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The G7 Summit was held in Charlevoix, Quebec (Canada) on June 8 and 9, 2018. The Urgences-santé Corporation (USC), in charge of prehospital emergency services in Montreal and Laval, was asked to intervene outside of its usual territory during the Summit, mainly because it has the only tactical medical team in the province of Quebec to be equipped and trained for high-risk situations.
Aim:
Part of USC’s tactical medical team was deployed to the Charlevoix region from May 29 to June 10, 2018. The team had two responsibilities: act in the event of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack, and in the event of social disturbance or violence, provide care for protestors and the police officers tasked with maintaining and restoring order.
Methods:
The mission required rigorous preparation to ensure the team’s safety outside its usual area of activity while maintaining full coverage of metropolitan Montreal, where the impacts of the G7 Summit were also felt. Emphasis was placed on intensive coaching of the tactical medics, on joint training, and on the coordination of intervention protocols across EMS, fire and law enforcement.
Results:
A total of 14 tactical medics and two managers were sent to Charlevoix for the Summit. Before their departure, three joint training days were held, and our training center provided six days of training to our partners.
Discussion:
While no CBRNE incident or major social disorder occurred during the Summit, USC was able to gain more visibility and therefore reach out to different organizations on site. Close ties were developed with the Sûreté du Québec (provincial police), with whom USC now regularly collaborates during training and interventions. The lessons learned also helped consolidate our extra-territorial deployment procedures.
Since its inception about 66 years ago, Pakistan has experienced a variety of both natural and man-made disasters like earthquakes in 2005 and 2015 and widespread flooding in 2010. Pakistan has also experienced a range of politically motivated violence, bombings in urban areas, as well as mass shootings. Such events generate a large number of casualties. To minimize the loss of life, well-coordinated prehospital and in-hospital response to disasters is required.
Aim:
To identify all the existing peer-reviewed medical literature on prehospital and in-hospital disaster preparedness and management in Pakistan.
Methods:
The search was conducted using PubMed and Hollis plus search engines in accordance with the PRISMA guidelines. The articles selected included articles on both natural and man-made disasters, and their subsequent prehospital and in hospital management. The following search terms and keywords were used while searching PubMed: mass casualty incident preparedness and management Karachi, mass casualty incident preparedness, disaster preparedness Karachi, and disaster management Karachi. To search Hollis plus, we used the terms: mass casualty incident preparedness and management Pakistan, mass casualty incident Pakistan, mass casualty incident preparedness and management Karachi, and disaster preparedness Karachi. We selected only peer-reviewed articles for a literature search and review.
Results:
The reviewed articles show a lack of data regarding disaster management in Pakistan. Almost all the articles unanimously state the scarcity of planned prehospital and in-hospital management related to both man-made as well as natural disasters. There is a need for planned and coordinated efforts for disaster management in Pakistan.
Disasters disturb the balance of medical supply and demand. Because normal supply chains break down in the wake of disasters, it is difficult to deliver daily necessities to affected areas. In addition, without a reliable supply of medical equipment and medicines, the number of sick and injured patients increases.
Aim:
We propose that emergency medical teams should bring medical equipment and daily necessities when responding to disasters.
Methods:
The Social Emergency Management Alliance (SEMA) was established in 2017. SEMA is a cooperative system between NGOs and the private sector for disaster relief in Japan. Humanitarian Medical Assistance (HuMA) utilized this system to provide emergency medical assistance during the Western Japan Floods in 2018.
Results:
After the flooding, increased amounts of dust caused many cases of conjunctivitis. There were also numerous cases of heat stroke and dehydration, especially in the elderly. We requested SEMA to bring eye drops to wash out dust and isotonic drinks to prevent dehydration and heat stroke to Mabi Town, Okayama. SEMA coordinated with the private sector to provide eye drops and isotonic drinks via a forwarding agent, and we were able to distribute them to affected people and prevent worsening disease.
Discussion:
NGOs working within affected areas can assess the exact needs of affected people in order to avoid waste. Such collaboration through SEMA will allow for more effective disaster relief in the future. It is our hope that more private companies join SEMA to reduce the suffering of disaster victims.
Paramedicine is a rapidly evolving profession, growing from its initial role of providing emergency care and transportation of the sick and injured into a broad discipline providing a wide range of care in multiple practice settings, yet the field is relatively unexplored. Much of the research in the field centers on patient care, often from the perspective of emergency medicine. A growing body of literature describing the discipline itself is largely descriptive.
Aim:
This interactive presentation describes and contributes to an applied research project that will define and describe Canadian paramedic practice. The research will develop frameworks, common taxonomy and designs, and evidence to support development of a national Canadian Paramedic Information System.
Methods:
This two-year mixed methods study is gathering data from a literature review, stakeholder workshops, and key informant interviews. The project will develop “user cases” that explore the issues and challenges facing Canadian paramedic stakeholders and identify the information and data required to address those issues.
Results:
The presentation will present initial findings that describe core concepts, data/knowledge structures, and models that are foundational to understanding and informing current and emerging paramedic practice. It will explore this data in relation to operational needs of practitioners, operations, communities, and stakeholders to inform decision-making, guiding policy and direction, and advancing the profession. Lastly, it will develop explanatory principles, models, and relationships in a conceptual framework that describes paramedic practice.
Discussion:
The study will develop models and core data sets that guide research and support policy development at local and national levels, and inform operational and strategic decision-making. The presentation will provide an overview of the research and findings to date. Participants will engage in activities that explore the user-cases and selected findings, applying the results of the study through the lens of their own backgrounds and operational contexts.
Wildfires are life threatening incessant fires in thickly vegetated areas that spread extremely rapidly to human habitat and are difficult to control by human force. The impact of wildfires is enormous on population health and causes tremendous financial burden to individuals and communities.
Aim:
The aim is to understand the potential disease burden secondary to wildfires both at an individual and population level and reflect upon the immediate and delayed neuropsychiatric manifestations of smoke exposure.
Methods:
Data on wildfires associated direct and indirect costs on individual health and health care delivery appears to be scant. The effort of this presentation is to present the federal data from 2012 to 2016 on nationwide wildfires, estimated acreage consumed in wildfires, the population exposed, and deaths. Information was extracted from the National Interagency Fire Center, the United States Fire Administration, and the Federal Emergency Management Agency. Through literature review on neuropsychological sequelae of wildfires smoke inhalation and associated trauma, the goal is to reflect upon potential healthcare burden secondary to neuropsychiatric manifestations.
Results:
Per National Center for Health Statistics, the national fire death rates from 2012 to 2016 ranged 10 to 11 per million population each year, and the property loss both residential and non-residential was estimated at 9 to 10 billion dollars each year. We know healthcare cost is expensive in the United States, and with the stated estimates, one can only envision the health care and public health system burden.
Discussion:
The characteristic neuropathology of carbon monoxide toxicity is bilateral Globus pallidus necrosis and the common neuropsychological symptoms include fatigue, affective conditions, emotional distress, memory deficits, sleep disturbance, vertigo, dementia, and psychosis. The health effects and associated disability demand policymakers to allocate resources for wildfire prevention/ containment and primary health care providers education, research, and building effective healthcare delivery systems.
The community-based integrated management of newborn and childhood illness (CBIMNCI) training package has been widely used throughout Nepal. Adding a component of disaster response and management to this program would greatly impact the community, and could improve the knowledge and skills of community workers for the management of children during a disaster.
Aim:
Describe the development and implementation of a community-based training for children in disasters.
Methods:
Using expertise from emergency and pediatric emergency physicians, pediatricians, and psychiatrists, we developed a two-day training and facilitator manual covering topics such as trauma, resuscitation, burn, drowning, disaster, nutrition, and care of the newborn. The information and manuals were presented to the Nepal Division of Child Health for approval. Four pilot trainings were conducted in Bardia and Bardibas in Nepal in September 2017, including knowledge and skill-based sessions. Knowledge was tested pre- and post-training using multiple choice questions (MCQ) and self-reflections. Skills were evaluated by direct observation and marked using a Likert scale. Confidence was assessed using a confidence matrix before and after the course. Overall feedback was taken at the end of the session.
Results:
Of 82 participants, 74 participants from four trainings were included for analysis. Post-test Cronbach’s alpha for MCQ was 0.82 and the confidence matrix was 0.86. Mean score for the pre-test MCQ was 6.12 (SD 2.22) compared to the post-test mean of 10.97 (SD 2.97), which was a statistically significant improvement (p<0.05). Trainees reported that the trauma teaching was helpful. They felt that it improved confidence regarding trauma and disasters.
Discussion:
Adding this training to current CBIMNCI can be an effective tool to reach out to primary health care workers, and provide further knowledge and skills on care of children during a disaster or humanitarian crisis.
After Hurricane Harvey and the flooding that ensued, 3,829 displaced persons were transported from their homes and sheltered in the Dallas Convention Center. This large general population sheltering operation was medically supported by the onsite Mega-Shelter Medical Clinic (MMC). In an altered standard of care environment, a number of multi-disciplinary medical services were provided including emergent management, acute pediatric and adult care, psychiatric/behavioral services, onsite pharmaceutical, and durable medical equipment distribution, epidemiologic surveillance, and select laboratory services.
Aim:
To describe how onsite medical care in the adapted environment of a large population shelter can provide comparable services and limit the direct impact on the local medical community.
Methods:
A retrospective chart review of medical records was generated for all clinical encounters at the MMC. Data were sorted by daily census, disease surveillance, medical decision making, treatment, and transport destinations.
Results:
40.7% of registered evacuees utilized the MMC accounting for a total of 2,654 clinic visits by 1,560 unique patients representing all age groups. During the sustained MMC operations, 8% of patients required emergency transport and 500 additional patient transports were arranged for clinic appointments. No deaths occurred and no iatrogenic morbidity was reported.
Discussion:
Medical care was provided for a large number of evacuees which mitigated the potential impact on the local medical infrastructure. The provision of medical services in a large population shelter may necessitate adaptation to the standard of care. However, despite the nontraditional clinical setting, care delivery was not compromised.
Cyclones are expected to increase in frequency and intensity, significantly impacting communities and healthcare services. During these times, those with chronic diseases such as opioid dependence are at an increased risk of disease exacerbation due to treatment regimen interruptions. Disruptions to the continuity of the opioid replacement therapy (ORT) service can be detrimental to both clients and the community which can potentially lead to relapse, withdrawal, and risky behaviors.
Aim:
To explore the impacts of cyclones on opioid treatment programs within community and hospital pharmacies in Queensland.
Methods:
Qualitative research methods were used in this study with two methods of data analysis employed: the text analytics software, Leximancer®, and manual coding. Interviews were conducted with five hospital and five community pharmacists and four Queensland opioid treatment program (QOTP) employees. Participants worked in Mackay, Rockhampton, Townsville, and Yeppoon in a community impacted by a cyclone and involved with ORT supply.
Results:
The themes developed in the manual coding were “impact on essential services,” “human experience,” “healthcare infrastructure,” “preparedness,” and “interprofessional networks.” These themes were aligned with those identified in the Leximancer® analysis. The community pharmacists focused on client stability, whereas, the hospital pharmacists and QOTP employees focused on the need for disaster plans to be implemented.
Discussion:
The greatest concern for participants was maintaining the stability of their clients. Communication amongst the dosing sites and ORT stakeholders was most concerning. This led to a lack of dosing information in a timely manner with pharmacists being hesitant to provide doses and takeaways due to legislative restrictions. A review of coordinated efforts and the legislative constraints is recommended to ensure continuity of ORT supply during cyclones.
Medical errors are a reality for Emergency Medical Technicians (EMT’s) working in a prehospital, high-stress environment. A “medical error” can be defined as a mistake or system failure which results in improper care of a patient’s injury.
Aim:
To study the frequency, severity, types, and causes of medical errors committed by Abu Dhabi Police Ambulance (ADPA) crews, and how to prevent these errors. The study is retrospective. All the data was collected using the Electronic Patient Care Report (EPCR) of all the patient treated and transported by ADPA crew from January to October 2018. After the EPCR auditing and monitoring, the medical errors were identified and discussed by a medical committee.
Results:
The total number of studied EPCR (trauma and medical cases) was 36.000. The medical errors identified were 265 cases (0.74%). 134 cases (51%) were moderate (can cause side effects), 115 cases (43%) were minor, and 16 cases (6%) were critical (can lead to death). The most common type of medical errors were cognitive errors. The causes were skill-based errors 27 times (10%) with 16 intravenous failures, 10 intraosseous failures, and one dislodged endotracheal tube after orotracheal intubation. The rule-based errors were committed five times (2%) when the Paramedics did not follow ACLS Algorithm, three times shockable cardiac arrest and two times Pulseless Electrical Activity. The knowledge-based errors were drug indications errors five times (2%). The three EMT’s levels in ADPA (Basic, Intermediate, and advanced) committed medical errors. The question to ask is not who made the mistake, but why the mistake was made. Preventing ADPA crew errors requires a systematic approach to modify the conditions that contribute to errors. The strategies are developing more awareness of cognitive errors by education and incorporating simulation into training.
HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.
Aim:
The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.
Method:
By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.
Results:
Main points of modification are to:
1. Replace a system peculiar to the UK with a Japanese system.
2. Add unique contents of a Japanese disaster.
3. Add the important subjects especially in Japan.
4. Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.
Discussion:
Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.
The Sendai Framework seeks to substantially reduce disaster risk and losses in lives, livelihoods, health, and other assets including persons, communities, and countries. The framework focuses on reducing mortality while increasing population wellbeing, early warning, and promotion of health systems resilience. The use of scientific evidence to inform policy and formulate effective initiatives and interventions is crucial to disaster risk reduction within health. Different instruments and methodologies are available to guide policy and operations. The potential value of routinely collected patient data from health registers is that they can provide pre-event health and comparison group data without burdening affected populations.
Aim:
The current contribution aims to illustrate how health registers can help monitor the health impact of natural and human-made disasters.
Methods:
Patient data from health registers of general practitioners and other health professionals, sometimes combined with other registers and data sources, have been utilized to monitor the health impact of disasters and environmental hazards in the Netherlands, Norway, and Sweden since 2000.
Results:
Health registers allowed monitoring of mental health problems, medically unexplained symptoms, chronic health problems, and social problems. These were compared to groups not directly exposed. The health impact and care utilization was tracked after the fireworks explosion in Enschede affecting inhabitants of the neighborhood (2000; data range 1999-2005), children and parents after the Volendam café fire (2001; data range 2000-2006), Swedish survivors of the Tsunami in Southeast Asia (2004; data range 2004-2010), and parents of children affected by the terrorist attack on Utøya (2011; data range 2008-2014).
Discussion:
Health systems with registers have an important advantage when it comes to the potential for monitoring population health, and perhaps offer early warnings of pandemics. However, data generation should be closely connected to policy-making before and during the planning and evaluation of public health intervention.
Hospitals are fundamental infrastructure, and when well-designed can provide a trusted place of refuge and a central point for health and wellbeing services in the aftermath of disasters. The ability of hospitals to continue functioning is dependent on location, the resilience of buildings, critical systems, equipment, supplies, and resources as well as people. Working towards ensuring that the local hospital is resilient is essential in any disaster management system and the level of hospital resilience can be used as an indicator in measuring community resilience. The most popular measure of hospital resilience is the World Health Organisation’s Hospital Safety Index (HSI) used in over 100 countries to assess and guide improvements to achieve structurally and functionally disaster resilient hospitals. Its purpose is to promote safe hospitals where services “remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.” It identifies likely high impact hazards, vulnerabilities, and mitigation/improvement actions.
Aim:
The HSI can be a valuable tool as part of the 2015-2030 Sendai Framework for Disaster Risk Reduction. However, to date, it has been used infrequently in developed countries. This project pilots the application of the HSI across seven facilities in a North Queensland health service (an area prone to cyclones and flooding), centered on a tertiary referral center, each providing 24-hour emergency health services.
Results:
Key indicators of resilience and the result of the audit will be discussed within geographical and cultural contexts, including the benefits of the HSI in augmenting existing hospital assessment and accreditation processes to identify vulnerabilities and mitigation strategies.
Discussion:
The research outcomes are to be used by the health service to improve infrastructure and provide anticipated community benefits, especially through the continuation of health services post disasters.
Ultrasound applications are widespread, and their utility in resource-limited environments are numerous. In disasters, the use of ultrasound can help reallocate resources by guiding decisions on management and transportation priorities. These interventions can occur on-scene, at triage collection points, during transport, and at the receiving medical facility. Literature related to this specific topic is limited. However, literature regarding prehospital use of ultrasound, ultrasound in combat situations, and some articles specific to disaster medicine allude to the potential growth of ultrasound utilization in disaster response.
Aim:
To evaluate the utility of point-of-care ultrasound in a disaster response based on studies involving ultrasonography in resource-limited environments.
Methods:
A narrative review of MEDLINE, MEDLINE InProcess, EPub, and Embase found 20 articles for inclusion.
Results:
Experiences from past disasters, prehospital care, and combat experiences have demonstrated the value of ultrasound both as a diagnostic and interventional modality.
Discussion:
Current literature supports the use of ultrasound in disaster response as a real-time, portable, safe, reliable, repeatable, easy-to-use, and accurate tool. While both false positives and false negatives were reported in prehospital studies, these values correlate to accepted false positive and negative rates of standard in-hospital point-of-care ultrasound exams. Studies involving austere environments demonstrate the ability to apply ultrasound in extreme conditions and to obtain high-quality images with only modest training and real-time remote guidance. The potential for point-of-care ultrasound in triage and management of mass casualty incidents is there. However, as these studies are heterogeneous and observational in nature, further research is needed as to how to integrate ultrasound into the response and recovery phases.
A trauma registry is a disease-specific data collection composed of a file of uniform data elements that describe the injury even, demographics, prehospital information, diagnosis, care, outcomes, and costs of treatment for injured patients.
Aim:
To establish a trauma registry system on an electronic platform enabling data capturing through Android phones.
Methods:
A software has been developed for the registry data collection for road traffic injury patients arriving at JPNATC, AIIMS, New Delhi. The software has been designed to use in the Emergency Department on Android phones/laptops with internet access.
Result:
A detailed registry data set has been prepared to enter prehospital, in-hospital, and post-discharge details of all the admitted patients. This includes demographic data, prehospital data, injury event data, vital signs within 24-hrs of arrival, ED disposition (date and time), operative procedures within 48 hours of arrival, chest x-ray (date and time), CT (date and time), ventilation days, ICU-stay days, hospital disposition (date and time), injury coding data (region, severity level, ISS, AIS, ICD-10) and Others, e.g., first neurosurgical consultation (date and time) and first blood transfusion (date and time). There are two panels for this software; one for user panel and another for the administrative panel. User panel is being used for data collection by the trained data collectors 24/7 at the emergency department on a rotation basis. The administrative panel is accessible to only the investigator or other authorized persons. The administrative panel and user panels are password protected. The entered data is being saved in a spreadsheet in the backend and can be used for periodic data quality check and data analysis.
Discussion:
There is no trauma registry in India so far for the road traffic injury patients. Present innovation would lay the foundation of national Trauma Registry in India.
During a mass casualty incident (MCI) seminar in Rome, Italy a survey was used to gauge the self-efficacy and confidence of the participants in managing an MCI. Following the course, a follow-up presentation was held by the Torino EMS Medical Director to evaluate and debrief the Torino Railway incident that occurred one day prior. Students partook in a seminar on MCI management, as well as a debriefing of the Turin Railway accident in which they evaluated the skills used by teams on the scene to manage the incident.
Methods:
Medical students partook in a seminar to learn to manage an MCI scene, as well as a debriefing of the Turin Railway accident. Following both seminars, the students were given a survey to assess their sense of self-confidence in managing such a situation.
Results:
The mean level of self-efficacy prior to the MCI training (M=3.43, SD+0.42) increased after the training (M=3.71, SD+0.37) and remained at the same higher level (M=3.71, SD+0.51) after the medical students were exposed to the details of the Turin train accident. The overall difference between the mean self-efficacy scores in the three time frames was not found to be significant. The mean level of confidence in managing MCIs prior to the training (M=2.83; SD+0.89) increased after the training (M=3.56; SD+0.53) and remained higher following the presentation of the Turin train accident, despite a slight decrease (M=3.52, SD+0.63).
Discussion:
The participants’ surveys showed an increase in their self-efficacy and confidence following the course and follow-up presentation. It is our professional recommendation that real-life events be used in such seminars to increase self-efficacy and confidence. The topic will continue to be evaluated further.
The use of rail transport is increasing in Sweden, as well as within Europe, and train speeds are escalating. These factors contribute to an increasing frequency of train crashes and major crashes so severe that they can be classified as disasters. There is a lack of knowledge concerning factors of importance related to the rescue operation that can influence survival rate at train crashes, especially in cold environments.
Aim:
The aim was to identify preventable death and severe complications among passengers in a train crash in rural and cold environments using a simulation-based model.
Methods:
A train crash scenario was developed based on scientific research, crash reports, and lessons observed in incidents. The scenario was set to a train with seven carriages consisting of 150 passengers that derailed in a curve in 160km/h, 10km from the hospital. In Umeå in the north of Sweden, 12 participants from seven emergency/disaster organizations joined in two preparing workshops and a real-time simulation-based train crash. The Emergo Train System (ETS) was chosen as a simulation tool. Data collection such as rescue capacities, response time, and patient surge were collected and transferred into the ETS.
Results:
The results show 17 preventable death and 9 preventable severe complications since the actions were not implemented in the recommended time.
Discussion:
The results show that an extended rescue operation can have devastating consequences especially in cold environments. Further experimental simulations are needed with defined interventions to find out how preventable deaths and severe complications can be reduced.
The Western Pacific Region, comprised of 37 diverse countries and areas, is one of the world’s areas most prone to be affected by disaster. Seven of the top ten countries most at risk of a natural disaster are in this region. The Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 in the Western Pacific identifies mental health in disasters and emergencies as a priority area and calls for a social movement for action on mental health and well-being. To increase understanding of and need for mental health and psychosocial support in emergency situations, regional guidelines are necessary. It is unclear to what degree international guidelines are applicable in this region.
Aim:
To synthesize the contents of available evidence-based guidelines and assess their potential to address the mental health and psychosocial needs of people in emergency settings in the Western Pacific Region.
Methods:
A systematic literature review of existing guidelines for mental health and psychosocial support in disasters and emergencies was conducted. Using the Appraisal of Guidelines for Research and Evaluation II instrument, the quality of each guideline was determined covering the following: (1.) scope and purpose, (2.) stakeholder involvement, (3.) rigor of development, (4.) clarity of presentation, (5.) applicability, and (6.) editorial independence.
Results:
The results provide an overview of the quality, number, and specificity of available guidelines. A framework was developed to categorize these guidelines on each stage of the disaster management cycle (prevention, preparedness, response, and recovery) while considering their guidance regarding coordination, monitoring, communication, human resources, and connection with regular health services.
Discussion:
The framework and its implications for further research and development are presented at the conference. We will specifically focus on the question, “What is needed to move from a reactive to a more proactive stance in policy and practice?”
In British Columbia (BC), Canada, it is increasingly commonplace for communities to experience yearly disaster events such as floods, forest fires, avalanches, and mudslides. Nurses are known to be one of the largest groups of healthcare workers and are often challenged to care for members of the public during these events. Many nurses have stated that they do not have enough education to provide quality care in a disaster role, as they received no education in their undergraduate nursing degrees.
Aim:
The aim of this study was to explore how and what nurse educators are teaching undergraduate nursing students regarding the disaster nursing role within Schools of Nursing in BC, Canada. Understanding the current practice of teaching will serve as a starting point for shaping future best practice undergraduate nursing disaster educational frameworks.
Methods:
This study used a qualitative case study methodology guided by Merriam’s procedural approach with a theoretical framework of adult teaching and learning.
Results:
The findings indicate that disaster nursing knowledge is taught either within existing global health courses or rarely is leveled throughout the program. Many challenges exist for educators, which include lack of current resources, workload restrictions, and lack of personal disaster knowledge. Content is determined by the educator. However, there is no specific model or link to disaster nursing competencies or assessment strategies. Most content is delivered didactically by the educator with some expert guest speakers or collaborative simulation events.
Discussion:
The identified priority challenge is to obtain clarity and understanding around just what knowledge is required and how it should be evaluated. Some suggestions for a specific undergraduate disaster nursing model will be presented in order to ensure that students have the foundational knowledge that they require and that our educators are prepared to teach them.
The Dallas Convention Center received over 3800 evacuees because of the unprecedented flooding caused by Hurricane Harvey. A multidisciplinary medical clinic was established onsite to address evacuee needs for medical evaluations, emergency care, chronic disease management, pharmaceuticals, durable medical equipment, and local health services integration. To operate efficiently, the Dallas Mega-Shelter Emergency Operations Center (EOC) worked with the Mega-Shelter Medical Clinic (MMC) under a fluid incident command (IC) structure that was National Incident Management System (NIMS) compliant. Iterations of MMC IC demonstrated maturations in organizational structure while supporting MMC operations that varied from rigid NIMS doctrine.
Aim:
To explore the use of a fluid IC structure at a large evacuation medical shelter after Hurricane Harvey.
Methods:
We observed evolutions of IC organizational charts and operational impacts.
Results:
Modifications through just-in-time iterations of the IC organizational chart were posted and reviewed with MMC IC and EOC sector chiefs. Changes in the organizational chart were noted to improve identification of logistical needs, supply delivery, coordinate with other agencies, and to make decisions for resource typing and personnel utilization. Adaptations also improved communication, which led to timely situational awareness and reporting accuracy.
Discussion:
MMC medical services were improved by allowing modifications and adaptations to NIMS compliant MMC IC organizational roles and duty assignments. The fluidity of IC structure with ability for just-in-time modifications directly impacted the provision of disaster medical services. Unique situational awareness, coordination of care pathways within the local innate health infrastructure, compliance with health service regulations, and personnel resource typing all contributed to and benefitted from these IC modifications. MMC and EOC IC collaboration facilitated effective communication and maintained an appropriate span of control and efficient activity reporting.
The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.
Aim:
To give a rundown of the 14th APCDM and a proposal for WADEM.
Methods:
Retrospective analysis of participants, the category of presentations, and deliverables.
Results:
With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.
Discussion:
Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.