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Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.
Aim:
To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.
Methods:
Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.
Results:
The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.
Discussion:
Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.
The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) evaluates experienced needs among disaster-affected populations and has been frequently used in both humanitarian emergencies and research. Today, the use of this tool is increasing among people affected by crises and emergencies. Web-based methods have shown to reduce several methodological and practical challenges in disaster health research.
Aim:
This project aims to develop and evaluate HESPER SW (a self-administered, web-based version of the HESPER scale).
Methods:
Alternative reliability and test-retest validity of HESPER SW were evaluated using different analytic statistical methods.
Results:
The first analysis suggests that HEPSER SW is a reliable and valid instrument which is easy to use and that it reduces several methodological and practical challenges in disaster health research.
Discussion:
HESPER SW can be used both for humanitarian and research purposes and offers a quick, self-administered, web-based, and scientifically robust way to investigate experienced needs in populations affected by disasters or humanitarian crises.
Overcrowding in the emergency department (ED) has been a global problem for a long time, but it is still not resolved.
Aim:
To determine if an ED expansion would be effective in resolving overcrowding.
Methods:
This was a retrospective study comparing two 10-month periods before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The existing ED consisted of 45 beds in the adult area and eight beds in the pediatric area. After the construction, the number of beds was not increased, but a fast track area was newly established in the adult area, and a 25-bed ward for emergency hospitalized patients was opened.
Results:
The number of patients visiting the ED increased from 77,078 to 87,927. The proportion of patients who returned home without treatment significantly decreased from 11.5% to 0.9% (p<0.001). The number of adult patients increased from 40,814 to 60,720, but the number of patients who could be treated on the bed decreased (22,166 (54.3%) vs. 17,776 (29.3%), p<0.001). The number of pediatric patients was similar in both periods. Median ED length of stay (LOS) of total patients increased from 193.0 min to 205.8 min (p<0.001). Of the 18,900 hospitalized patients during post-period, 1,255 (6.64%) were admitted to the emergency ward, and the boarding (from admission decision to hospitalization) time of the admitted patients decreased from 239.2 min in the pre-period to 190.9 min in the post-period by 38.3 min. However, more time was required for admission decision in the post-period (216.8 vs. 253.3, p<0.001).
Discussion:
The ED expansion allowed more patients to be treated, and the emergency ward reduced boarding times of admitted patients. However, due to the increase in the number of patients, the time required for medical treatment increased.
A heatwave hit the Greater Montreal area during the week of July 1 to July 8. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), saw its crews struggling to respond to a record-breaking number of emergency calls while going door-to-door to make sure the at-risk population was not overburdened by the heat.
Aim:
USC’s mission was to ensure its population’s emergency medical care and safety under extenuating conditions. In conjunction with our municipal partners and the public health services, we deployed an aggressive communication strategy, urging people to only call 911 in the case of a life-threatening emergency, with the aim of limiting ambulance transports.
Methods:
Ambulance resources were increased (> 20% compared to the same period in 2017). More than 60 media interviews were given. Paramedic supervisors were sent to emergency departments to contain the offload delays. USC’s community response team was going door-to-door in pre-identified urban heat islands (UHI), bringing medical attention directly to those in need.
Results:
Despite our communications efforts, a record-breaking 1,568 calls (> 37% compared to the same period in 2017) were received in a 24 hour period. Through the door-to-door campaign, 12 people in need received medical attention. More than 90 people are suspected to have died as a result of a July heat wave in Quebec, with figures showing that 60 deaths in the cities of Montreal and Laval alone may be linked to elevated temperatures.
Discussion:
Through strong collaboration with our municipal and provincial partners, and the public health services, an important communication strategy and additional resources were deployed. Crews were able to prevent additional deaths. With the observed increase in extreme weather events, this strategy will definitely be useful in the future.
Climate change and overdevelopment increase the intensity and frequency of flash flooding, which may generate more swiftwater rescue (SWR) incidents. Rescue personnel may fail to properly risk stratify (triage) these victims due to limited medical and/or variable SWR training, or due to an adverse rescuer-to-victim ratio. Some victims may attempt to refuse medical evaluation due to lack of awareness of incident-related morbidity and/or comprehension of risk.
Aim:
To develop an SWR emergency medical triage tool.
Methods:
A cross-sectional literature search identified SWR-related medical conditions. A flow diagram reliant upon incident history, chief complaint, and observational exam rather than interpretation of vital signs was created to guide medical decision-making.
Results:
Every SWR victim should receive a medical screening exam focused on six clinical categories—drowning, hypothermia, hazmat exposure, physical trauma, psychological trauma and exacerbation of pre-existing disease. Drowning potential is identified by dyspnea, new cough or a history of (even brief) submersion. Shivering SWR victims and those with altered mental status but no shivering are assumed to be hypothermic. Any victim with open skin lesions/wounds who was immersed in floodwater and anyone who has swallowed floodwater is contaminated; these victims require decontamination and possible antibiotic therapy. SWR victims injured upon entering the water or from contact with either water-borne stationary or floating objects require trauma evaluation. Distraught victims and those who exhibit exacerbation of pre-existing organ-system disease also require ED evaluation.
Discussion:
Most SWR course curricula are oriented towards technical rescue; they do not address comprehensive medical decision-making. We present a rapid medical screening exam designed to determine which SWR victims require an ED evaluation. Such a triage tool will assist rescuers to simultaneously honor patient autonomy and avoid risky and uninformed refusal of medical aid. Simplified medical decision-making should enable the application of this tool worldwide.
The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.
Aim:
The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.
Methods:
Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.
Results:
A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).
Discussion:
As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.
The underground mining industry has one of the most hazardous industrial occupations, and requires an increased level of preparedness for injury incidents. The most important outcome for seriously injured victims is the reduction in morbidity and mortality. Receiving effective and timely care may mean the difference between life and death. However, mines are usually located in a rural area and the incident site may be deep underground which makes it an extraordinary challenge for the rescue services. A successful rescue response in an extraordinary milieu demands a high level of inter-organizational cooperation skills at the incident site.
Aim:
To analyze statements of collaborate activities during a major incident exercise in the underground mine industry, essentially for patient outcome.
Methods:
A Delphi technique was performed, asking opinions from experts in iterative rounds to generate, understand, and form consensus on group opinion around this complex issue. The experts were personnel from disaster medicine (n=3), emergency and prehospital medicine (n=10), rescue service (n=16), and mine industry (n=9), all with operative command positions.
Results:
Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important inter-organization cooperation activities to optimize patient outcome from an injury incident in an underground mine. This resulted in 63 statements. The statements included information about: early alarm routines, collaborative support and efforts of early life-saving interventions, relevant resources and equipment, command and control room, and functions. In round two participants shared and communicated decisions about safety, situation awareness, and guidelines for response. All statements reached consensus among the experts in round three.
Discussion:
These inter-organizational statements are considered important by experts, and could be used to evaluate collaboration in major incident exercises. Hence, the statements can also be quality indicators for reporting results from major incident management.
Roof-harvested rainwater held in domestic tanks is used for a variety of purposes in Australia, including drinking and irrigation. There is limited evidence about the quality of rainwater after bushfires. Current health guidelines can be interpreted that landholders need to drain their rainwater tanks to avoid the risk of contamination. Anecdotal reports indicate that following such advice caused additional distress to landowners affected by bushfires in South Australia. Sustainable water management is important for future resilience and more evidence on water quality following bushfires is needed.
Aim:
This project investigated whether there is contamination of roof-harvested rainwater after bushfires, and if so, whether such water was safe for various purposes.
Methods:
In 2017 we tested artificially contaminated water spiked with chemicals associated with bushfires (chromated copper arsenate-treated ash and firefighting foam) and conducted a pilot field study using two purposely built roofs during a pre-fire season burn off. A field validation is planned for the summer of 2018/19 (December 2018 - March 2019), i.e., we plan to obtain 200 samples from 50 households affected by bushfire – two samples immediately after the fire event and another two after the first rain.
Results:
The artificially created contaminated water fell within guidelines for non-potable uses such as irrigation and stock watering, but was found unsuitable for drinking even after being filtered through two commercially available water filtration systems. We also plan to present results from our field study of 50 households.
Discussion:
Contaminant concentrations, even in artificially spiked water samples, are low and acceptable for non-potable uses. Bottled water should be used for drinking. Landholders should be encouraged to use their water for recovery purposes. Such advice may assist with decreasing the stress experienced by affected landholders and help with recovery efforts through the availability of a greater body of water.
A learning project was launched to prepare for natural disasters such as earthquakes and floods. Competencies were developed for clinical nurses in the Initial phase of disasters as an indicator to build a bridge between daily training and actions during crises. There are two predominant features of the competencies that differ from other works. First was to concentrate only on “the initial phase” of a crisis outbreak. The second was to associate each competence with services and roles of clinical nurses.
Methods:
The development has been conducted in accordance with the ibstpi® competency development model. First, 50 outlining competencies from earlier studies were selected, like ICN Framework and Disaster Nursing Core Competency for undergraduates in Japan. Then a web-based questionnaire was carried out with a four-point scale of “able,” “probable,” “impossible,” and “cannot understand meaning” for incumbent nurses in order to gauge their adequacy.
Results:
There were 86 responses with an average of 14 years (1-40) of nursing experience. We compared them in three groups; those with a job post (G1), those with experience of longer than five years (G2), and those with experience of fewer than five years (G3). The average competency score (total 150 points) was 96.7 (67-129) in G1, 88.2 (53-145) in G2 and 80.2 (59-114) in G3.
Discussion:
The results imply, even in G1, the average score is low at 65/100 points. This may indicate most clinical nurses should make efforts to develop their skills and knowledge of disaster nursing through daily work. Only 32 competencies (G1), 14 (G2), and 5 (G3) were marked as “able” or “probable” by over 80% of responders. Thus with consideration, depending on the result and expert reviews, the competencies determined to be “required” for clinical nurses were finally refined down to 35 items including the premise of ten.
Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.
Aim:
To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.
Methods:
Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.
Results:
All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).
Discussion:
Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.
Children are a vulnerable population in disasters. However, there were few pediatricians, neonatologists, and obstetricians in the Japan Disaster Medical Assistance Team (DMAT), so disaster medical headquarters had limited knowledge to solve these problems. Pediatric and perinatal disaster liaison coordinators were trained to improve disaster medical management for children and pregnant women since the 2016 Kumamoto earthquake.
Aim:
To analyze and report the activity of PPDML during these years in Osaka, Japan.
Methods:
The records of PPDML in major disasters and disaster drills from 2017 to 2018 were reviewed.
Results:
The DMAT had disaster drills twice a year in Osaka, and PPDML participated in the drill for the first time in July 2017. In the drill, PPDML coordinated the pediatric and perinatal issues with DMAT and Japan Ground Self-Defense Force (JGSDF) in disaster headquarters. In June 20184. months after the drill, PPDML participated for the second time in February 2018 when the North Osaka Earthquake occurred. PPDML coordinated transport of 22 children and babies with congenital heart disease from the damaged National Cerebral and Cardiovascular Center Hospital. The operation was finished within 5 hours after requested transportation.
Discussion:
To protect children and pregnant women, cooperation between the disaster medical network and the pediatric and perinatal network is absolutely important for any phase in disaster. Because PPDML had attended in disaster drills before, the experience could make PPDML achieve good performance in a real disaster in North Osaka Earthquake. It can be concluded that cooperation between disaster medical network and PPDML is very useful to manage the disaster issues for children and pregnant women, and the most important thing is to cooperate not only in disaster but also in ordinary days.
Acute infection in post-disaster settings is associated with increased morbidity and mortality. Sepsis management in low resource settings is controversial with recent research suggesting that aggressive fluid resuscitation may cause greater harm than benefit. However, the vast majority of international sepsis guidelines still suggest large initial fluid boluses as part of sepsis algorithms.
Aim:
To create an adult and pediatric sepsis algorithm to be applied in low resource clinical settings. This is part of a larger project to create clinical algorithms to provide standardization of emergency case management for low-resource clinical environments.
Methods:
A literature search was performed through PubMed identifying and reviewing fluid resuscitation in adult and pediatric sepsis patients in high and low resource clinical environments. The pathways were created based on interpretation of the available evidence-based literature. Focus groups were conducted in Zambia in March 2018 for feedback from local practitioners regarding feasibility of pathways. The pathways were then modified, reviewed by experts peer-review and revised.
Results:
Final pediatric and adult sepsis clinical algorithms were created and posted to the free web-based application AgileMD™. They will be available via app access, an online platform, or printable pathways for use in the clinical environment.
Discussion:
The study is currently undergoing IRB approval with a plan for implementation of multiple clinical algorithms at a referral hospital site in Zambia in January 2019. Site direction at Ndola Hospital will be conducted under the leadership of an Emergency Medicine trained physician, who will assist in implementation of algorithms and collection of data. Initial data review will be conducted in May 2019. There will be incremental site visits by organizing researchers throughout the implementation and data collection period. Statistical analysis will examine sepsis associated processes and outcome indicators pre and post-intervention to further delineate sepsis management in low resource clinical environments.
In recent years, the development of disaster medicine has made rapid progress in China after the Wenchuan earthquake in 2008. China formed a more systematic and specialized health emergency force. In addition, the Ministry of Emergency Management was established In 2018, which demonstrated that the Chinese government is paying more attention to the disaster rescue work. In this report, the practice, experience, and prospect of disaster medicine in China was reviewed.
Aim:
To explore the current status and prospects of disaster medicine development in China.
Methods:
The literature research method was used to analyze literature at home and abroad. It was used to retrospectively analyze the rescue experience of Chinese medical rescue teams, sort out the current situation of disaster medical disciplines and rescue teams, and propose disaster medical development recommendations suitable for China’s national conditions.
Results:
After years of construction, China has formed a more systematic and specialized health emergency force, but the personnel, equipment, plans, and training of the professional rescue team need to be improved. The discipline system of disaster medicine in China is still lagging behind, and it is still unable to meet the needs of the rescue situation at home and abroad.
Discussion:
Disaster medicine is the area of medical specialization serving the dual areas of providing health care to disaster survivors and providing medically related disaster preparation, disaster planning, disaster response, and disaster recovery leadership throughout the disaster life cycle. It requires multidisciplinary intervention, integration, and application. A forward-looking perspective must be strengthened on the discipline and team building of disaster medicine.
On January 13, 2018, a false ballistic missile alert that lasted 38 minutes was issued across Oahu, Hawaii, United States. As a result of a system failure, an erroneous text message was sent that stated, “Ballistic missile threat inbound to Hawaii. Seek immediate shelter.”
Aim:
The research team wanted to know the degree of reported anxiety triggered by the event and if knowledge, attitudes, or behaviors for individual/family emergency preparedness (EP) changed post-event.
Methods:
A 50-question survey that asked about individual and family EP pre- and post-event, and the level of anxiety triggered by the event, was administered to a convenience sample of full-time adult residents of Oahu. The study was conducted over a 6-8 week period post-event. Statistical analysis was used to identify factors associated with an increasing level of EP post-event and reported event-triggered anxiety.
Results:
209 participants completed the survey (29% male, 71% female) with about one half living with children. One third were essential workers. Key factors that correlate with increasing various areas of EP post-event include higher educational, receipt of electronic emergency alerts, prior emergency training, and higher reported connectedness to community. Those with higher event anxiety were more likely to develop and practice an EP plan post-event, encourage EP with friends, and report a higher level of community connectedness. The elderly were more likely to have higher levels of EP before and after the event but were less likely to receive emergency alert notifications or have EP training.
Discussion:
While the event was very unfortunate, it did seem to stimulate citizen disaster EP among some groups. Additional research should explore the utility of increasing EP education for communities immediately after disasters, tailoring this education for groups, and targeting the elderly for participation in the emergency alert system.
This research starts from the assumption that work accidents, in addition to fortuitous or individual phenomena, imply social and organizational factors, and highlights the social character of the production of the accident at work. For this reason, this study investigates the living conditions and the ways of workers in the oil and gas industry in Brazil.
Aim:
To analyze the human factors in the relationship with work accidents on oil platforms from the social dimensions.
Methods:
It is qualitative research and it has as instruments of collection the focal group and individual interviews with workers and managers of the platforms, participant observation, and documentary analysis.
Results:
The research is still being carried out, but some reflections are possible so far: accidents at work depend on the direct or indirect relationship of workers with the work process itself, the modalities of production of work, and management of work. Possible causes underlying the accident are the quality of life and the conceptions of health and safety. Associated with it are social constructs and the multifactorial causes of occupational accidents including the relations between acts and unsafe conditions.
Discussion:
The increase in outsourcing and the decrease in training quality, as well as the prioritization of production, targets the detriment of meeting safety criteria. There is a need to reassess labor management, safety policies, and outsourcing processes. Lack of awareness of the proper use of safety equipment and the organization of the work environment are major causes of work-related accidents. The human factor focuses on the individual, group, organizational, and social dimensions in complex interactions. The identification of social processes between working groups in empirical reality, the influence of elements of culture, organizational management, and their impacts on relations and on safe work performance allows an understanding of social risks.
The human disaster is a permanent challenge for the Brazilian government because the difficulties faced are related to the lack of interface between public policies, resulting in fragile analyses of risk and non-prevention, being that annually several Brazilian lives are lost in disasters that continue to happen.
Aim:
The article is the result of research and presents the analyses of health policy, actions, and programs developed to anticipate the fire victims of the Nightclub Kiss concert hall that took place in 2013 (Santa Maria, Brazil). The objective was to investigate and analyze the disasters and human disasters, especially the fire of Nightclub Kiss when 242 young people died. Causes and determinants were analyzed in order to subsidize public policies, in particular, the health policy.
Methods:
A qualitative case study supported by the critical dialectic method with semi-structured interviews, focus group, documentary analysis, and bibliographic review.
Results:
The experiences accumulated throughout history show that disaster situations require public policies to be able to act readily, resolve, and pay attention to the needs of the population involved. Disasters are increasingly recurrent episodes and generate deep social consequences that mark human life. Managing a human disaster remains a challenge for the health policy in Brazil. The difficulties faced are related to the lack of interface with other public policies. The urgency to incorporate intervention/action strategies into health plans is important. Implementation of prevention and training programs, and adopting strategies and protocols for the whole network of attention is critical.
Discussion:
It is important to emphasize the importance of broadening the theoretical definitions by overcoming the divergences of the concepts adopted between the theoretical and operational field, by elaborating a review of the Brazilian legislation in order to broaden and contemplate the needs of different people.
Disaster medicine has been identified as a fundamental discipline for health professionals. In Italy, the role of physicians during disaster response is officially recognized by the Italian Code of Medical Ethics and by the Ministry of Education. Nevertheless, few Italian medical schools include this discipline in their curricula.
Aim:
With the aim of teaching basic knowledge of disaster medicine to Italian medical students, Research Center in Emergency and Disaster Medicine (CRIMEDIM) and Italian Medical Students’ Association (SISM) developed DisasterSISM, a nationwide training project in disaster medicine.
Methods:
DisasterSISM consists of three courses: Basic, Advanced, and Train-of-Trainers (ToT). The Basic courses are managed by medical students who are trained during the one-week intense ToT. All courses are delivered using innovative training methodologies, such as e-learning, peer education, table-top exercises, and virtual reality simulations.
Results:
From 2012 to 2018, a total of 122 courses (111 Basic, 5 Advanced, and 6 ToT) have been delivered. DisasterSISM reached 37 out of 45 Italian medical schools, training more than 2,500 students. A survey conducted after the end of each course showed that participants considered the knowledge in Disaster Medicine essential for their future profession, regardless of the specialty chosen. Students also expressed their appreciation about the blended-learning approach, with a predilection for virtual reality simulations. The comparison between the entrance and the final exam scores showed a significant increase in knowledge.
Discussion:
In six years, DisasterSISM reached the majority of Italian medical schools, providing disaster medicine knowledge to hundreds of undergraduates. Considering the fast growth and diffusion of the project, the significant increase of knowledge, and the positive feedback received from participants, we suggest that the DisasterSISM model be implemented in other countries to widely disseminate information about prevention and disaster preparedness among medical students and health professionals.
Currently, there is no uniform and standard disaster medicine course for students in medical school.
Aim:
To design a disaster medicine course model based on knowledge structure, teaching and evaluation methods according to experts’ advice and interest of undergraduates majoring in clinical medicine.
Methods:
The first and second level catalog defined as chapters and sections for the disaster medicine curriculum were drafted based on literature and summary of fragmentary experience. The teaching syllabus with methods of teaching and evaluation was initially outlined. The expert consultation form and student questionnaire were designed and validated. Experts in disaster medicine in China were consulted and students in our medical school were investigated. Delphi Methods was used and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts and students.
Results:
A total of 31 experts were consulted. 320 students were inquired. By two rounds of consultation with Kendall coordination coefficient W value 0.207, chi-square value 128.781(p=0.01), consensus about the knowledge structure for the curriculum were achieved, which consisted of 6 chapters (as Introduction to disaster medicine, incident command, medical knowledge and skills in disaster, public health, ethics in disaster, information management, with the weights of 0.1486, 0.1999, 0.4209, 0.0785, 0.0748, 0.0774 respectively)and 25 sections. Teaching methods for different knowledge module were determined, which included lecture, demonstration, case discussion, drill and sand table simulation. And the evaluation methods were affirmed as a quiz, written examination, skill test and teamwork test assessed by intra-group and inter-group evaluation.
Discussion:
Through scientific investigation of experts in disaster rescue and undergraduates majoring in clinical medicine, a disaster medicine course model for clinical medical students was established.
Despite a large number of nurses involved in disaster situations in different ways, there are few theories or models that define and describe the goal and content of disaster nursing.
Aim:
This study aimed to present a model for disaster nursing, based on a literature review of the concept and content of disaster nursing.
Methods:
A systematic literature review of 15 original qualitative or quantitative articles was conducted. A thematic synthesis was used to analyze the data.
Results:
The main theme of Disaster Nursing: Crossing Borders, included three dimensions (personal borders, professional borders and environmental borders) and four themes describing the process of disaster nursing (being hit by reality; adapting to the conditions; providing aid, relief, and caring; recovering, remembering, and growing). Based on these results the HOPE model was developed. ‘HOPE’ stands for ‘Holistic health assessment and promotion; Organization and management of immediate response; Professional adaptation; Endurance and recovery.
Discussion:
The HOPE model for disaster nursing describes the core element and essence of nursing in the disaster response phase and can serve as guidance both for nurses deployed in disasters and in disaster nursing training.
Climate change is intricately related to human health and impacts acute and chronic diseases leading to increased demands on the health care system.
Aim:
The University of Colorado Graduate Medical Education (GME) Fellowship in Climate Change and Health Science Policy (CCHSP) aims to train and equip a new generation of clinicians knowledgeable in climate science, proficient in climate health education, and facile with advocacy skills in order to become leaders in health policy.
The CCHSP fellowship is funded by the Living Closer Foundation and hosted through the University of Colorado Department of Emergency Medicine. It is a one to two-year program tailored to the fellow’s specific goals with the opportunity to earn an MPH or MA. Clinical work is supported through the UCHealth network. Site placement occurs at partnering organizations, including the National Institutes of Health, the Centers for Disease Control and Prevention, and fieldwork throughout the world (via Colorado School of Public Health, Harvard FXB Center for Health and Human Rights).
The first fellow was recruited in 2017 and has participated in and completed multiple projects: technical contributor to the US Government’s Fourth National Climate Assessment; advocating for women’s health policy in India; authorship of climate change and health resource documents for the World Bank; climate change leadership within SAEM; advocacy work with local and state governments; multiple research publications.
Discussion:
As climate change continues to impact human health with widespread consequences, we need effective and articulate leaders to affect policy. Although this Fellowship originated in Emergency Medicine, its competencies and structure are replicable for other clinical specialties. Climate change will be one of the core global health challenges for generations. A strong foundation of clinicians who understand its causes and the strategies for adaptation and mitigations are necessary to optimize health outcomes amidst this growing threat.