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To evaluate the value of ultrasonic measurement of the respiratory variability of inferior vena cava (IVC) in the preoperative volume-response evaluation of elderly hip fracture patients.
Methods:
Volume-loading tests were carried out in elderly patients with hip fractures requiring surgical treatment from August 2017 to February 2018. The maximum diameter (IVCe) and minimum diameter (IVCi) of the IVC were measured by ultrasound, and the variation of IVC (IVC-CI) was calculated before surgery. SV was monitored by a FloTrac/Vigileo system, and positive volume responsiveness was defined as ΔSV increasing by more than 15%. The sensitivity and specificity of IVC-CI to volume responsiveness evaluation was analyzed by ROC, and the correlation between IVC-CI and ΔSV was analyzed by Spearman correlation analysis.
Results:
Ultrasound measurements and volume-loading tests were successfully performed in 39 of the 44 patients. Among them 21 cases were volume responsiveness positive (group R) and 18 cases were volume responsiveness negative (group N). Before the volume-loading test, IVCi in group R was significantly smaller than group N and IVC-CI was significantly larger than group N (P<0.05), while the difference between IVCe and group N was not statistically significant (P>0.05). After the volume-loading test, the differences between IVCe, IVCi, IVC-CI, and group N were not statistically significant (P>0.05). Area under curve (AUC) of IVC-CI to assess volume responsiveness in geriatric hip fracture patients was 0.80±0.08 (0.65-0.95, P=0.001), with a 20.69% cut off value, 77.78% sensitivity, and 76.19% specificity. Through the Pearson correlation analysis, IVC-CI and Δ SV were positively correlated with the coefficient r = 0.367 (P<0.05).
Discussion:
As a rapid and noninvasive monitoring method, ultrasonic measurement of the respiratory variability of inferior vena cava in assessing the volume responsiveness of geriatric hip fracture patients can provide guidance for perioperative fluid management.
In China, many disaster rescue operations need cooperation between civil forces and military forces. Understanding the key elements of civil-military disaster rescue operations is a basic problem faced by Chinese rescuers and scholars.
Aim:
To summarize the key elements of civil-military disaster rescue operations in China.
Methods:
On July 17, 2016, an expert round-table meeting was held on our campus to discuss some basic problems in disaster research. The participants arrived at a consensus that the key elements of civil-military disaster rescue operation under Chinese cultural context should be carefully analyzed using Six Sigma (Why, Who, What, When, Where, and How, 5W1H)
Methods:
The minutes of the meeting was summarized into a brief report.
Results:
(1) Why to rescue - it is the responsibility of modern government to protect its people; (2) Who are the rescuers - individuals or groups with passion and ability to do such work, but they should be organized properly; (3) What to do - make vital systems of the community run normally as soon as possible; (4) When to rescue - different disasters have different laws, but it is better to render help in the golden hour; (5) Where to rescue - it depends on the input process (material, human resources, etc.) and output process (patients, waste material, etc.) of the rescue operation, not merely confined to the disaster site; (6) How to rescue - cooperation among all branches of social sectors is vital to succeed, especially civil-military cooperation. Military force is the backbone force in an austere environment.
Discussion:
The discipline of disaster medicine is developing rapidly in China. The research and evaluation framework should be established carefully. Civil forces and military forces should have an identical understanding of the same question. This abstract is only part of the research framework.
Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The 2011 Queensland flood disaster affected central and southeast Queensland, resulting in 2.5 million people being adversely affected. Seventy-two local government areas disaster were activated under the Natural Disaster Relief and Recovery Arrangements, which was more than 99 percent of Queensland. The issues regarding the role and responsibility across governments relating to planning, setup, and management of evacuation centers will be discussed.
Aim:
This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in Australia during the Queensland floods in 2011. The objective is to illuminate the challenges officials faced, and the resolutions and lessons learned in the preparation of evacuation centers through this event.
Methods:
The study involved interviews with local government and relevant agencies’ officials who have been involved in establishing evacuation centers for vulnerable populations during the 2011 floods. Six officials were recruited from local government areas affected by the disaster in Queensland, Australia. Semi-structured phone interviews were audio-recorded and thematic analysis was conducted using NVivo software.
Results:
Three core themes emerged: 1) understanding of the importance of preparation, 2) challenging evacuation center environments, and 3) awareness of good governance principles.
Discussion:
This pilot study demonstrated that communication with stakeholders during the preparation period prior to a disaster is essential to best practice for evacuation center management. Understanding and being aware of good governance is also an important element to establish evacuation centers effectively.
Prehospital emergency care is a vital and integral component of health systems, particularly in resource-constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities, and trauma caused by road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the prehospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).
Methods:
A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions, respectively. Data were descriptively analyzed, and a principal component analysis was employed to identify the most influential weaknesses and capacities affecting the prehospital emergency care for the victims of RTI in the GKMA.
Results:
From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 20164. key weaknesses and 5 key capacities were identified to affect the prehospital emergency care for RTI victims in the GKMA. Although some strengths exist, (e.g., ambulance facilitation, EMS structuring, and coordination), the key weaknesses affecting the pre-hospital care for victims were noted to relate to the absence of predefined EMS systems, particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment, insufficient skills/training of the first responders, inadequate EMS resources, and avoidable delays to respond and transport RTI victims to medical facilities.
Discussion:
Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.
Mexico has suffered multiple social and natural events that tested its response capacity. Hospital units of the third level of care are an axis of response and a central reference. Guaranteeing their integral and organized response promotes risk prevention and mitigation strategy in emergencies and disasters.
Aim:
To analyze the national and international regulations and the existing documents about emergency and disasters related to a hospital with the identification of the critical actors in the response.
Methods:
This research consists of a cross-sectional and descriptive study with a mixed methodology (qualitative and quantitative), that generates a protocol for response in a third level care hospital. Quantitative analysis was carried out using central tendency measurements based on a surveys (training, knowledge) performed in the hospital services that provide a critical response with the ED in emergencies or disasters (ED, ICU, Supplies, Nursing, Operating Room, Security, Hospital Admission, Crisis Committee). In the quantitative analysis, the staff were interviewed about their experience in responding to previous events (to the same critical services), recognizing importance and points of improvement with a discourse analysis methodology.
Results:
With the information collected and based on the protocols of Safe Hospital program (PAHO/WHO) we generated a protocol organized by the ED that involves massive victims.
Discussion:
Regulations oblige hospital units to have protocols of action in critical situations linked to Safe Hospital program, so it is a great tool for planning. All the surveyed personnel consider that it is important to have a plan that allows for immediate steps to ensure quality and timely patient care, considering it an ethical and social obligation. Analysis suggests that continuous training and the contribution of an operational plan per service provide security and better prognosis to the victims. The protocol includes all critical response services with a clinical practice guide.
This research identified a gap in understanding the lived experience of long-term disaster resilience (LTDR). Increasing disasters could influence more people. Therefore, understanding LTDR becomes imperative. Little research documents men and women’s reflections following disasters. Current research highlights survivors’ mental health, particularly clinical diagnoses like PTSD. Research remains limited on the social impacts long after disasters.
Aim:
Research aimed to identify a gendered perspective of the lived experience about what contributes to LTDR three years after Ash Wednesday in 1983, the Victorian floods in 1993 and 2010-11, and the 2009 Black Saturday fires.
Methods:
A comprehensive, systematized search was conducted of peer-reviewed, grey, and secondary literature for a narrative review and thematic analysis.
Results:
106 references were identified. After removing duplicates and papers not fitting the inclusion criteria, two papers met the criteria. However, two borderline papers were included due to the closeness of the timeframe and brevity of research available.
Discussion:
Most research is related to the immediate aftermath or short-term resilience. Papers provided no specific attributes to enhance the lived experience of LTDR as it related to gender. However, factors that could enhance the lived experience of LTDR were drawn from six themes in sociological studies. Presumptive interpretations were made about what factors may provide insight into the social and contextual issues of LTDR. The literature dearth identified the need for long-term disaster resilience research. The most striking conclusion drawn from themes tells how people perceived the way a disaster and the ensuing period affected their personal relationships and circumstances. Overall, positive experiences strengthened their resilience while negative experiences hindered their resilience. While the review resulted in a disappointing outcome, the dearth of LTDR research lacked any reference to gender but confirmed research opportunities for innovative research that could influence policy and practice.
The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.
Methods:
The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.
Results:
Pending configuration of necessary talk groups, the system will be functional and in use in 2019.
Discussion:
Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.
Located in the Pacific Ring of Fire, Indonesia is prone to natural hazards, such as earthquakes, tsunamis, floods, and volcanic activity. Management in the health sector is a necessary foundation for dealing with a disaster. Management lessons and essential experiences identified from disasters are often forgotten. The faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada has been developing disaster health management since 2009 after Padang Earthquake, followed by Merapi Volcano Eruption (2009), Pidie Jaya Earthquake (2016), and Lombok Earthquake (2018). The latest series of earthquakes that struck Central Sulawesi has revealed management problems with respect to the communication process, the development of coordination, and information and data synchronization.
Aim:
To show the importance of effective management in a health cluster, including what went well, what went poorly, and what will happen from the acute phase until the transition phase.
Methods:
Disaster health management implementation was compared from Padang to the Central Sulawesi’ earthquake. Then health cluster management was compared in Lombok and Central Sulawesi. Indicators were coordination, communication, data information, and organization.
Discussion:
There has been good progress for disaster health management in Indonesia. The health cluster approach makes coordination, data collected, and communication much easier. However, it also needs to focus on disaster planning, training, or simulation for the district health office while enhancing district response capacity. Although the challenges have changed in the last few decades, additional research is planned to limit management difficulties in the health cluster.
Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.
Aim:
The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.
Methods:
Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.
Results:
A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.
Discussion:
Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.
As Florence Nightingale stated, nursing plays a critical role in environmental management for people in sick, injured, and even good conditions. In current practice, affected people are forced to reside in the evacuation shelters for a prolonged period in Japan. Unfavorable living conditions lead to adverse physical and psychological outcomes including cardiovascular events, depression, and more. However, environment management cannot be achieved without involving the community.
Aim:
To initiate community into shelter environment management a multi-cluster drill was coordinated by the Department of Psychiatric and Mental Health Nursing, University of Miyazaki, which appointed a director of Shelter Management for the annual nation-wide disaster drill hosted by the Cabinet Office of Japan.
Methods:
With the Department of Health and Pharmaceuticals, Miyazaki Prefecture, the director invited local communities and held an exhibition type disaster drill on August 4, 2018.
Results:
36 organizations, including prefectural and municipal crisis management departments, health care organizations, a social welfare council, Red Cross, a telecommunication company, WASH cluster organizations, and the Japan Ground Self-Defense Force participated. The director requested to develop a plan filled with tactics and techniques protecting the health of people living in the shelter. Through meetings, the organizations recognized similarities and differences in roles, responsibilities, and capacities leading to an organized inter-cluster network. Participants created and prosecuted the plan independently and the director only orchestrated and negotiated with other supporting entities. The organizations exhibited and demonstrated how residents can protect their own physical and psychological health by setting up a proper shelter environment. Direct feedback from residents to organizations resulted in an expanded local network and the organizations improving their capacities.
Discussion:
Shelter environment cannot be managed by nursing solely but coordination by nurses may consolidate multi-cluster aid organizations so that shelter environment management would be done by residents and local organizations.
This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.
Methods:
Data routinely collected by the Ghana NAS from 2004–2014 were described, including: patient demographics, reason for the call, response location, target destination, and types of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.
Results:
In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%–80% and 10%–57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.
Discussion:
The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services.
Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data. A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.
Aim:
To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess feasibility, strengths, and limitations for future use in assessing prehospital ambulance performance.
Methods:
With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We evaluated this program for collecting patient encounter data against the investment of time, personnel, and financial resources.
Results:
Over a two-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance traveled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter.
Discussion:
Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols. Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal permission, and observer training must be considered.
Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analyzing structure, process, and outcome individually and collectively in systems has been found to focus improvement efforts in the audit cycle. The second Irish report on Major Trauma Audit (MTA) was published in December 2017. The median age of trauma patients in Ireland was 59, indicating an aging trauma population. 28% of patients required secondary transfer to complete their care. The mortality rate for 2016 was only 4%.
Aim:
To determine the ability of a road-based EMS system to bring patients from areas of Wexford County to proposed receiving centers within 60-90 minutes.
Methods:
Analysis took population centers in Wexford County, used Google Maps to estimate travel times at 3pm on a weekday, and proposed new trauma units and centers in Dublin, Cork, and Waterford.
Results:
In Wexford County urban centers, >95% of patients will not reach a trauma unit in less than 60 minutes with current prehospital medical service capabilities. This even excludes response/on-scene time by prehospital practitioners in land-based EMS vehicles.
Discussion:
The proposed introduction of trauma bypass systems in Ireland should not disenfranchise patients with respect to the standards they are currently receiving. Gap analysis suggests considerable work is required within the ambulance service to increase critical skill levels of paramedics to support critical patients in the golden hour of their transfer. An increase in vehicles/resources will be required to ensure adequate staffing to meet Health Information and Quality Authority (HIQA) targets of 8 and 19 minutes for response acuity, and for longer durations of transport allied to dynamic resource deployment model as used by National Emergency Operations Centre (NEOC). Unintended consequences of system changes will need to be monitored carefully to avoid further adversely impacting recruitment of staff to bypassed Model 3 hospitals.
Advanced Practice Providers (APP) are utilized in the United States National Disaster Medical System (NDMS) and consist of Certified Registered Nurse Anesthetists (CRNA), Nurse Practitioners (NP), and Physician Assistants (PA). They fill a critical role as Medical Officers in the Federal Disaster Medical Response on both Disaster Medical Assistance Teams (DMAT), Trauma & Critical Care Teams (TCCT), and United States Public Health Service (USPHS). DMAT teams and components of TCCT and USPHS responded to National Security Special Events, multiple natural disasters over the past two years including prolonged hurricane response in 2017 and 2018. The APPs were heavily utilized in key roles throughout the responses with much success.
Aim:
To explain how APPs are a vital component to US Federal Disaster Medical Response and are able to fill a multitude of roles as Medical Officers.
Method:
We used qualitative data from APPs in the US NDMS system illustrating what roles they filled during recent disaster responses.
Results:
The APPs were key components to the US NDMS response to disasters in the US and US territories by providing direct medical care as APPs, aid in medical evacuation, triage, healthcare administration, and medical infrastructure evaluations.
Discussion:
The APP is essential in the US Federal Disaster Medical Response and future research would be to obtain quantitative data on APPs in the U.S. NDMS. With increasing natural and man-made disasters affecting more people across the world annually, the increasing global population, and expected international health care worker shortages, APPs can be part of the overall solution to Medical Officer shortfalls and other key components in future disaster responses throughout the world. As APPs are not widely utilized worldwide, there will need to be education on what APP training is and how they can be utilized in areas not familiar with their abilities.
Pressure in the workplace has been studied in a number of settings. Many studies have examined pressure from physiological and psychological perspectives, mainly through studies on stress. Performing under pressure is a fundamentally important workplace issue, not least for complex, volatile, and emergency situations.
Aim:
This research aims to better understand performance under pressure as experienced by health and emergency staff in the workplace.
Methods:
Three basic questions underpin the work: (1) how do health and emergency workers experience and make sense of the ‘pressures’ entailed in their jobs? (2) What impacts do these pressures have on their working lives and work performance, both positively and negatively? (3) Can we develop a useful explanatory model for ‘working under pressure’ in complex, volatile, and emergency situations?
The present paper addresses the first question regarding the nature of pressure; a subsequent paper will address the question of its impact on performance. Using detailed interviews with workers in a range of roles and from diverse settings across Ecuador, this study set out to better understand the genesis of pressure, how people respond to it, and to gain insights into managing it more effectively, especially with a view to reducing workplace errors and staff burnout. Rather than imposing preformulated definitions of either ‘pressure’ or ‘performance,’ we took an emic approach to gain a fresh understanding of how workers themselves experience, describe and make sense of workplace pressure.
Results:
This paper catalogs a wide range of pressures as experienced by our participants and maps relationships between them.
Discussion:
We argue that while individuals are often held responsible for workplace errors, both ‘pressure’ and ‘performance’ are multifactorial, involving individuals, teams, case complexity, expertise, and organizational systems, and these must be taken into account in order to gain better understandings of performing under pressure.
On Friday, September 28, 2018, the 7.4 Richter Scale earthquake hit Central Sulawesi and was followed by a tsunami. Within a month after the unpredictable earthquake and tsunami, a 773 aftershock earthquake was noted. These events took a major toll on the population in the affected areas. 2,086 people died and more than four thousand people were injured. 1.373 people went missing and 206.494 were evacuated. Surveillance data from November 4, 2018, to October 24, 2018, showed that an increased number of illnesses such as diarrhea was the second leading reported cases. Data showed that the number of diarrhea cases was 3.350 with two peaks of epidemic curves on October 10 and 22, 2018.
Aim:
To verify the diarrhea outbreak after the tsunami in Palu, Donggala, and Sigi District.
Methods:
Verification of medical records at six selected primary healthcare institutions with the highest number of cases of diarrhea.
Results:
A pseudo-epidemic of diarrhea occurred. A high number of diarrhea cases occurred due to double reporting and misdiagnosed cases. Investigation reports showed that liquid defecation was considered diarrhea even though it occurred less than three times a day. The follow-up activity was contacting data entry managers to revise data, disseminate findings during the daily meeting of the health-related officers, and broadcasting findings through a WhatsApp group of provincial and district surveillance officers. Post-investigation, the number of diarrhea incidences was lower and the peak was not shown on the epidemic curve. It can be interpreted that a diarrhea outbreak did not occur in the tsunami-affected area in the Palu, Donggala, and Sigi districts.
Discussion:
During a time of disaster, a chaotic situation led to improper data collection. Data verification should be conducted to assure the validity of reported data.
Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.
Aim:
To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.
Methods:
The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.
Results:
The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.
Discussion:
The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.
Two major public health issues facing Nigeria in 2017 and 2018 were the terrorist activity by the Boko Haram Islamist group and an unprecedented outbreak of Lassa fever.
Aim:
To determine if Boko Haram activity was temporally or spatially related to the incidence of Lassa fever in Nigeria and if so, to identify potential concurrent causes and mitigation measures.
Methods:
The study was a mixed-methods design. First, we conducted a secondary analysis of the Armed Conflict Location and Event Data (ACLED) Project for all known Boko Haram activity and of the weekly Nigeria Centre for Disease Control reports for suspected Lassa fever cases. Data were analyzed for January 2017 through June 2018. The ACLED data were spatially overlaid with suspected Lassa cases for each of Nigeria’s 36 states. Secondly, we conducted interviews with six aid workers in Nigeria regarding Boko Haram activities and Lassa fever cases.
Results:
In the study period, 596 Boko Haram activities occurred in 13 states (36.1%): 416 in 2017 and 180 between January and June of 2018. During the same period, 3,137 suspected Lassa cases were reported from 21 states (58.3%): 1,022 in 2017 and 2,115 in January through June 2018. Only one state, Sokoto, was unaffected by either issue. Aid workers reported a positive relationship between Boko Haram activity and increased negative health outcomes.
Discussion:
The investigation found little geographic overlap in Nigeria between Boko Haram activity and the 2018 Lassa fever outbreak, suggesting independence of these two issues. However, unmeasured factors, such as public fear and mistrust of governmental activities, may affect both issues. It is also critical to note that widespread co-occurrence (97.2% of 36 states) of these two issues presents significant public health, medical, and security challenges for Nigeria, calling for overarching solutions such as governmental stability and economic stimulus.
Mass casualty incidents, whether man-made or natural, are occurring with increasing frequency and severity. Hospitals and health systems across the United States are striving to be more rigorously prepared more such incidents. Following a mass shooting in 2012 and significant growth and expansion of our hospital and health system in the following years, a need was identified for more staff to support preparedness efforts.
Aim:
To discuss the roles and responsibilities of Nurse Disaster Preparedness Coordinator (NDPC), a dedicated position in the Emergency Department (ED).
Methods:
The role of Nurse Disaster Preparedness Coordinator was implemented in 2016, is a part-time position in the Emergency Department and reports to the ED Manager while working closely with the ED Director of Emergency Preparedness and the hospital Emergency Manager. The role addresses all areas of the emergency management continuum, from planning and mitigation to response and recovery.
Results:
The NDPC’s responsibilities fall into the categories of all-hazards preparedness, chemical, biological, radioactive, nuclear and explosive (CBRNE) response, and general nursing practice. All-hazards preparedness includes ED staff training, policy and procedure development, and liaising with hospital emergency manager to coordinate hospital-wide efforts. CBRNE response includes the training and maintenance of a patient decontamination team, a high-risk infectious disease team, and their equipment. General nursing practice addresses research, nursing indicators as they apply to disasters, promoting evidence-based practice, and community outreach.
Discussion:
A dedicated Nurse Disaster Preparedness Coordinator has allowed transition from intermittent larger exercises to a regular and frequent exercise schedule and better application of full-scale exercises. Overall, the creation of the role has strengthened hospital readiness for mass casualty incidents while alleviating the vast scope of emergency management responsibilities for a large suburban hospital.
Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.
Aim:
After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.
Methods:
The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.
Results:
Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.
Discussion:
An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.