Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The opioid epidemic is overwhelming communities across the United States. West Virginia (WV) has been devastated, heralding a 86% increase in deaths from 2012-2016, and over 1,000 deaths last year as per WV Health Statistics Center. Treatment centers and providers have emerged throughout the state to provide medication-assisted treatment (MAT). The impact of these clinics on the opioid abusing population is not yet fully understood.
Aim:
Utilizing Geographic Information System (GIS), a comparison of MAT provider locations versus regions of historical overdoses can indicate areas of deficiency. If no providers emerge in underserved counties, overdose deaths in those areas will continue to rise.
Methods:
Maps were created using current DEA-X licenses in WV registered through Substance Abuse and Mental Health Services Administration (SAHMSA). Overdose death rates were taken from WV Public Health Records from 2010-2017. Two maps and corresponding data were compared for overlap or lack thereof.
Results:
Of the 338 locations of DEA-X licenses registered, 17.5% are in Cabell County, which led the state in overdose deaths in 2017. Only 2.5% of the total providers are currently in Wayne County, which had the second highest overdose death rate. Berkeley County, which was 3rd highest, has a mere 6.5% of total providers. Comparatively, Kanawah County, home to the state’s capital, has over twice this number of providers despite consistently having at or below the state average of overdose rates. Resources are pulled towards population-dense areas or university centers, where the epidemic is present but misses counties with higher overdose rates.
Discussion:
Results show a lack of MAT providers in many of WV’s devastated counties. Treatment centers exist throughout the state but are concentrated in regions with large cities or academic centers. This distribution limits accessibility to a marginalized patient population, making improvements unlikely in WV’s future opioid-overdose death rates.
Residency education delivery in the United States has migrated from conventional lectures to alternative educational models that include mini-lectures, small group, and learner lead discussions. As training programs struggle with mandated hours of content, prehospital (EMS) and disaster medicine are given limited focus. While the need for prehospital and disaster medicine education in emergency training is understood, no standard curriculum delivery has been proposed and little research has been done to evaluate the effectiveness of any particular model.
Aim:
To demonstrate a four-hour multi-modal curriculum that includes lecture based discussions and small group exercises, culminating in an interactive multidisciplinary competition that integrates the previously taught information.
Methods:
EMS and disaster faculty were surveyed on the previous disaster and prehospital educational day experiences to evaluate course content, level of engagement, and participation by faculty. Based on this feedback, the EMS/Disaster divisions developed a schedule for the four hour EMS and Disaster Day that incorporated vital concepts while addressing the pitfalls previously identified. Sessions included traditional lectures, question and answer sessions, small group exercises, and a tabletop competition. Structured similarly to a strategy board game, the tabletop exercise challenged residents to take into account both medical and ethical considerations during a traditional triage exercise.
Results:
Compared to past reviews by emergency medical faculty, residents, and medical students, there was a precipitous increase in satisfaction scores on the part of all participants.
Discussion:
This curriculum deviates from the conventional education model and has been successfully implemented at our 3-year residency program of 66 residents. This EMS and Disaster Day promotes active learning, resident and faculty participation, and retention of important concepts while also fostering relationships between disaster managers and the Department of Emergency Medicine.
Disasters are a major challenge for public health because of damage caused by death, injury, or illness that exceeds health services’ ability to respond. Health professionals and students require awareness and understanding of particular aspects of disaster planning, mitigation, response, or recovery. In Brazil, despite the increase in the number and intensity of disasters, there is no formal acceptance regarding the need to integrate disaster content into curriculum guidelines (1)
Aim:
To develop and test referential and models for disaster management health professional education.
Methods:
Competence-based education has been proposed. The methodology adopted was developed by the Association (2) and adapted to be used in the Brazilian context. An initial literature search was performed in MEDLINE via PubMed, Google Scholar, Lilacs, and Scielo databases using disaster and competencies as descriptors.
Results:
Articles and documents in Portuguese, Spanish, and English were identified for: public health (21), nursing (20), multi-professional (16), psychology (4), pharmacy (4), dentistry (2), medicine (1), veterinary (2), and nutrition (1). Data were organized according to a proposal from the literature (3) Selection of benchmarks for the preparation of education models identified 27 referential, three of them developed in Brazil.
Discussion:
Application and evaluation of the methodology developed with undergraduate students of the Federal University of Rio Grande do Sul consisted of an initiative to prepare health care professionals for disaster management.
The Hyogo and Sendai Frameworks for Disaster Reduction are well known and have been influential globally. However, less is known of their broader contexts.
Aim:
A recent opportunity to visit Kobe, Japan, provided an opportunity to experience the rich, and largely unknown tapestry behind the scenes of the Hyogo and Sendai Frameworks. This paper aims to illuminate the journey of the Kobe Legacy and its global influence.
Methods:
An experiential visit to Kobe and exploring its rich resources relating to disaster risk reduction.
Results:
The First World Conference on Natural Disasters, was held in Yokohama, Japan, in 1994. Almost immediately, Kobe experienced the Great Hanshin Earthquake, January 17, 1995, resulting in 6,434 dead, 43,792 injured, and 249,180 homes damaged. The United Nations International Strategy for Disaster Reduction (2000 – 2005) culminated in the Second World Conference on Disaster Reduction, Kobe, 2005 and the Hyogo Framework for Action 2005 – 2015. The Great East Japan Earthquake occurred on March 11, 2011, with 18,453 dead or missing, 6157 injured, 1.1M homes damaged, with a tsunami and nuclear accidents. The Third World Conference on Disaster Risk Reduction followed in Sendai in 2015 with the Sendai Framework for Disaster Risk Reduction 2015 – 2030 agreed on. Subsequently, the Sendai Framework has further evolved. However, behind the scenes, Kobe has developed a rich tapestry of insightful and valuable resources which will be outlined in this presentation.
Discussion:
In the words of the Mayor of Kobe, Mr. Tatsuo Yada in 2010, “I would like to reaffirm my determination to never allow our experiences of the disaster to fade away. It is our responsibility to make the utmost effort for disaster prevention and mitigation and keep passing on our experiences and the lessons learned to future generations”. This is the real legacy of Kobe.
On March 11, 2011, the Great East Japan Earthquake and Tsunami hit the northeastern part of Japan, causing 15,895 deaths and 2,539 missing persons as of March 1, 2018. Moreover, many medical facilities were destroyed, resulting in the loss of medical information stored in paper records or on servers in hospitals and clinics.
Aim:
To highlight the need for a backup system for saving all clinical information during disaster preparation.
Results:
In 2012, a prefectural medical network system - the Miyagi Medical and Welfare Information Network (MMWIN) - introduced a cloud backup data storage service for disasters. This system facilitates the sharing of clinical data among hospitals, clinics, pharmacies, and other care facilities. The backup system is based on the Standardized Structured Medical Information Exchange (SS-MIX), which enables data from medical record systems, developed by different vendors, to be stored in a common format. By the end of September 2018, the total backed up clinical data, including patients’ basic information, disease names, blood tests, and prescription list, reached 370 million items from 11.2 million persons. We renewed the system last year and initiated an image data sharing service this year. The number of facilities within the MMWIN was 948, while the number of opt-in patients exceeded 80,000.
Discussion:
Although the project was financed by the government, a usage fee was collected from the participating facilities. To sustain this project, it is crucial to improve the balance between cost and income by increasing the number of participating facilities and decreasing maintenance cost. Thus, our clinical information backup system for disasters facilitates information sharing among medical facilities.
Compared with traditional START Triage Method, the Sacco Triage Method is a new way to access death risk in disaster scenes. However, due to the difficulties in disaster medical research, there is still no evidence to prove which one is more effective.
Aim:
To assess and compare the value of START Triage Method and Sacco Triage Method in the death risk assessment of transport and the one-month death risk assessment of the earthquake mass trauma patients.
Methods:
A retrospective analysis was conducted on 1,612 patients who were transferred to the West China Hospital by assigning to different triage levels by Sacco Triage Method and START Triage Method respectively. Both of the triage methods were evaluated based on death cases on either during transport or in the emergency department, using the area under the receiver-operator curve.
Results:
For death during the transport and in the emergency department, the receiver-operator curve of two groups reflected as 0.721 and 0.649. For death in a consequence, the receiver-operator curve of the two groups was revealed as 0.667 and 0.519.
Discussion:
As an accurate triage method, the Sacco Triage Method may be used in a mass casualty incident. It is a more effective way than the START Triage Method for the evaluation of death risk assessment of the mass trauma patients.
Healthcare professionals working in a disaster face destroyed physical infrastructures, scarce supplies, and a limited-in-training peer group. During a mass casualty event, disaster victims are triaged to the “expectant” category of care because either their injuries are not survivable or the resources needed to care for them are not available.
Aim:
To examine the challenges that disaster responders face in caring for dying patients in the field, and advocate for basic palliative care training prior to deploying to a disaster.
Methods:
The world’s literature was reviewed to identify challenges for disaster teams in providing compassionate end-of-life care and to find training exercises for pre-deployment competency building.
Results:
Training Topics in Palliative Care Prior to Disaster Deployment include the following:
1. Symptom Management Protocols:
Pain
Anxiety
Respiratory distress
Delirium
Nausea and Vomiting
2. Spiritual Management
Grief
Identify meaning
3. Cultural Training specific to the location of the disaster
The meaning of death in the culture
Who are the decision makers in the family
4. Training for difficult conversations
Delivering Bad News
Managing a grieving family
5. Self-Care Training
Develop a system for debriefing
Develop a buddy system
Self-care exercises: deep breathing, prayer, meditation, yoga
Discussion:
Challenges to the care of the dying during a disaster include a loss of medical infrastructure and scarce medical or physical resources. Palliative care training for non-palliative care specialists can be instructive for the development of palliative care training for medical care responders after disasters. Applying standards, identifying goals of care for the expectant patient, communication to the patient and family members, if available, can help reduce suffering of this group of devastatingly vulnerable patients. In addition, peer support, on-site discussions and debriefing, and problem-solving when resources are limited will help alleviate moral distress among the providers.
It is a requirement for a World Health Organization verified Emergency Medical Team (EMT) that all members be immunized against common diseases in the deploying region. Most jurisdictions use private suppliers such as travel doctors for immunization services. When a deployment is announced, members are nominated by their jurisdiction under the condition they are fully immunized. It is up to the individual to monitor their immunization status.
Aim:
To determine how many members nominated for deployment were fully immunized.
Methods:
Nominated members sent their completed vaccination record to a central location for assessment of their immunization status. The following data were recorded: vaccination status, last-minute booster doses required, and the number of emails sent by the assessor in processing the records. The number of phone calls made and received were not recorded.
Results:
To complete the skills matrix for a field hospital containing an emergency department and operating theater (an EMT type 2), 61 members were nominated. At the time of assessment, 32 (52%) were fully immunized, requiring no further booster doses (vaccinations or serology tests). Three members were removed from the deployment as they were not fully immunized. Last-minute booster doses were required by 27 (44%) members, with a total of 74 booster doses administered (range 0-5). 19 of the booster doses administered were immunizations required to work in any health facility in Australia. The most common vaccines requiring booster doses were rabies (n=21) and typhoid (n=15). 58 emails were sent over a period of 5 days to 24 members to clarify vaccination status.
Discussion:
This deployment highlighted a gap in members’ perception of their immunization status, leading to delays in deployment readiness for the team. A new electronic system where vaccine status tracking occurs in real time should address this issue.
Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.
Aim:
To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.
Methods:
Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.
Results:
The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.
Discussion:
Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.
Nurses have long been utilized in disaster response and recovery and they possess broad skill sets, which are critical in times of crisis. However, studies show that more than 80% of nurses who volunteered in disasters settings have no disaster education.
Aim:
This project explored the disaster knowledge, preparedness, and resilience of 2nd and 3rd-year undergraduate student nurses in a Bachelor of Nursing Science program in a regional university to garner support for the introduction of dedicated disaster nursing education, which is currently absent from Australian undergraduate nursing curricula. Whilst disaster management processes in Australia are robust and Australian health care systems have explicit plans in place, the same cannot be said for all countries and health care systems. Australian trained nurses are highly valued and actively sought in the global health workforce market. In a world marked by increasing change and instability, the lack of dedicated disaster education and skills in the largest health workforce increases the overall vulnerability.
Methods:
Data were collected using the Disaster Preparedness Evaluation Tool, the Connor-Davidson Resilience Scale, simple demographics, and a previous disaster experience questionnaire.
Results:
The results highlight important gaps in current practice and vulnerabilities in the current disaster management framework. Local students scored higher results in preparedness and resilience.
Discussion:
Student nurses are an underutilized resource in disaster preparation and by response teams around the world. With a global intent of shared responsibility and increased resilience in individuals and communities before, during, and after disaster events, dedicated capacity building of nursing staff has the potential to address key factors and simultaneously utilize an underappreciated demographic of student nurses. To the best of the author’s knowledge, this project is the first to explore disaster knowledge, preparedness, and resilience in undergraduate student nurses using validated disaster preparedness and resilience tools in Australia.
Japan experienced several major disasters in 2018.
Aim:
Evaluation of medical response was conducted and problems determined to solve for future response.
Methods:
An evaluation conducted on DMAT responding report of Northern Osaka Earthquake, West Japan Torrential Rain Disaster, Typhoon Jebi, and Hokkaido Iburi East Earthquake.
Results:
DMAT responded 58 teams for Osaka Northern Earthquake, 119 teams for West Japan Torrential Rain Disaster, 17 teams for Typhoon Jebi, 67 teams for Hokkaido Iburi East Earthquake. At the Osaka Northern Earthquake, by comparing the report of seismic diagnosis, results and, a magnitude of each region, hospital damage was evaluated. At the West Japan Torrential Rain Disaster, a flood hazard map was used to expect inundation at hospitals. At the Hokkaido Iburi East Earthquake, information of hospital generator was gathered and planned assistance for loss of power. Water supply cessation in the West Japan Torrential Rain Disaster and loss of power in the Hokkaido Iburi East Earthquake influenced hospital functionality. More precise preparation for hospital management in the event of a loss of power and water supply situation required in not only in local government but also each hospital. For the West Japan Torrential Rain Disaster, we experienced the same type of major disasters in the past, but could not manage accordingly. For the Hokkaido Iburi East Earthquake, we applied what was learned from the West Japan Torrential Rain Disaster.
Discussion:
Disaster medical operation was supposed to be managed with information from the Emergency Medical Information System (EMIS). However, 2018 disasters provided lessons that require a full understanding of disaster prior information and expected disaster damage information to manage disaster assistance. To accomplish effective disaster assistance, information must be gathered of supplies and assistance required by hospitals. An effective system to facilitate lessons learned needs to be developed
Major injury incidents in confined settings such as tunnels and underground mineral- and metalliferous mines are rare, but when they do happen, the consequences may be severe with potential for many injured. The incident site is underground and it is difficult for the rescue and emergency medical service to get an overview and reach the injured. Therefore, it is important for the emergency medical service, rescue service, and the company responsible for the underground environment to have a good collaboration.
Aim:
To develop best practices of conducting rescue response from a disaster medicine perspective in tunnels and underground mines through increased education.
Method:
Within an EU-program, the university collaborates with stakeholders such as rescue service, emergency medical service, and two mining companies. Within this project, an explorative case study with participatory research is conducted. This is managed with the help of representatives of the stakeholders, workshops, and through planning for and conducting observations of table-top and full-scale exercises.
Results:
At the first workshop the stakeholders built a timeline presenting their activities from a major incident occurring in an underground mine until the last injured was transported to the hospital. Thereafter, several workshops were conducted to find improvements that could be made regarding collaboration between the organizations. Table-top and full-scale exercises have also revealed further challenges. Within the project, prototypes are being developed and will be presented during the conference.
Discussion:
This project involves stakeholders in the research process, and they, therefore, have a direct impact on the development of best practices of rescue in major underground incidents.
Obstacle Course Races (OCR) are mass participation sporting events, challenging participants to complete physical and mental tasks over a variety of distances and terrains. The case series studied, Spartan Race, has races occurring in urban, rural, and wilderness venues, ranging from 5 to 42 kilometers, while incorporating 20 to 60 obstacles.
Aim:
To understand the injury rates, injury and illness patterns, and transport considerations within OCRs.
Methods:
A secondary data analysis of de-identified medical charts from 56 Spartan Race events occurring in Eastern Canada from 2014 to 2018 was performed. The scope of practice was first aid from 2014 to 2017, with the addition of advanced life support onsite in 2018.
Results:
Over 5 years, 2,387 injuries occurred among 127,481 participants, creating a patient presentation rate of 18.7/1000. Although the majority of injuries (92%; n=2,204) were treated onsite, a transport to hospital rate of 1.2/1000 (n=154) occurred along with an ambulance transport rate of 0.23/1000 (n=29). Lacerations (55%) and musculoskeletal (36%) injuries were the most frequent clinical presentations observed, whereas life-threatening emergencies (affecting airway, breathing, and circulation) were infrequent (n=10). Transport to the closest local tertiary care center was on average 49.8 kilometers (25.3 kilometers) and 40.5 minutes (17.9 minutes) away from the venue.
Discussion:
These results suggest that there may be an upper limit to the injury rates within Spartan Races. The majority of patient presentations were able to be treated onsite, supporting the need for a qualified onsite medical team to mitigate the strain on local healthcare systems. Although life-threatening emergencies were uncommon, they do occur, and medical teams must be appropriately prepared. Further research is needed to understand the staffing and equipment requirements of medical teams, the demographic information of the injured, and the examination of the impact OCR events have on the local health care systems.
In 2017, members of our workgroup published on the readiness for nuclear and radiological incidents among emergency medical personnel.1 Our findings, along with a review of pertinent literature, suggest that the state of medical preparedness for these incidents is in crisis. A 2018 publication addressing nuclear terrorism preparedness relegates medical preparedness to a low priority and describes it as potentially dangerous.2 The crisis status of medical preparedness for these incidents is addressed.
Aim:
To establish a prepared medical workforce and trained public for those at risk from nuclear or radiological disasters.
Methods:
This Institutional Review Board (IRB)-approved survey published an article and used a relevant literature review.
Results:
Readiness for nuclear and radiological incidents is lacking in multiple areas including education, training, identifying medical needs, willingness to come to work, and perception of relative risk among medical personnel.1 Confounding this is recent prominent publication downplaying and discouraging medical preparedness for nuclear terrorism.2 The importance of a readied workforce and a prepared public is identified.
Discussion:
In 2013, we formed a multi-national workgroup focused on preparing health professionals and the public for clinical management of casualties during nuclear and radiological disasters. Modeling has demonstrated predictable casualty injury and illness patterns suggesting that early appropriate medical response will save lives. Readiness demands an educated, skillful, and willing-to-engage medical workforce. Our 2017 publication identified several areas that place medical preparedness at risk.1 A significant risk to medical preparedness may lie in prominent publications discouraging the pursuit.2 We firmly believe that medical preparedness is essential and begins with a prepared public.
A 2018 poll by the American College of Emergency Physicians shows 93% of surveyed doctors believe their emergency department is not fully prepared for patient surge capacity in the event of a natural or man-made disaster. While an emergency disaster plan is activated during any incident where resources are overwhelmed, many US emergency physicians today think of a mass casualty incident (MCI) as the inciting event. To better prepare our communities, an MCI simulation took place in Chicago 2018 with participation from local and federal representatives. Included were Chicago fire, police, and emergency medical services agencies, emergency medicine physicians, resident participants, and medical student volunteer victims.
Aim:
The study’s aim was to determine whether resource intensive moulage was an expected component or a beneficial adjunct, if moulage-based training would improve physician preparedness, and if such a training would increase the likelihood of future involvement in local disaster preparations. Analysis was performed on pre- and post-training surveys completed by participants. By reviewing the benefits versus cost, future MCI simulation planners can efficiently use their funds to achieve training goals.
Methods:
Thirty-two emergency medicine physicians were surveyed before and after a five-hour training session on October 20, 2018, which included 89 moulage victims. Twenty-four after-event surveys were completed. All completed surveys were utilized in data analysis.
Results:
Of polled participants, a 68% improvement in general preparedness was achieved. While only 19% of participants cited current involvement in their facility’s disaster planning in pre-event survey, the likelihood of involvement after training was 8.2/10. Overall, the importance of moulage an essential component to such trainings remained constant.
Discussion:
Moulage is an expected and crucial element to MCI training and should be incorporated as extensively as resources allow. MCI trainings improve physician preparedness and potentially increase physician involvement in disaster planning at home institutions.
Westmead Hospital (WMH) recognized gaps in its preparedness to respond to the Ebola 2014 outbreak in West Africa. A fragmented system was identified. A ‘State of Bio-preparedness’ project team convened to discuss all healthcare services in the planning, training, and implementation of a biopreparedness response.
Methods:
A survey targeting the staff’s competence and confidence in biologically hazardous infection management was conducted. Semi-structured interviews explored staff members’ experiences and perspectives of biopreparedness response. The collaborative team called “State of Biopreparedness” (SOB) was assembled and a clinical practice improvement project was undertaken. To assess readiness, nine simulated Viral Haemorrhagic Fever (VHF) exercises involving staff and consumers were conducted. These exercises were debriefed by the multidisciplinary committee and themes and issues were identified. These nine simulation drills then assessed readiness and evaluated performance.
Results:
A number of consistent issues continue to emerge including:
1. A standard communication pathway for notification was needed - use of the incident paging system (111 pages) to notify the hospital’s incident management team.
2. A consistent and coordinated approach to the training and maintenance of standardized and high-level Personal Protective Equipment (PPE) protocols for frontline clinical and clinical staff was required.
3. Clear delineation of roles and responsibilities and supporting these roles by translating the VHF Control Guideline and policy into task cards and checklists.
4. Strengthening intra- and interdepartmental staff collaboration and communication.
5. Infection control measures to be taken by staff after identifying a patient with possible VHF to reduce the risk of transmission of disease to staff, other patients, and visitors.
Discussion:
Integrating disaster management processes with clinical protocols had a positive impact on the hospital’s biopreparedness response. Simulation exercises were a vital and practical way for staff to feel confident and competent to perform their roles.
Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.
Aim:
To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.
Methods:
The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel
Results:
Disaster response programs should ensure:
Collection of data to identify vulnerable populations
Establishment of procedures for monitoring and reporting
Inclusion of female staff at all levels of planning and response
Implementation of holistic services including physical and psychosocial care and legal response
Safety in designing accommodations and distribution centers
Pre-Deployment training should include:
Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence
Familiarity with behaviors and conditions associated with gender-based violence
Non-judgmental, supportive, and validating approach to inquiry and response
Familiarity with risk assessment tools
Mobilization of social supports
Knowledge of resources, including medical and legal services
Discussion:
Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.
The need to use evidence in humanitarian settings is recognized, yet utilizing that evidence to make decisions about humanitarian response remains a challenge.
Aim:
To identify how, when, and why decision makers in humanitarian response use scientific, peer-reviewed evidence to make decisions.
Methods:
An online cross-sectional survey of fifteen open- and closed-ended questions on demographics, experience, and role in humanitarian response was developed by Evidence Aid (EA) and Karolinska Institutet (KI). The online survey was available on the EA website from August 2015 to October 2018. Participants were self-selected, recruited through social media channels and mailing lists of EA and KI. All respondents and responses were anonymized. Responses were analyzed with descriptive statistics and content analysis.
Results:
47 people responded, primarily working in Europe or North America with roles of humanitarian response director/manager, independent consultant, or policymaker. Personal assessment of the quality of information, trust in the source, and information that was contextually relevant or based on field experience were factors for deciding whether information should be considered evidence. Reasons for using evidence when making decisions included adhering to good practice to maximize impact and effectiveness of aid, reassurance that the right decisions were being made, personal or organizational values, and using evidence as a tool to protect beneficiaries and organizations from poor quality decisions and program content.
Discussion:
Using evidence for decision making was common practice during the process of designing implementing and evaluating humanitarian response content, yet reasons for use varied. The importance of evidence developed and validated from field experience and trust in the source reported by this sample suggests that strengthening collaborative efforts between decisionmakers and evidence generators could be one approach to improve evidence and evidence use in humanitarian response.
In a patient going into shock, blood is redistributed from the periphery to the central circulation, making an assessment of skin perfusion useful in a prehospital setting. Capillary refill time (CRT) is the time required for a pressure blanched skin site to reperfuse. Currently, CRT is tested by manually applying pressure for 5s to the skin and observing the time before reperfusion. Guidelines state that CRT should be 2-3s in a healthy patient. Shortcomings in this procedure include lack of standardization of pressure, subjective assessment of the time for reperfusion, and not accounting for the patient’s skin temperature.
Aim:
To develop a standardized objective procedure for testing CRT in the prehospital setting.
Method:
The study protocol was approved by the Ethics Committee at Linköping University (M200-07, 2015-99-31). An electro-pneumatic device exerting constant force (9N) over 5s was developed. CRT was measured using the Tissue Viability Imager (Wheelsbridge AB, Sweden) which relies on polarization spectroscopy. To simulate hypothermic conditions, healthy volunteers were subjected to low ambient temperature (8°C). Blood loss was simulated using a custom-built lower body negative pressure (LBNP) chamber. In both scenarios, the CRT test was carried out on three test sites (finger pulp, forehead, and sternum).
Results:
CRT on the finger pulp and sternum was shown to be increased following the hypothermic conditions, but not on the forehead. Skin temperature on the three sites followed the same pattern, with the forehead being virtually unchanged. Tests performed during LBNP revealed an apparent effect on CRT following the simulated blood loss, with prolonged CRT for all sites tested.
Discussion:
A successful methodology for objective assessment of CRT was developed, which was validated on healthy volunteers following hypothermia or simulated blood loss. Ongoing work will investigate a combination of hypothermia and blood loss to more accurately simulate the prehospital setting.
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 disasters such as the Queensland flood and Great East Japan Disaster in 2011, affected regions of Australia and Japan. This study is followed by two pilot studies in both countries after the disasters. While both countries have different evacuation center procedures for evacuees, the issues regarding the role and responsibility across governments involving planning, setup, and management of evacuation centers demonstrate similarities and differences.
Aim:
This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia and Japan concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in recent natural disasters. The objective is to illuminate the similarities and differences that officials and agencies faced, and to highlight the resolutions and lessons learned in the preparation of evacuation centers through this event.
Methods:
This is the final stage of the study. After completing an analysis of both phases, a comparative framework to highlight similarities and differences was developed.
Results:
Each government’s role in relation to the establishment of evacuation centers is legally defined in both countries. However, the degree of involvement and communication with non-governmental organizations from the planning cycle to the recovery cycle demonstrates different expectations across governments.
Discussion:
While the role of governments is clearly established in both countries based on the legal frameworks, the planning, set-up, and management of evacuation center differs.