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The Kingdom of Bhutan is a small, mountainous country with limited financial resources. Its population is scattered in hard-to-reach villages with poor road access. Ambulance drivers piloting Toyota Landcruisers provide the majority of the country’s emergency response and are dispatched by the national emergency response center (Health Help Service/112) to calls in the nation’s twenty districts.
Aim:
By collecting and analyzing prehospital response data, we aimed to describe Bhutanese emergency medical response (EMS) ambulance activities and make system-wide recommendations to improve the speed of emergency vehicle dispatch, reduce the time between ambulance activation and ambulance arrival on scene, and adequately describe emergency vehicle drive time as it relates to distance driven.
Methods:
The following data was compiled in Excel: Dispatch center phone records, EMS ambulance activation times, drive times, vehicle geospatial data, and written records of ambulance drivers. No identifiable data was collected.
Inclusion Criteria: All prehospital calls from 2017 and 2018 where complete data was available.
Exclusion Criteria: Complete data unavailable, i.e. geographic data without a matching call or report.
Statistical Tools: SPSS Statistics Version 25, NVivo 12-12.2.0.3262.
Results:
Preliminary analysis of the data shows a significant difference between data collected and data previously reported, the speed of emergency vehicular response and dispatch, drive times, and distance traveled. Facility transfer rather than scene response was found to take more time.
Discussion:
Due to adverse road conditions, lengthy drive times, and an inadequate number of personnel and satellite ambulance locations, we recommend optimizing ambulance location using an optimization model that will minimize the number of ambulances needed and maximize response time. Future considerations may include adding a ground arm to the Bhutan Emergency Aeromedical Retrieval team, or a second aeromedical team in the eastern part of the country.
More than 14 million children in the United States attend summer camps yearly, including many special medical needs children. Summer camps are at risk for multiple pediatric casualties during a disaster. The American Camp Association, in the 2017 critical issues report, identified emergency preparedness as the top critical health and safety issue. Camps, compared to school-based settings, face unique challenges when planning for disasters, but research has been challenging because of the lack of access to camp leadership and data.
Aim:
Provide a targeted up-to-date synopsis on the current state of disaster preparedness and ongoing collaborative research and technology interventions for improving preparedness among summer camps.
Methods:
Researchers partnered with a national health records system (CampDoc.com) and American Academy of Pediatrics disaster experts to review results from a national camp survey. Main themes were identified to assess gaps and develop strategies for improving disaster preparedness.
Results:
169 camps responses were received from national camp leadership. A substantial proportion of camps were missing 4 critical areas of disaster planning: 1) Most lacked online emergency plans (53%), methods to communicate information to parents (25%), or strategies to identify children for evacuation/reunification (40%); 2) Disaster plans failed to account for special/medical needs children (38%); 3) Staff training rates were low for weather (58%), evacuation (46%), and lockdown (36%); 4) Most camps (75%) did not plan with disaster organizations.
Discussion:
Collaboration with industry and disaster experts will be key to address the gaps identified. Current research and interventions include the recent release of a communication alert tool allowing camps to send mass text emergency notifications. Additionally, a recent pilot to incorporate disaster plans into the electronic health records platform emphasizing communication, evacuation, and identification of local experts has begun. Efforts to develop a unified disaster tool kit for summer camps remains a challenge.
Major injury incidents in underground metalliferous and mineral mines are rare, but if, e.g., a major fire would occur, it is the emergency medical service (EMS) together with the mining company and rescue service who perform the rescue operation. Therefore it is important to develop safe and efficient rescue operation procedures for all the organizations involved, especially the EMS personnel.
Aim:
To examine EMS personnel’s perceptions and experiences regarding underground mining incidents.
Method:
Individual interviews were performed with 13 Swedish EMS personnel. The interviews were transcribed verbatim and analyzed with qualitative content analysis.
Results:
The theme “providing the same care in a difficult environment” emerged. Depending on the type of incident, the EMS personnel considered if the injured mining workers could be cared for either outside or in the mine in order to access and care for the injured mining workers as quickly as possible. The EMS personnel mentioned that it was difficult to make the decision if they should enter the mine or not due to the uncertainty of their safety. They also considered that it could be harder to accomplish the same level of care as in other incidents due to the difficult environment. In some instances, they cannot drive their ambulance vehicles into the mine, so they have to prioritize which equipment to bring as well as consider how to transport the patients.
Discussion:
The results identify some of the difficulties the EMS find challenging. Therefore the results could be used in finding solutions and making the EMS prepared for an effective and timely response for injured in underground mines.
The large number of casualties during major or mega-disasters are a global problem.
Aim:
The role of medicine against mega-disasters is analyzed from a worldwide perspective.
Methods:
Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.
Results:
These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).
Discussion:
Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.
Mass gatherings may have far-reaching effects on medical care because of the potential high load on the health care system. In preparation of large events (mass gatherings), such as music festivals or marathons, an extended risk assessment forms the basis for issuing advice on health and safety and possible necessary precautionary measures. In the Netherlands, the 25 regional Public Health Directors are responsible for public health and safety. This includes responsibility for advice on large-scale events, based on which the local authorities (e.g. the mayor) decide on the approval. Health care professionals are looking for better tools with regard to the arising dilemmas around responsibilities and risks. Also, as new forms of events are created, uniform (safety) regulations are lacking. GGD GHOR Netherlands (Dutch Society of the regional Public Health Services [GGD] and Major Incident Medical Planning and Coordination Offices [GHOR]) has updated the existing national guideline in collaboration with the Academic Network for Applied Public Health and Emergency Management (Anaphem). The focus was on improving the guideline by including all current expertise and experience in the field.
Methods:
Various expert sessions were held in 2017 and 2018 to collect all relevant knowledge, evidence, and experience that is currently accessible to develop an improved uniform approach for risk assessment and process steps.
Results:
A new dynamic national guideline, including factsheets in various topics being effective by 2019. As a result, a list of topics is formulated for further research.
Discussion:
The new guideline includes the current knowledge and raised awareness among the experts of some important gaps in current evidence on several topics.
Published reports on health impacts from natural disasters causing injuries, poisonings, infectious disease, chronic illness, and NCDs continue to grow exponentially. Simultaneously, calls for the improvement in scientific rigor to improve causal links, strength of association, and efficacy of interventions are increasing. At the heart of this challenge is demonstrating mortality and morbidity risk across a time continuum, where the health effect is not detected for weeks, months, or years after the disaster event. In some circumstances, the presence and acuity of illness are not apparent until after an insidious or cumulative point has been reached. Notwithstanding medical observations or disaster-attributed morality classification matrices being available for 20 years, natural disaster mortality continues to be measured narrowly, on those confirmed dead (acute physical trauma, drowning, poisoning, or missing). There has been little effort to expand mortality assessment beyond this historical lens. For example, it fails to consider suicide in drought and was not redefined when the Indonesian fires caused the highest mortality in 2015. Tens of thousands of lives were lost from smoke exposure.
Aim:
This study sought to test the progress of two decades of published medical and scientific literature on natural disaster mortality reporting.
Methods:
A retrospective analysis of natural disaster impact reports for the past ten years was performed on three of the world’s largest disaster databases, including CRED, Sigma, and ADRC.
Discussion:
WADEM members must commence a strategic process to expand the recognition of health impacts from natural disasters. Global and domestic advocacy is required for building evidence through improved systematic collection of data and especially reporting patient continuum of care as a minimum standard. Without this leadership, disaster health impacts will continue to be underestimated and emergency health program responses and financial resources will fall short in protecting those most at risk.
Canada, like many countries, increasingly faces environmental public health (EPH) disasters. Such disasters often require both short- and long-term responses, necessitate evacuation and relocation, cause major environmental impacts, and generate the need for specific knowledge and expertise (chemistry, epidemiology, risk assessment, mental health, etc.).
Aim:
Given the importance of evidence-based, risk-informed decision making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster risk management in several Canadian and other jurisdictions.
Methods:
In-depth interviews were conducted with 23 leaders in disaster risk management from Canada, United States, United Kingdom, and Australia, and were complemented by other methods (i.e. participant observation, information gathered from participation in scientific events, and document review). Three criteria were explored: governance, knowledge creation and translation, and related needs and barriers. An interview guide was developed based on a standardized toolkit from the World Health Organization. Data were analyzed through a four-step content analysis.
Results:
Six cross-cutting themes emerged from the analysis. These themes are identified as critical factors in successful disaster knowledge management: 1) blending the best of traditional and modern approaches, 2) fostering community engagement; 3) cultivating relationships, 4) investing in preparedness and recovery, 5) putting knowledge into practice, and 6) ensuring sufficient human and financial resources. A wide range of promising knowledge-to-action strategies was also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources.
Discussion:
There is no single roadmap to incorporate EPH knowledge and expertise into disaster risk management. Our findings suggest that beyond structures and plans, it is necessary to cultivate relationships and share responsibility for ensuring the safety, health, and wellbeing of affected communities while respecting the local culture, capacity, and autonomy. Any such considerations should be incorporated into disaster risk management planning.
Every year, 71% of all deaths globally are due to NCDs. Over 85% of these deaths occur in low- and middle-income countries (LMICs), with 36% of all reported deaths in Rwanda attributed to NCDs. Approximately 24 million lives are lost each year in LMICs due to emergency medical conditions. The collaboration between VCU and the EMS Rwanda designed and implemented a pre-hospital medical emergencies training course and train-the-trainers program to address the rise of NCDs.
Methods:
During the course, pre and post 50 assessment questions were administered. Two cohorts participated 25 prehospital staff identified by EMS to form an instructor core and 19 emergency staff from public hospitals who are likely to respond to local emergencies in the community. A two-day EMCC was developed using established best practices. The Instructor core completed EMCC 1 and a one-day educator course and then taught the second cohort (EMCC2). Student’s t-test and matched paired t-tests were used to evaluate the assessments.
Results:
Mean score on EMCC 1 was 43% (SD: 20) compared to 85% (SD: 5) on post-course assessment. Pre-assessment failure rate was 88%. Mean scores for EMCC 2 were 45% (SD: 14) and 81% (SD: 10) on post-assessment. Pre-assessment score was low (50%). A paired t-test comparing pre-course to post-course assessment means demonstrated an increase by 42% (SD 30) for EMCC 1 (p<0.001) and 37% (SD: 14) for EMCC 2 (p<0.001) with 95% confidence. No items had to be removed from analysis based on the discrimination index (di).
Discussion:
NCDs often present as emergencies such as myocardial infarction and stroke. Effective management of these in the prehospital setting is essential to optimal outcomes. This study effectively implemented a training program in Kigali, Rwanda and created an instructor core to allow scale-up of effective pre-hospital services across the country.
The purpose of this pilot study was to analyze the current cold chain storage methods of Class 8 stores, specifically thermolabile medications and temperature sensitive diagnostics, dressings, and fluids, for the Australian Army in a training area within Australia. This research was designed to identify deficiencies in current storage methods, including the inability to maintain the recommended storage temperature of pharmaceutical stores in accordance with the Therapeutic Goods Administration, as well as foster communication between key stakeholders, including the Royal Australian Army Medical Corps and the Department of Defence Joint Health Command, and to develop a cold chain protocol specific for the Australian Defence Force.
Methods:
This pilot study identified the common occurrence of breaches in a specific climate and recommends that current mission essential equipment be replaced. It also discusses the need for clearly defined guidelines with accountability of the stakeholders to ensure that the provision of health support to all Australian Defence Force personnel is in accordance with civilian standards.
Results:
This pilot study identified that the carried thermolabile medications and temperature sensitive diagnostics, dressings, and fluids were commonly exposed to temperatures outside the range recommended by the manufacturers. These findings related mainly to the storage equipment for Class 8 stores used by the Army. As a result, it is recommended that such equipment is replaced so that the cold chain storage meets the Therapeutic Goods Administration Guidelines to ensure that health support to Australian Defence Force Personnel in the field is in accordance with the standard of care expected at a civilian health facility.
Discussion:
This pilot study has enabled the Australian Defence Force to qualify and quantify the temperature exposure of the medications and stores and engage with key stakeholders to trial and apply new technologies and processes for the management of the cold chain.
Venezuela has plunged into a humanitarian, economic, and health crisis of extraordinary proportions. This complex situation is derived from dismantling of structures at the institutional, legal, political, social, and economic level affecting the life and wellbeing of the entire population.
Aim:
This study aims to assess the impact of Venezuela’s healthcare crisis on vector-borne and vaccine-preventable diseases and the spillover to neighboring countries.
Methods:
Since October 2014, there is a paucity of official epidemiological information in Venezuela. An active search of published and unpublished data was performed. Venezuela and Latin America data were sourced from PAHO Malaria Surveillance and from Observatorio Venezolano de la Salud. Brazil and Colombian data were accessed via their respective Ministries of Health.
Results:
Economic and political mismanagement have precipitated a general collapse of Venezuela’s health system with hyperinflation rates above 45,000%, people impoverishment, and long-term shortages of essential medicines and medical supplies. In this context, the rapid resurgence of previously well-controlled diseases, such as vaccine-preventable (measles, diphtheria) and arthropod-borne (malaria, dengue) diseases has turned them into epidemics of unprecedented magnitudes. Between 2000-2015 Venezuela witnessed a 365% increase in malaria cases followed by a 68% increase (319,765 cases) in late 2017. The latest figures have surpassed 600,000 malaria cases with a prediction to reach 1 million by the end of 2018. Measles and diphtheria have recently re-emerged after a progressive interruption of the national immunization program, with vulnerable indigenous population being particularly affected. In response to Venezuela’s rapidly decaying situation, a massive population exodus is ongoing towards neighboring countries causing a spillover of diseases.
Discussion:
Action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. Global and hemispheric health authorities should urge the Venezuelan government to allow establishing a humanitarian channel to bring relief.
Major incident exercises are expensive to plan and execute, and often difficult to evaluate objectively. There is a need for a generic methodology for reporting results and experiences from major incidents so that data can be used for analysis, to compare results, exchange experiences, and for international collaboration in methodological development. Most protocols use data describing the incident hazards, prehospital and hospital resources available and alerted transport resources, and communication systems. However, the successful management of a rescue response during a major incident also demands a high level of command skills.
Aim:
The aim of this study was to analyze the command and collaboration skills among the emergency service on-scene commanders and the mine director for safety and security during a full-scale major incident exercise in an underground mine.
Methods:
The commander functions were observed during a full-scale major incident exercise. Audio and video observations and notes were analyzed using a study-specific scheme developed through a Delphi study, including inter-agency collaborative support and efforts of early life-saving interventions; relevant resources and equipment; and shared and communicated decisions about safety, situation awareness and medical guidelines for response. After the exercise additional interviews were made with those responsible for the command functions.
Results:
Preliminary results indicate that most decisions were not taken in collaboration. Elaborated results will be presented at the conference.
Discussion:
Command and collaboration skills can benefit from objective evaluations of full-scale major incident exercises to identify areas that must be improved to optimize patient outcome.
Disaster medical team response by governmental and non-governmental responders is highly variable and poorly characterized. Each response is unique in terms of caseload, patient demographics, and medical needs encountered. This variability increases the difficulty of determining team member composition as well as supply and equipment needs. In an effort to demonstrate this issue, we have reviewed the National Disaster Medical Response to Hurricane Sandy.
Methods:
This project was a retrospective chart review of Hurricane Sandy data abstracted from the National Disaster Medical System (NDMS) Health Information Repository (HIR) medical records from the NDMS system response, and were abstracted for data including vital signs, ages, sex, chief complaint, and final impressions. In addition, length of stay among other parameters was abstracted. The data was analyzed using Microsoft Excel and Access with descriptive statistics. In addition, the results were compared to similar indices in a community emergency department and prior NDMS responses.
Results:
The results indicate a wide range of patient ages, chief complaints, and final impressions. The vast majority of patients seen by Disaster Medical Assistance Teams (DMAT) were stable with relatively low acuity issues. The total number of charts reviewed were 7,905. Respiratory complaints were the most frequent at 845 patients followed by toxicology/injuries at 706 patients and mental health issues at 452 patients. In approximately 3,400 patients, no diagnosis was present in the chart. Length of stay averaged below 1 hour and peak patient ages were between 50-60 with a significant number of infants less than 2 years.
Discussion:
Characterization of NDMS responses by DMATs and comparison with prior events and community emergency department caseloads can provide an insight into the needs of DMATs and other response organizations in future responses.
At various accidents or disaster sites, rescue, first aid, and transport to hospitals has been provided by ambulance crews (paramedics). In the case of mass casualties, they also need to operate triage for injured people.
Aim:
To consider and reveal challenges in triage by ambulance crews (paramedics) on-site.
Methods:
Interviews of seven ambulance crews (paramedics) and their instructors were conducted and their answers were analyzed.
Results:
(1.) Triage black tags: declaring “deceased: not able to survive” might give a heavy mental burden and psychological responsibility. Legal protection and an interstitial rule will be necessary in the future. (2.) Missed triage: the ambulance crew cannot perform a triage that may develop a legal problem. It is always important to prevent ambulance crews from being charged. (3.) Triage education and training: there are few triage trainings at fire departments although the number of emergency medical responses is increasing compared to fire response. It will be necessary to increase time of the triage education and training in near future. (4.) Command system (characteristic rank system in the fire department): There is a problem with the rank system in fire departments since confusion occurs when a commander of the First Aid Station is not a licensed paramedic. The ambulance crew (paramedic) usually consists of the three different ranked people. Individual operations are difficult during operation. Education for the paramedic executive is necessary for the fire organization.
Discussion:
For the triage by ambulance crew (paramedic), legal protection by medical control operation is required, and it may lead to a reduction of heavy mental burden. Triage training is needed to improve the training of triage. The ambulance crew (paramedic) operates under the fire department command system. However, at the time of disaster, the ambulance crew (paramedic) should also work under the medical command system.
Use of Point-of-Care Ultrasound (US) has grown considerably in resource-limited and wilderness environments because of a combination of features, including portability, durability, and safety. However, the optimal method of powering US devices in such environments is not well established.
Aim:
This project has the following aims:
1. Develop a solar power generation and storage system that maximizes power capacity and minimizes weight while being easily transportable by a single person.
2. Test the system in a real-world environment to evaluate actual performance relative to stated performance.
3. Determine the approximate US scan-time where solar systems would outperform pre-charged batteries with respect to weight.
Methods:
We developed multiple solar collecting systems using a combination of polycrystalline, monocrystalline, and thin-film solar arrays paired with different powerbanks and tested them using a variety of US systems. From this, the duration of usage was calculated, which makes the solar power generation system a superior option to pre-charged batteries.
Results:
Lithium-ion energy storage was found to be superior to lead-acid batteries for multiple reasons, most prominently, weight. Several models of US systems were tested revealing that portable US systems consume between 30 to 50 watts. Tri-fold monocrystalline solar panels coupled with lithium-ion powerbanks provided the best combination of weight and transportability. Total weight of the combined solar array, powerbank, and US system is 10 kilograms and easily packs into a backpack carrier. It was found that systems using solar generating capacity become superior to pre-charged powerbanks in regard to weight at approximately 14 hours of scanning time.
Discussion:
While these results are not fully generalizable due to seasonal and geographic variability as well as the type of US system used, use of solar generating capacity to power US systems is optimal for extended durations of use in resource-limited environments.
Bruges is the largest city in the province of West-Flanders in Belgium. Because of its ample canals, it is sometimes referred to as “Venice of the North.” As such, it is a major tourist destination, and during New Year’s Eve, there are many festivities. The AZ Sint-Jan is the largest hospital providing medical care to the area.
Aim:
To examine the impact of the New Year’s Eve festivities on the workload of the emergency department of AZ Sint-Jan.
There were 826 patients included for analysis. On average, 41 patients presented themselves to the emergency department on New Year’s Eve between 06:00 PM and 08:00 AM. On a random day, there were only 31 patients. Most of the patients on New Year’s Eve arrived between 00:00 AM and 08:00 AM. 57% of all patients were male. 22% of all patients were intoxicated with alcohol. From 00:00 AM until 08:00 AM, one in three patients were intoxicated. The average age on admission was 36 years.
Discussion:
During New Year’s Eve there is a consistently higher workload in the emergency department. There is an influx of young males who are intoxicated. These patients tend to stay a long time to “sleep it off” and put considerable stress on the available resources. More attention should be given to risk mitigation strategies tailored to this group to prevent excessive drinking.
Emergency situations (ES) are situations within a certain territory, which have arisen because of an accident, a dangerous natural phenomenon, natural disaster, or other that may cause or have caused human casualties, damage to human health or the environment, significant material losses, and unbalance of living conditions of people. Important characteristics of ES are suddenness and involvement of a significant number of victims who need first aid and emergency medical care. These characteristics determined the organization of the Unified State System for Emergency Prevention and Elimination of the Russian Federation.
Aim:
To study the structure of ES in Russia. By the scale of spread and damage caused, ES can be local, municipal, inter-municipal, regional, interregional, or federal, by the source of origin – technogenic, natural, biological, or social. The terrorist acts are usually allocated in a separate group of ES. The structure of ES, according to the EMERCOM of Russia in 2005-2017, is as follows:
1. Technogenic (59.61%)
2. Natural (29.42%)
3. Biological and social (9.91%)
4. Major terrorist acts (1.06%)
Methods:
Statistical analysis was conducted. According to the EMERCOM of Russia, every year in 2005-2017 there were 422.5 ± 46.5 ES, resulting in the death of 796 ± 56 people. Polynomial trends in the number of ES and deaths, according to the EMERCOM of Russia, (with significant coefficients of determination R2 = 0.85 and R2 = 0.64, respectively) show a decrease in the number of ES and deaths.
Discussion:
The resulting analysis of the structure and number of ES, the number of deaths, the risk of being in an emergency, and the individual risk of death in an emergency can predict the forces and means necessary for the elimination of the consequences of ES.
Fatalities at music festivals are seldom reported in the academic literature, making it difficult to understand the full scope of the issue. This gap in our knowledge makes it challenging to develop strategies that might reduce the mortality burden. It is hypothesized that the number of fatalities is rising. Building on earlier research, two further years of data on mortality at music festivals was analyzed.
Methods:
Synthesis of grey/academic literature.
Results:
The grey literature for 2016-2017 documented a total of 201 deaths, including both traumatic (105; 52%) and non-traumatic (96; 48%) causes. Deaths resulted from acts of terror (n = 60), trampling (n = 13), motor-vehicle-related (n = 10), thermal injury (n = 6), shootings (n = 5), falls (n = 4), structural collapses (n = 3), miscellaneous trauma (n = 2), and assaults (n = 2). Non-traumatic deaths included overdoses/poisonings (n = 41), miscellaneous causes (n = 36), unknown/not reported (n = 18), and natural causes (n = 1). The majority of non-trauma-related deaths were related to overdose (44%). No academic literature documented fatalities that occurred while attending a music festival during 2016 or 2017.
Discussion:
Reports of fatalities at music festivals are increasingly common. However, the data for this manuscript were drawn primarily from media reports, a data source that is problematic. Currently no rigorous reporting system for fatalities exists. In the context of safety planning for mass gatherings, a standardized method of reporting fatalities would inform future planning and safety measures for festival attendees. The hypothesis that mortality rate reporting increased was substantiated. However, the proliferation of music festivals, the increase in attendance at these events, and the overall increase in internet usage may have influenced this outcome.
The SALT Triage system has been advocated as an easy-to-use sorting and treatment system for mass casualty incidents (MCI). Minimally injured (GREEN) patients tend to be in the majority and may cause impediments to access and treatment of the most critically injured (RED). By identifying flaws in MCI communications that impair effective patient care, responders can be more effective.
Aim:
To discover strategies that effectively manage the minimally injured and leverage their help, increasing triage efficiency and treatment of the immediate casualties.
Methods:
Direct observation, after-action debriefing, and literature search.
Results:
The literature was vague regarding recommendations on a bystander and trained provider communication best practices. Feedback from standardized patients (actors) and participants during a structured debriefing following a 2018 American Society of Anesthesiology MCI exercise suggested that triaging providers under stress may communicate poorly, contributing to increased patient anxiety, disruptive behavior, and less effective team dynamics during a disaster. Strategies suggested include: eye contact; therapeutic touch (culturally appropriate); using slow, clear, reassuring speech; clearly explaining what is happening and why (sickest (RED and YELLOW) first priority, minimal (GREEN) next, expectant (BLACK) last); acknowledging their emotional state and their grief (not ignoring them); assigning nontechnical tasks to those capable of helping (putting pressure on a wound, moving casualties, or comforting the injured, dying, and the emotionally distraught).
Discussion:
Bystander engagement has been repeatedly identified as a means to increase the capacity of first responders to provide care to patients during an MCI. Utilization and management of the minimally injured and any uninjured bystanders and responders can become a force multiplier for the triage/treating responders. Developing a best practice dialogue to be used in training first responders could help improve many of these issues and augment current MCI training programs.
As Israel's National Emergency Medical Services (EMS) provider, Magen David Adom (MDA) is constantly looking for ways to improve the response to mass casualty incidents (MCIs). Previous research has shown that in an MCI situation, the demand for resources is disproportionate to the available resources, thus creating a dilemma of how to triage and treat the patients, as well as how to best prioritize and treat the critical patients.
Aim:
Smartwatches have become an integral part of society. MDA constantly looks for ways to integrate new technologies into their emergency response protocols. Smartwatches were used in this experiment to determine if in an MCI, relaying live information to the dispatch center would improve the time it takes for emergency crews to effectively treat and transport critical patients.
Methods:
A drill and scenario were designed to simulate an MCI in which there were 3 severe, 2 moderate, and 5 lightly wounded patients. There were then different colored smartwatches placed on each victim. The watches transmitted real-time blood pressure, pulse, and oxygen saturation readings to the dispatch center. The live information was transferred directly to responding teams. A second drill was conducted using the same scenario, same number of patients, but without watches to examine the differences in response times.
Results:
MDA found that the use of smartwatches directly improved the times (by 3.27 minutes) in which emergency teams were able to reach the most severely wounded patients and evacuate them to the hospital in a timely manner.
Discussion:
Using smartwatches to transmit live information to the dispatch center allowed for effective treatment and transport of patients in an MCI. Use of such information allows the dispatch center to direct teams to provide accurate treatment to the patients according to their needs.
Public health (PH) and nursing students are an underutilized demographic in disaster response. Knowledge of the disaster response phase may enhance student understanding of preparedness, and provide response capabilities.
Aim:
A single four-hour simulation-based training session, with toxicologists as instructors, can effectively improve PH and nursing student knowledge and skills in chemical and radiation response, despite minimal prior experience.
Methods:
A convenience sample was used to test PH and nursing students in a response training program. An introductory lecture and simulation training reviewed: mass casualty care, triage, personal protective equipment, decontamination, and chemical and radiation exposure toxidromes. An examination was administered pre-training, and then post-training, to evaluate relevant training, knowledge, risk perception, and comfort in response capabilities to chemical and radiation incidents.
Results:
Forty-two students attended the course; 39 were included in the study. Seventy-two percent (n=28) of participants had no prior disaster training. Overall, there were significant differences between the pre-test and post-test scores for all students [95% CI: 5.4 (4.7-6.1); p<0.0001, paired t-test]; maximum score 15/15. Comparing scores of nursing and PH students, despite statistical difference in pre-test scores (median, IQR: 9.0 (7.5-10±2.0); 7.0 (5.7-9.0) respectively; p=0.048, Mann Whitney U-test), there were no statistical differences in post-test scores (median, IQR: 14.0 (13.0-14.0); 13.0 (12.0-14.0), respectively, Mann Whitney U-test). All students recognized nerve agent toxidrome and performed SALT triage after the training (p <0.0001, McNemar test). Subjectively, participant comfort level in responding to a chemical or radiological incident improved (p <0.0001, McNemar test). Individual risk perception for chemical or radiological disasters did not improve after training.
Discussion:
Improvement of knowledge and comfort was demonstrated, irrespective of previous experience. Simulation-based training of chemical and radiation disaster preparedness, led by medical toxicologists, is an effective means of educating PH and nursing students, with minimal prior fluency.