post-event public inquiries available in the public domain.
Results:
Informed by a Conceptual Framework for a Hazard Evolving into a Disaster (Birnbaum et al., 2015), Wong and colleagues promote a Core Structure of a Comprehensive Framework for Disaster Evaluation Typologies (Wong, 2017). This Core Structure provided an adequate model to examine the sequence of events in the Morwell event. Definitions of cascading effects is more complex (Zuccaro et al., 2018). Our analysis of the Morwell event used the authoritative definition of cascading disasters published by Pescaroli and Alexander (2015). Using this definition, the Morwell event increased in progression over time and generated unexpected secondary events of strong impact. The secondary events could be distinguished from the original source of disaster, and demonstrated failures of physical structures as well as inadequacy of disaster mitigation strategies, while highlighting unresolved vulnerabilities in human society.
Discussion:
The Morwell coal mine fire of 2014 reflects the key criteria of a cascading disaster and provides understandings to mitigate the consequences of similar events in the future.
Sri Lanka has experienced a multitude of natural and man-made disasters during the last five decades. Man-made destructions were common during the 30-year-long conflict period. Though the local system in the country was able to manage the dead in such circumstances, the South-Asian tsunami in 2004 highlighted the limitations and deficiencies of the system that was in place to handle the management of the dead during major disasters. Though the first Disaster Management Act was introduced in 2005, it has no mentioning regarding management of dead in mass disasters. Inappropriate handling of the dead could hinder the establishment of the identity of the dead, loss of valuable forensic evidence, and dignified burial. Hence, the families could experience difficulties in calming insurances and inheritance, resulting in economic hardships. In this backdrop, the forensic community strongly felt the necessity of stipulating best practices in managing dead.
Aim:
To critically assess the measures taken to improve the standards of managing dead in mass disasters in Sri Lanka over the past 15 years.
Methods:
The process of drafting guidelines for management of dead was initiated with a series of consultative meetings with the Disaster Preparedness and Response Unit of the Ministry of Health, the Disaster Management Centre (DMC) and the Institute of Forensic Medicine and Toxicology (IFMT) in collaboration with the College of Forensic Pathologists of Sri Lanka. A working group representing forensic and legal experts, military, police, fire brigade department, and disaster management were involved in drafting these guidelines. Further guidelines for the effective conduct of mass burials following mass disasters were also prepared and published in 2007.
Discussion:
Despite all these efforts the efficacy of managing dead in recent mass disasters is still far from satisfactory.
By prioritizing emergency patients, triage facilitates the timely provision of care to the largest possible number of patients arriving at an emergency room (ER). Previous triage methods include the Canadian and Japan Triage and Acuity Scales. Since these methods sort patients into five categories, multiple patients are often categorized into the same category. Furthermore, since these scales adopt original complex algorithms to determine the triage category, triage personnel need to be very familiar with the algorithm. Hence, a simple triage method is needed to prioritize ER patients.
Aim:
To develop a new triage method to prioritize patients arriving at the ER.
Methods:
Patients aged ≥13 years who arrived at the ER of Yodogawa Christian Hospital without being transported by ambulance between January 2016 and October 2018 were assessed. We analyzed correlations between the items included in the triage sheet and admission. We calculated risk ratios (RRs) of the items that were significantly related to admission. The RR of an item was considered its score, and the triage score was calculated by summing the individual RR scores for each patient. We performed receiver operating characteristic (ROC) analysis of admission and triage scores.
Results:
Among 20992 patients, 2030 patients (9.7%) were admitted to the hospital. The triage scores of all the patients ranged from 26.5 to 62.3. According to the ROC analysis, the area under the curve was 0.791 and the optimal cutoff value for the triage score was 32.7 (sensitivity: 0.74, specificity: 0.70).
Discussion:
Since this research was based on data from a Japanese secondary level emergency hospital in an urban area, our triage method can be adapted to the many ERs in Japan that share a similar background. The method used to develop this triage method can also be used to develop triage methods for ERs with different backgrounds.
Climate change has brought more extreme weather events to Hong Kong. The increasing number of powerful tropical cyclones that hammered Hong Kong in recent years reminded the territory to review typhoon preparedness of the community.
Aim:
Typhoon Mangkhut slammed Hong Kong in September 2018 and caused significant devastation. Three weeks after the devastation, the Hong Kong Jockey Club Disaster Preparedness and Response Institute commissioned the Public Opinion Programme at The University of Hong Kong to conduct a survey to understand the general Hong Kong public’s typhoon preparedness measures and their information seeking behaviors.
Methods:
A cross-sectional population-based anonymous telephone survey was conducted on a random sample of 1,018 Cantonese-speaking adults aged 18 or above.
Results:
The most common typhoon preparedness measures were taping windows (45%), followed by food stockpiling (18%), and closing of doors/windows (10%). Only 2% and 1% of the respondents were prepared for water and power outage, respectively. 36% of the respondents did not take any precautionary measures. 29% sought typhoon precautionary measures information from the mass media and 31% of respondents relied on their previous experience. Other sources of information included government sources (7%) and social media (7%).
Discussion:
Though no death cases were reported related to Typhoon Mangkhut, the effect of the superstorm caused over 300 casualties, blocked roads, and transportation chaos caused by fallen trees and other debris, power and water outage, serious floods, and severely damaged public and private facilities. Around 40,000 households experienced a power outage and some residential estates were left without water. The survey revealed the lack of precautionary measures of the Hong Kong public for power and water outage. More education on typhoon preparedness, especially on power and water outage and more community-level support on localized disaster preparedness advice, would likely improve disaster preparedness for the Hong Kong public.
There has been a dramatic increase in the number of mass shootings (loosely defined as an incident with four or more indiscriminate victims) in the United States (1). Additionally, the use of high-caliber, military-style weapons, has become more common in civilian shootings. These trends should influence how emergency departments prepare for disasters, including an inventory of what critical care medical materials (supplies) are readily available in the event of a disaster.
Aim:
To demonstrate the need for the adoption of medical materials planning for disasters to account for new injury patterns from mass shootings.
Methods:
A review of injury patterns from recent mass shootings was conducted using available literature (2). The average number of victims presenting to the emergency department in these events was reviewed. Estimation of critical care specific medical materials in the emergency department required for the management of an “average” number of victims with the typical injury pattern of these events was conducted.
Results:
Some critical care specific medical materials: intubation equipment, chest tubes, and central venous catheters may be in short supply during a mass shooting event.
Discussion:
Emergency physicians must anticipate and prepare for new disaster trends such as mass shootings and high caliber weapons injuries. This includes having specialty medical supplies readily available in sufficient amount. Normal stocking of critical care specific medical materials may be inadequate in a mass shooting event based on the available literature.
Managing an MCI (Mass Casualty Incident) can be a daunting task for emergency responders. Effective management can be a matter of life and death but can be directly impacted by the feelings of the incident commander.
Aim:
Students were trained to be incident commanders, then following the course were given a survey. In the days following the training, an MCI occurred involving a train full of passengers. The students were then given another survey to assess their readiness following the practical use of their studies.
Methods:
Students were given a survey to determine their mean level of confidence in managing MCIs prior to training, and following the training. Following the training, there was an increase in confidence. After the training, there was an MCI in which their theoretical knowledge was put to the test.
Results:
The pre-training self-efficacy mean scores of younger students (M=3.5, SD+0.23) increased after the training (M=3.8, SD+0.28) and rose even more following the presentation of the Turin train accident (M=4, SD+0.26). While a similar increase in self-efficacy was found among the more mature students post-training compared to the level prior to the training (M=3.7, SD+0.44 versus M=3.4, SD+0.56), the mean self-efficacy score of the mature students decreased following the presentation of the Turin train accident to the pre-training level (M=3.4, SD+0.51).
Discussion:
Mean scores of self-efficacy and confidence in managing MCIs were found to be higher among medical students that were previously trained in coping with MCIs compared to medical students who participated in such a training program for the first time.
The continuous development of the knowledge and skill of the emergency medical technicians (EMTs) in Ghana is important for the success of the pre-hospital system. Due to distance and time constraints, an online e-learning platform is a good way to educate the Emergency Medicine Technicians in Ghana.
Aim:
The study looked at the feasibility of developing a distant learning module for the training and continuous medical education of EMTs.
Methods:
EMTs in the Ashanti Region were randomly selected to be part of the study. They received online lectures and notes that were accessible by their mobile phones. They all received a test at the end of each model. The study measured their willingness to participate, average attendance for each model, and the scores for each model test. The study also measured the overall feasibility of the distant learning program.
Results:
The study developed a training course comprised of 7 modules: trauma and surgical emergencies, obstetric emergencies, pediatric emergencies, disaster management, medical emergencies, basic ultrasound, and medical research. Tests and quizzes were electronically sent to EMTs over the course of the research period, with an average test score of 70.14% (low: 35%, high: 95%) for the cohort. Feedback from participants showed gains in knowledge and skill delivery. The average attendance for all model was 56.6% ranging from 47.37%-63.16% for the models. Challenges for attendance included internet access, heavy duties, and other personal reasons. The post-training interview showed 100% willingness to participate in future online programs with the most common reasons stated as low cost, ease of attendance for models, and reduced expense.
Discussion:
The study concluded that online, distant learning models can be used in Ghana for training and continuous medical education for EMTs. It is an easy and cost-effective model compared to a face-to-face model.
This poster will document the environmental domain variables of a mass gathering. They include factors such as the nature of the event, availability of drugs or alcohol, venue characteristics and meteorological factors.
Method: A systematic literature was used to develop a set of variables and evaluation regarding environmental factors that contribute to patient presentation rates.
Results:
Findings were grouped pragmatically into factors of crowd attendance, crowd density, venue, type of event, mobility, and meteorological factors.
Discussion:
This poster will outline a set of environmental variables for collecting data at mass gathering events. The authors have suggested that in addition to commonly used variables, air quality, wind speed, dew point, and precipitation could be considered as a data points to be added to the minimum standards for data collection.
Emergency Medical Service (EMS) increases survival rates and reduces possible disability among emergency patients. However, the number of requests is relatively low in Thailand.
Aim:
To inspect the awareness, perspective, and reasons behind the rejection of EMS by patients or their relatives who visit the emergency room.
Methods:
Responses were analyzed in 45 government, university, and private hospitals from December 2015 to February 2016. The hospitals were scattered in 7 provinces with the sample group including 2,028 patients, whereby 646 patients visited using EMS and 1,368 did not. The key reasons for self-visit or other means are the convenience of personal transportation (76.0%), not wanting to wait for an ambulance (31.0%), and anxiety caused by the emergency situation (28.9%). Most misconceptions about the service include; 1) Ambulances are used only for casualties from accidents and 2) Ambulance service are not free. In terms of perspective, most patients or relatives hold a negative view towards the emergency medical service, especially the idea that they can help themselves when the condition is not severe or if there are medications or relief devices available. Another view is that the service will delay them from getting to the hospital. These perspectives are from non-users.
Discussion:
The study indicated that the cause of non-user involved misunderstandings, poor perspectives, lack of awareness, and the ignorance of the threat of the particular emergency condition. Thus, they do not realize the benefit of using EMS. As a result, regional agencies, the National Institute of Emergency Medicine, and the Ministry of Public Health should discuss the solutions to raise public awareness and improve the perspective towards emergency medical services to promote more usage.
Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.
Aim:
This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.
Methods:
This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.
Results:
42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).
Discussion:
Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.
As the incidence of cancer and the frequency of extreme weather events rise, disaster mitigation is becoming increasingly relevant to oncology care.
Aim:
To investigate the effect of natural disasters on cancer care and the associated health effects on patients with cancer through the means of a systematic review.
Methods:
Between database inception and November 12, 2016, Embase, ScienceDirect, MEDLINE, Scopus, PsycINFO, Web of Science, and CINAHL were searched for articles. Those identifying the effect of natural disasters on oncology services, or the associated health implications for patients with cancer, were included. Only articles published in English were included. Data extraction was done by two authors independently and then verified by all authors. The effects of disaster events on oncology services, survival outcomes, and psychological issues were assessed.
Results:
Natural disasters cause substantial interruption to the provision of oncology care. Of the 4,593 studies identified, only 85 articles met all the eligibility criteria. Damage to infrastructure, communication systems, medication, and medical record losses substantially disrupt oncology care. The effect of extreme weather events on survival outcomes is limited to only a small number of studies, often with inadequate follow-up periods.
Discussion:
To the best the authors’ knowledge, this is the first systematic review to assess the existing evidence base on the health effects of natural disaster events on cancer care. Disaster planning must begin to take into consideration patients with cancer.
The principles of Disaster and Emergency Medicine are applicable beyond the confines of planet Earth. With the accelerating rate of climate change, natural disasters, and overpopulation, as well as the innate human appetite for knowledge and technological advancement, there has recently been an increased interest in the prospect of long-duration spaceflight with a view to colonize extra-terrestrial bodies, such as Mars. However, there is a need to understand the risk of adverse medical events in the hostile environment of space. For example, previous incidences of infectious disease and immune dysregulation during a short-term mission have threatened to jeopardize the crew dynamic and the mission objectives. The risk of infectious diseases to the astronaut is one of the many knowledge gaps that must be addressed before long-duration flight is considered.
Aim:
To review how spaceflight impacts an astronaut’s in-flight susceptibility to infectious diseases.
Methods:
Research was guided by the Microbiology section of the NASA Human Research Roadmap Program. Search terms in the University of Adelaide Library Search database collection included: “infectious diseases + spaceflight,” “astronaut + immunity,” “analog,” and “inflammatory marker.”
Results:
Studies that have been conducted in-flight and on Earth demonstrate that both the astronaut and the microbe are affected by spaceflight. Stress, microgravity, and the isolated nature of the spacecraft have been found to compromise the immunity of the astronaut, as shown by reduced T cell counts and increased viral shedding of dormant viruses. Microbes have demonstrated rapid adaptation mechanisms, including genetic mutation and increased virulence.
Discussion:
This paper identifies a significant need for further research into host immunity during spaceflight to mitigate infectious disease risk. It is recommended that in-situ studies and terrestrial space analogs are most effective and that current knowledge on the principles of wilderness and expedition medicine be applied where possible.
More than one million runners have joined the marathon games since 2007 in Taiwan. There were over 150 marathon games held in Taiwan in 2018. The increase rate was 21% as compared to that of 2014. The medical encounter rate was 1.33% in 2015 and increased to 1.41% in 2017. The most common type of injury was muscle spasm. The second most common was abrasion due to falls. The treatment for muscle spasm was RICE only. Cardiac arrest of marathon runners was reported occasionally and time is critical for rescue.
Aim:
To shorten the rescue time of the runners in an emergency. Base on the prodromal research, BLE communication technology is further used to improve the rescue positioning communication technology in the marathon.
Methods:
After rescue notification devices have been set up in each 0.5 km on the runway of the marathon, the runner can send a rescue signal through the rescue notification devices in case of emergency. The rescue signal, periodically advertisement SN# with rescue mark, of the runner can be precisely located and the rescue can be started very soon.
Results:
In the simulation, the rescue signal can be located in 7.5 minutes, fastest in 3 seconds. The precision rate of timing is ±160ms/6σ that under IAAF accuracy requirement. The location error is less than 20 meters, and the rescue time can be shortened to one half as before.
Discussion:
The rescue time of runner is correlated with the quality of marathon EMS. It is critical to the runner, especially in cardiac arrest. By using BLE communication devices, the runner can be located faster and more precisely. As rescue time shortened, CPR & AED can be given sooner. The quality of marathon EMS will be improved substantially.
Some patients presenting to rural or regional hospitals may be deteriorating so rapidly that emergency procedures might be necessary before transfer to specialist facilities. Such interventions might include placement of an ICC, establishing a surgical airway, evacuation of an EDH, laparotomy, or intra-abdominal packing. The treating clinician may have had little or no experience in the procedure. Interactive telepresence technology offers further point of care support to the treating clinicians through the virtual presence of a specialist from a major trauma center.
Aim:
To explore the feasibility of wearable interactive telepresence technology that can provide sub-specialist support to remote clinicians treating patients with traumatic injuries.
Methods:
Thirty-seven wearable near-field display devices and annotation software applications were tested against a set of pre-specified technical and user experience requirements. A shortlist of three devices and two software applications underwent usability evaluations with a convenience sample of 24 junior clinicians and sub-specialists. The junior clinicians trialed the wearable devices and the sub-specialists trialed the annotation applications in three simulated trauma scenarios. Measures included participants’ ratings of acceptance and workload, technical issues encountered (e.g. frequency of call drop-outs), and anecdotal comments.
Results:
Participants’ subjective ratings of the solutions and anecdotal feedback were positive. However, there was no clear solution that satisfied the functionality and ease-of-use requirements for all participants. For example, the solutions that were rated more favorably by the junior clinicians were rated less favorably by the sub-specialists, and vice versa.
Discussion:
This work provided preliminary evidence of the feasibility and usefulness of interactive telepresence technology in healthcare. A second phase of usability testing is currently underway to explore additional device and software combinations, including those with augmented reality functionality. Future phases of the project will evaluate the solutions under higher-fidelity conditions followed by in-situ trials across selected regional centers.