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In the southern Philippines, human-induced disasters, such as terrorist attacks, have caused unprecedented damage to the economic, social, and political life of the attacked and nearby areas. More gruesome is the direct impacts to human life and wellbeing. This study focuses on the 2017 Marawi armed siege, the longest urban battle in the Philippines. The 154-day siege took a heavy toll, including 1,132 deaths among militants, soldiers, police, and civilians, and caused the displacement of some 400,000 local inhabitants. The city is in total ruins leaving its economic center as “Ground 0.” The aftermath of the siege demands major interventions to address physical and economic damages, but more importantly, to ameliorate the human impacts caused by the brutalities of war. The displaced peoples need to recover from health impacts – psychological trauma, as well as social, environmental, and cultural. The Sendai Framework for Disaster Risk Reduction (DRR) 2015-2030 states that DRR requires society-wide engagement. Everyone, regardless of their age, gender, ethnicity, religion, or socio-economic position, should be involved in thinking, planning, and deciding about DRR. Studies on youth participation in disaster recovery are still scarce.
Aim:
This current research aims to help fill this gap and to contribute to providing the much-needed evidence base for the formulation and implementation of future policies to enable and improve youth participation in post-disaster initiatives in the Philippines.
Results:
Initial findings reveal that the following are crucial factors for youth mobilization: (1.) avenues for volunteering, (2.) access to adequate resources and support including information, funds, manpower, and social capital, (3.) opportunities for the youth to participate in the form of events or activities, (4.) legal mandate for youth participation in local, national, and international policies and frameworks. The study also looked at barriers or challenges to youth participation and their motivations.
This research builds on a previously developed triage: Mass Gathering Triage Scale (MaGaTT) by Cannon, et al (2017). This tool was targeted towards non-health care professional first responders within mass-gathering events (MGEs). However, this tool had not been evaluated.
Aim:
To further develop the previously designed MaGaTT using vignettes of clinical cases to: 1) determine variation in decision-making, and 2) inform further tool development prior to real-world testing.
Methods:
Volunteer members of St. John Ambulance Australia were surveyed using 18 vignettes of de-identified real patient record forms from MGEs covered by St. John Ambulance Australia (NSW) in 2013-2014. Participants were given the MaGaTT and written instructions on its use. Participants triaged 18 patients, recording their decisions on the online survey. Responses against the vignettes were analyzed using Fleiss Kappa [p-bar] measure. A score of 0.61 – 0.8 represented substantial agreement and a score of between 0.41 and 0.6 represented moderate agreement between participants.
Results:
There were 110 completed responses. The majority of participants were male (n =66, 60%), having completed a Bachelor’s Degree (n =38, 34.5%), and holding the clinical skill level of “first responder” (n=42, 38.2%). The overall agreement [p-bar] for the 18 items was moderate at 0.55. When examined by triage category, the “Resuscitation” category had substantial agreement (0.69), when compared with moderate agreement for “Urgent” (0.52) and “Minor” (0.52) categories.
Discussion:
This research demonstrates that the MaGaTT can be used with moderate agreement, and substantial agreement within the resuscitation category. This is similar to triage tools internationally, where high levels of agreement relate to triage categories for patients requiring resuscitation when compared to patients requiring lower levels of clinical care. Slight changes have been made to the original MaGaTT as a result of this research.
Nankai Trough earthquake, with an anticipated death toll of 323,000, is a disaster for which the country of Japan set the highest priority on building capacities. Tokushima prefecture aims to minimize preventable death among survivors and has strived to build a medical and health response system and strengthen outreach systems for vulnerable populations. To actualize these aims, Tokushima prioritized human resource development.
Methods:
Tokushima has initiated periodic trainings based on the Sphere Standard, the internationally recognized minimum standards for humanitarian aid, since 2015. The trainings were conducted by certified trainers and trainees received an official certification recognized by the Sphere Project, Geneva. The training materials were localized and the trainings were contextualized to Japan as a developed and super-aged nation. The learning outcome was evaluated by a pre-post test.
Results:
Between April 2015 and November 2018 the two-day training was held seven times. There were two hundred twelve participants from various clusters such as health, education, logistics, nutrition and food, security, and protection. The results of the pre-post test were statistically significant (still in process) indicating the effectiveness of the training on knowledge. Training evaluations suggest nurturing ethical attitudes and skills utilizing the Sphere Handbook.
Discussion:
Despite under-recognizing the Sphere Standard in Japan, the Standard has been incorporated into the disaster risk reduction plan in Tokushima. For larger scale human resource development, training local representatives to be trainers would be the next step.
Tracking patients through health systems is fundamental to coordinated care provision. However, it is an inconsistent element of emergency preparedness. This presentation presents findings of a study undertaken after the 2011 Christchurch Earthquake, and the resultant nationally implemented changes.
Aim:
The intent was to investigate options to improve patient tracking in a mass casualty event. By looking at one scenario involving a mass casualty presentation with the central responder disabled by electricity loss, standards of practice were outlined and made scalable to meet the needs of various events.
Methods:
Clinical and clerical staff involved in the event’s patient tracking were interviewed. Data were analyzed using thematic analysis and reported using the structure, process, and outcomes framework.1
Results:
Structures were material and human resources. Material resources were identification number systems, technological requirements, disaster-specific documents, minimum data for entry, digital/paper/hybrid registration systems, and digital-paper integration. Human resources were role allocation, and familiarity of plans, roles, processes, tools, and facilities. Process identified the activities to manage unidentified patients, triage, registration, and ongoing tracking processes. Outcomes were management of patient flow, patient-care provision, and patient-family reunification.
Initial implementation was local. Structures and processes were agreed upon, with varying response levels according to the incident scope, while staying as close to business as usual for familiarity. National implementation followed via a Ministry of Health working group involving different district health boards. The group developed a consensus on the minimum data to be entered and the process to merge patient identities of initially unidentified patients. Written tools were shared for standardization.
Discussion:
With inter-agency and inter-organization emergency response, standardized processes and information are required. Collaboration prior to events can mitigate issues when an event occurs.
With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.
Aim:
This study assesses this model of response and evaluates it within the context of periop disaster exercises.
Methods:
The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.
Results:
Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.
Discussion:
Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.
Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1
Methods:
A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.
Results:
Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.
Discussion:
Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.
The US, as well as many countries, are being beseeched by more natural and man-made events; both small (e.g., shootings) and geographically vast (e.g., floods). Due to a myriad of issues, traditional first responders i.e., EMS, fire department, and police cannot be expected to be the only trained lifesavers on the scene. In the US (as in many countries), it is imperative to begin the discussion to better understand the role of the “injured” and “immediate” responders and how they interact with the “first” responders.
Aim:
To open a discussion amongst disaster experts about the merits of training and subsequent promotion of a curriculum for “immediate” responders.
Methods:
Literature review.
Discussion:
After recent evaluations of events, it is postulated that there are three categories of responders: the injured, the immediate, and the first (EMS, fire department, police). The premise upon which disaster risk reduction and building community resilience are achieved begin with strengthening, empowering, and equipping local populations with the appropriate tools. This would involve education, skills, and training. With the average general public trained, and if they are one of the first two categories, then the community would not only be better able to assist themselves, but also be able to integrate into the recovery process much more quickly and fully. By doing this, they will be empowered to take care of themselves, neighbors, and community, which in turn increases local resilience.
Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.
Aim:
To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.
Methods:
A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.
Results:
There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.
Discussion:
The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
Collaboration between Foreign Medical Teams (FMT) and Host Health Personnel (HHP) is a core standard for healthcare in a medical response to disaster,1 but descriptions of its application from recipient nation HHP are rare. This paper details the findings from a qualitative study on the experience of collaboration between International Foreign Teams (IMT) and HHP in Gorkha, Nepal since the 2015 earthquake.
Aim:
To present findings from a study that explored the experience of collaboration by Nepal health workers working with IMT since the 2015 earthquake.
Methods:
A qualitative study design using semi-structured interviews regarding the experiences and perspectives on collaboration of 12 Nepali health workers was used. The interviews were transcribed, translated, and collated using Nvivo software by QSR international, and themes regarding collaboration were identified.
Results:
Data collection is not yet complete. However, preliminary results from early analysis indicate that collaborative practice is not uniformly applied by IMT. HHP Satisfaction with IMT appears highly dependent on collaboration. Emerging themes are that rigid organizational procedures, language and cultural barriers, and intimidating leadership inhibit collaboration. Objectives were assumed to align immediately post-disaster, with evidence of objectives increasingly diverging over time. IMT leadership that was experienced, responsive to suggestions, and regularly involved HHP in planning, implementing, and reviewing activities were highly appreciated.
Discussion:
Emerging themes indicate the time-critical nature of many disasters, along with cultural/institutional/administrative barriers, make the building of collaborative relationships difficult despite being foundational for successful missions. Participants in IMT must proactively involve HHP in the objectives setting, planning, implementation, and reviewing of activities. Successful IMT participation is not only clinically competent but actively seeks collaborative relationships with HHP throughout the mission.
Between 2000 to 2017, there were over 150 hospital evacuations in the United States. Data received from approximately 35 states were primarily concentrated in California, Florida, and Texas. This analysis will provide disaster planners and administrators statistics on hazards that cause disruptions to hospital facilities.
Aim:
The aim of this study is to investigate US hospital evacuations by compiling the data into external, internal, and man-made disasters thus creating a risk assessment for disaster planning.
Methods:
Hospital reports were retrieved from LexisNexis, Google, and PubMed databases and categorized according to evacuees, duration, location, and type. These incidents were grouped into three classifications: external, internal, and man-made. Both partial and full evacuations were included in the study design.
Results:
There were a total of 154 reported evacuations in the United States. 110 (71%) were due to external threats, followed by 24 (16%) man-made threats, and 20 (13%) internal threats. Assessing the external causes, 60 (55%) were attributed to hurricanes, 21 (19%) to wildfires, and 8 (7%) to storms. From the internal threats, 8 (40%) were attributed to hospital fires and 4 (20%) chemical fumes. From the man-made threats, 6 (40%) were attributed to bomb threats and 4 (27%) gunmen. From the 20 total reported durations of evacuations, 9 (45%) lasted between 2 to 11:59 hours, 6 (30%) lasted over 24 hours, and 5 (25%) lasted up to 1:59 hours.
Discussion:
Over 70% of hospital evacuations in the US were due to natural disasters. Compared to 1971-1999, there was an increase in internal and man-made threats. Exact statistics on evacuees, durations, injuries, and mortality rates were unascertainable due to a lack of reporting. It is critical to implement a national registry to report specifics on incidences of evacuations to further assist with disaster and infrastructure planning.
Deploying an EMT to respond to a sudden onset disaster entails significant operational activities and support back home to deploy and support a responding team. These activities also include peacetime operations, exercising, innovation, engagement, training, and development of both team members and operational staff to further knowledge and experience.
Aim:
To exhibit the operational activities and complexities of maintaining a deployable cache of equipment and consumables for deploying a self-sustaining Emergency Medical Team (EMT). This includes the elements of managing a high-performance team, human resource management ensuring the readiness of personnel to rapidly respond, maintaining World Health Organization (WHO) international standards for EMTs, and the operational aspects and support behind the scenes to deploy a team.
Methods:
Analysis of operational activities and support for pre-deployment, deployment, and post-deployment phases including preparedness through innovation, collaboration, development, and maintenance of a high-performance team and cache.
Results:
The analysis of operational activities behind the scenes of deploying EMT maps the unique complexities of maintaining and deploying a high-performance team at all stages of deployment, demonstrating the success of a team in the field is attributed to the support and activities of the team back home to deploy them.
Discussion:
There is substantial preparation and behind the scenes operational activities that are undertaken to deploy and support a deployed EMT. Lessons learned from each deployment build on the operational capacity of staff deploying a team and on the future directions, innovations, and practices of a deployed team in the field.
Emergency responders face an increasing number of calls involving people with behavioral and mental crisis issue. Integrated multi-agency schemes involving ambulance, police and mental health services are now being developed to provide urgent and emergency care pathways for these vulnerable patients.
Aim:
The objectives were to study the situation, characteristics, issues, and accessibility to emergency medical services (EMS) and appropriate treatment for emergency patients with a mental crisis in Thailand.
Methods:
The sample included 26,511 mental crisis patients accessing EMS. Data were obtained from the database of the Information Technology for Emergency Medical System between 2015-2017 and from stakeholders from four provinces distributed regionally using focus groups and in-depth interviews. The data were analyzed using descriptive statistics and content analysis.
Results:
The number of patients with mental crisis accessing EMS increased in the past three years. Most patients are male in the working age group from the Northeastern area during the raining and winter season, especially between September and October. During patient encounters with maniacal attacks, assistance will be requested from the police and the emergency medical units. The response depends on the experience and community capability. The emergency responder teams had insufficient knowledge and skills. Emergency rooms in most hospitals lack specific caring unit. Psychiatric hospitals have different criteria for admitting patients. Most had no fast track system and even refuse admittance.
Discussion:
Mental crisis patient calls with EMS were rising. However, accessibility to appropriate service centers was still an issue. Most hospitals lack prioritized access and staffs had insufficient knowledge and skills. Cooperation among the police, emergency medical operation team and the rapid psychiatric emergency team is need to be reinforced.
Despite a longstanding focus on examining acute health impacts in disaster research, only limited systematic information is available today to further our understanding of chronic physical health risks of disaster exposure. Heterogeneity of studies and disaster events of varying type and scale compounding this challenge highlight the merit of a consistent approach to examining nationally representative population data to understand distinctive profiles of chronic disaster health risks.
Aim:
This epidemiological study examined the full spectrum and national profile of chronic physical health risks associated with natural and man-made disaster exposure in Australia.
Methods:
Nationally-representative population survey data (N=8841) were analyzed through multivariate logistic regression, controlling for sociodemographic variables, exposure to natural and man-made disasters, and other traumatic events. Key outcomes included lifetime national chronic health priority conditions (asthma, cancer, stroke, rheumatism/arthritis, diabetes, heart/circulatory) and other conditions of 6 month or more duration (based on the World Health Organization’s WMH-CIDI chronic conditions module).
Results:
Natural disaster exposure primarily increased the lifetime risk of stroke (AOR 2.06, 95%CI 1.54-2.74). Man-made disaster exposure increased the lifetime risk of stomach ulcer (AOR 2.21, 95%CI 1.14-4.31), migraine (AOR 1.61, 95%CI 1.02-2.56), and heart/circulatory conditions (AOR 2.01, 95%CI 1.07-3.75). Multiple man-made disaster exposure heightened the risk of migraine (AOR 2.98, 95%CI 1.28-6.92) and chronic back or neck conditions (AOR 1.63, 95%CI 1.02-2.62), while multiple natural disaster exposure heightened the risk of stroke (AOR 3.28, 95%CI 1.90-5.67). No other chronic health risks were elevated. Despite the relatively greater chronic health risks linked to man-made disasters, natural disasters were associated overall with more cases of chronic health conditions.
Discussion:
The analysis of nationally-representative population data provides a consistent method to examine the unique national imprint of disaster exposure and distinct profile of disaster health risks to inform future detection, prevention measures, disaster health preparedness, and response planning.
On February 6, 2018, a 6.0 magnitude earthquake struck Hualien, a county of East Taiwan. Hualien Tzu Chi Hospital, the only tertiary hospital in East Taiwan, activated the mass casualty incident (MCI) call and received 144 patients that night. Our operation did not perform satisfactorily despite regular MCI drills. Thus, a new strategy to cope with the increasing frequency of disaster-related MCIs was developed.
Aim:
To facilitate the management of disaster-related MCIs, we developed a novel Disaster Response System which includes a triage system combining Simple Triage and Rapid Treatment (START) and Five-Level Taiwan Triage and Acuity Scale (TTAS), a novel registration system for MCIs, and anonymous patient identification and reporting system.
Methods:
We begin the triage with the START method and then shift to the TTAS. The new registration system only needs the patient’s gender, age, and triage category. Patients are then assigned to different treatment areas accordingly. Further dispositions are applied after initial stabilization management. To identify the anonymous disaster victims, we take photographs of victims after clean-up and display them on an electronic bulletin with the patient list to the families in our emergency department. Real-time casualty statistics are collected automatically and synchronized to the governmental administrative system.
Results:
This novel Disaster Response System reduces the time from patient arrival to definite treatment and disposition in a simulated mass casualty incident exercise. The victim identification bulletin provides clear information to those who are seeking their family, and thus, avoids the chaos of the scene.
Discussion:
From the experience of the earthquake-related MCI, we found that inadequate training causes time mis-triage and treatment delays. Our Disaster Response System facilitates the workflow with an easily practiced algorithm, reveals on-time and easily accessible information to the public, and altogether improves our MCI management.
The global health threat posed by the ongoing deterioration in natural ecosystems and damage to our physical environment is growing at a rapid pace. Less recognized is the threat from natural hazard disasters, which concentrate contaminants from the damaged environment and expose large vulnerable populations to life-threatening medical conditions and disease. Currently neither international nor any national health and medical emergency response protocols or programs have prepared health responses to protect the health of communities in such events.
Aim:
This study performed a retrospective health risk assessment on two recent events where such impacts unfolded, namely the 2015 southeast Equatorial Asia smoke haze disaster and the 2016 Melbourne thunderstorm asthma epidemic. The primary objective was to test if the characterization of health risk could have been identified earlier and catastrophic levels of mortality and morbidity reduced.
Methods:
The study employed a two-staged retrospective health risk characterization assessment. The first step applied the UNISDR (2017) framework for health risk disaster assessment combing a thematic and targeted word literature review to identify the level of health and medical risk knowledge prior to each event. The second stage applied a risk characterization matrix developed using ISO and Australian Health Department semi-quantitative health assessment standards.
Results:
The 2015 southeast Equatorial Asia smoke haze disaster risk assessment was characterized as an extreme health risk and the 2016 Melbourne thunderstorm asthma epidemic characterized as a high health risk.
Discussion:
Innovative medical response approaches are urgently needed to mitigate the growing health risk to whole populations from natural hazard disasters compounded by deteriorating natural ecosystems and the physical environment. This requires emergency medical and health teams to recognize the two-tailed human health risk from natural disaster hazards, along with investment in advanced planning, environmental risk surveillance, specialist training, technical guidance, and multi-sector coordination.
The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.
Aim:
The goal of this study was to identify strengths and areas for improvement in pediatric disaster preparedness in participating Chicago hospitals.
Methods:
The impact of the EMSC Pediatric Preparedness Checklist was assessed during the 2016 Pediatric Facility Recognition hospital site surveys. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. All survey items were extracted, collated, and reviewed.
Results:
Fourteen Chicago hospitals participated in the survey. Almost all hospitals (93%) surveyed indicated that they consult staff with pediatric expertise when updating their EOP, incorporate pediatric trained mental health professionals into their disaster call lists (93%), and integrate staff with pediatric focus into their incident command system/emergency operation center during a disaster (79%). Almost all of the hospitals (93%) had an infant/child abduction plan and all hospitals (100%) were testing the process at least once per year. Finally, almost all of the hospitals (93%) had incorporated a patient connection program into their tracking and reunification plan. However, not all hospitals included drills for pediatric surge, decontamination, and evacuation. Less than one-third of the hospitals had pediatric components in their alternate treatment site plans. Half of the hospitals did not have pediatric components incorporated into their decontamination plans.
Discussion:
Integrating the EMSC Pediatric Preparedness Checklist surveys into the recognition process is an innovative approach to improve pediatric disaster planning and preparedness in hospitals.
Saudi Arabia, the largest country in the Middle East, has suffered numerous terrorist attacks and is the location of Hajj, one of the world’s largest annual mass gatherings. Healthcare providers’ pre-incident knowledge and understanding of basic disaster medicine (DM) concepts are crucial for a unified and effective health-system response. Introducing healthcare providers to best practices is a stated vision of the Saudi Commission for Health Specialties. Standardizing DM curriculum taught to physicians during their residency training will assist this goal.
Aim:
To produce expert consensus on the most critical DM topics for the residency curriculum in emergency medicine (EM) in the Kingdom of Saudi Arabia.
Methods:
Utilizing a Delphi approach, a panel of Saudi Arabian experts in DM and EM residency directors were surveyed regarding potential DM topics for EM residency curricula. The first round comprised of open-ended questions seeking lists of suggested DM curriculum topics. In subsequent rounds, each participant received a questionnaire asking them to review the items contributed in the first round, summarized by the investigation team. The participants rated each item on a five-point Likert Scale to establish preliminary priorities and added their comments. In further rounds, participants reviewed and prioritized subjects until they reached a consensus of >=80%.
Results:
The study is ongoing and full data will be available in the new year.
Discussion:
This expert consensus from major stakeholders can be used to improve the foundation of the DM curriculum. The Delphi Method gives an evidence-based approach to identification and prioritization of subjects, which should be integrated within the Saudi Arabian Emergency Medicine Residency Curriculum. It also can be used as a cornerstone for implementation in other medical education programs across the Kingdom in the future.
We opened a national conference in Australia with a surprise mass casualty simulation scenario of a van versus multiple persons outside the conference venue. The purpose of this exercise was to increase awareness of, and preparation for, mass casualty incident (MCI) events for the conference delegates who were paramedics, emergency department nurses, and doctors.
Aim:
The aim of the research is to understand whether a surprise MCI simulation is a useful way to increase knowledge and motivate preparedness.
Methods:
A survey hosted on Qualtrics was circulated to delegates via email. The survey was designed by the research team and had 38 questions about demographics and respondents’ experience with MCIs, as well as their perceptions of the simulation exercise. The questions were a mixture of 5-point Likert scales, multiple choice, and short answers.
Results:
The majority of respondents were clinicians (n = 66, 76%) and those who worked in emergency departments or the prehospital setting (n = 75, 86%). While the majority had not responded to an MCI in the past 5 years (n = 67, 77%), more than half (n = 50, 57%) had undertaken MCI training during this time. Overall, a vast majority of respondents found the simulation to be a worthwhile exercise that increased knowledge and preparedness. An overwhelming majority also reported that the simulation was relevant to practice, of high quality, and a useful way to teach about major incidents.
Discussion:
Our surprise major incident simulation was a fun and effective way to raise awareness and increase knowledge in prehospital and emergency department clinicians about MCI response. This approach to simulation can be easily replicated at relatively low cost and is, therefore, a useful solution to training a group of multidisciplinary health professionals outside of the workplace.
The Out of Hospital Cardiac Arrest (OHCA) procedures constitute one of the most quantifiable indicators of the quality of Emergency Medical Services (EMS). In Poland, HEMS teams perform such procedures both during primary missions and when they support EMS teams.
Aim:
To carry out a retrospective analysis of OHCA related calls received from January 1, 2011, to December 31, 2016.
Methods:
During the relevant period there were 2,447 OHCA related calls. Of those, 308 cases were excluded from the analysis because no cardiac arrest was confirmed or the patients showed signs of death that prevented any emergency procedures.
Results:
The Return of Spontaneous Circulation (ROSC) was achieved in 1,119 cases. Resuscitation was clearly much more effective if CPR procedures were commenced prior to the arrival of the HEMS team. The groups in which higher survival rates were obtained included women, patients younger than 40 and patients who had signs of shockable rhythms. The use of HEMS team allowed for faster transport of patients to relevant specialist institutions, specifically if an invasive cardiological intervention was needed.
Discussion:
The use of HEMS teams in OHCA related calls indicates that such actions are highly effective both in primary missions and when HEMS teams support other EMS terms. An additional advantage is the possibility of quick transportation to a relevant specialist medical center.
In 2010, an estimated 1.3 million road traffic injury (RTI) deaths occurred worldwide, accounting for about 2.5% of all deaths. Mortality in serious injuries is 6 times worse in a developing country such as India compared to a developed country. Strengthening and undertaking research on the public health burden and impact and understanding the risk factors of trauma is the need of the hour.
Aim:
To identify the nature of injury in terms of causes and severity of injury.
Methods:
Using a quantitative approach, a retrospective cross-sectional survey was conducted at the emergency and trauma center in Ram Manohar Lohia (RML) Hospital, New Delhi. The information of all the injured patients seeking health care during the past one year from October 2015 - September 2016 at Emergency and trauma center was collected from the trauma registry forms filled at the time of registration.
Results:
A total of 1952 cases of road traffic injury sought health care during the study period. The average number of cases reported per day was five. Maximum of the cases (40%) were reported between 12-6PM. Among the injured, 82% were males and the majority of victims were between 20-30 years age group followed by 30-40 years.
Discussion:
Trauma services need to be coordinated in infrastructure and human resources so that the right patient is taken to the right hospital at the right time. This calls for a lead agency at the district, state, and finally national level. Safety education regarding road safety should be imparted, especially to all victims, relatives, and the general public to make the care comprehensive. Students in schools and colleges should also be the target for intense safety education.