In order to prepare the healthcare system and healthcare personnel to meet the health needs of populations affected by disasters, educational programs have been developed by numerous academic institutions, hospitals, professional organizations, governments, and non-government organizations. Lacking standards for best practices as a foundation, many organizations and institutions have developed “core competencies” that they consider essential knowledge and skills for disaster healthcare personnel.

The Nursing Section of the World Association for Disaster and Emergency Medicine (WADEM) considered the possibility of endorsing an existing set of competencies that could be used to prepare nurses universally to participate in disaster health activities. This study was undertaken for the purpose of reviewing published disaster health competencies to determine commonalities and universal applicability for disaster preparedness.

In 2007, a review of the electronic literature databases was conducted using the major keywords: disaster response competencies; disaster preparedness competencies; emergency response competencies; disaster planning competencies; emergency planning competencies; public health emergency preparedness competencies; disaster nursing competencies; and disaster nursing education competencies. A manual search of references and selected literature from public and private sources also was conducted. Inclusion criteria included: English language; competencies listed or specifically referred to; competencies relevant to disaster, mass-casualty incident (MCI), or public health emergency; and competencies relevant to healthcare.

Eighty-six articles were identified; 20 articles failed to meet the initial inclusion criteria; 27 articles did not meet the additional criteria, leaving 39 articles for analysis. Twenty-eight articles described competencies targeted to a specific profession/discipline, while 10 articles described competencies targeted to a defined role or function during a disaster. Four of the articles described specific competencies according to skill level, rather than to a specific role or function. One article defined competencies according to specific roles as well as proficiency levels. Two articles categorized disaster nursing competencies according to the phases of the disaster management continuum. Fourteen articles described specified competencies as “core” competencies for various target groups, while one article described “cross-cutting” competencies applicable to all healthcare workers.

Hundreds of competencies for disaster healthcare personnel have been developed and endorsed by governmental and professional organizations and societies. Imprecise and inconsistent terminology and structure are evident throughout the reviewed competency sets. Universal acceptance and application of these competencies are lacking and none have been validated. Further efforts must be directed to developing a framework and standardized terminology for the articulation of competency sets for disaster health professionals that can by accepted and adapted universally.

Interactive voice response (IVR) technology may facilitate poison centers to handle increased call volumes that may occur during public health emergencies. On 28 April 2009, the Texas Poison Center Network (TPCN) added a H1N1 message in English and Spanish to its IVR system. This study tested whether IVR technology could be used to assist Texas poison centers during the H1N1 outbreak.

The distribution of callers who accessed the H1N1 message during 29 April–31 May 2009 was determined with respect to message language, subsequent caller action, and date of the call.

The H1N1 message was accessed by 1,142 callers, of whom, 92.9% listened to the message in English, and 7.1% listened to the message in Spanish. After listening to the message, 33.3% hung up while 66.7% spoke to a poison center agent. The number of callers who accessed the message was highest on 29 April 2009 and then declined.

Interactive voice response technology can be used to assist poison centers to provide information and handle calls from the public during a public health emergency.

Survival from pulseless cardiac arrest typically is dismal. Some suggest that adding vasopressin to epinephrine as a cardiovascular stimulant can improve outcomes.

This study compares survival outcomes using epinephrine verses vasopressin and epinephrine in persons with pulseless cardiac arrest.

This is a retrospective, cohort evaluation of two resuscitative protocols (P1-epinephrine or P2-vasopressin with epinephrine) in a tiered response, community emergency medical service (EMS) with an approximately 100,000 catchment area. Cases are defined as 18 years or older determined to be in pulseless cardiac arrest. Outcomes were survival to emergency department arrival, to 24 hours, and to hospital discharge. Data were entered into Microsoft Office Excel® and processed using Analyze-it® for continuous and categorical data and Epi-Info® for odds ratios with confidence intervals.

There were 204 cases (60.3% males and 39.7% females) who met the inclusion criteria. Thirteen cases received electrical therapy only, and were dropped from analysis, leaving 191 (93.6%) who were included in the study; P1 to 85 (44.5%) and P2 to 106 (55.5%). Younger age was associated with improved survival to discharge home in both protocols, p = 0.003 (95% CI = 0.004–0.010). No difference in survival was noted at the levels of emergency department arrival OR 1.42 (95% CI = 0.73, 2.76) p = 0.26; 24 hour survival OR 0.54 (95% CI = 0.22–1.30) p = 0.133, or discharge home OR = 1.81 (95% CI = 0.49–6.88) p = 0.319.

This study in a community EMS did not demonstrate improved survival with the addition of vasopressin to epinephrine for pulseless cardiac arrest.

Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE)-exposed patients is a component of hospital preparedness procedures.

The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs.

Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the “game” interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument.

Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either “confident” or “very confident”, with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical skills management of such incidents. Conclusions: These data suggest that training healthcare teams in online, virtual environments with dynamic virtual patients is an effective method of training for management of MCIs, particularly for uncommonly occurring incidents.

These data suggest that training healthcare teams in online, virtual environments with dynamic virtual patients is an effective method of training for management of MCIs, particularly for uncommonly occurring incidents.

Workforce planning for first aid and medical coverage of mass gatherings is hampered by limited research. In particular, the characteristics and likely presentation patterns of low-volume mass gatherings of between several hundred to several thousand people are poorly described in the existing literature.

This study was conducted to:

1. Describe key patient and event characteristics of medical presentations at a series of mass gatherings, including events smaller than those previously described in the literature;

2. Determine whether event type and event size affect the mean number of patients presenting for treatment per event, and specifically, whether the 1:2,000 deployment rule used by St John Ambulance Australia is appropriate; and

3. Identify factors that are predictive of injury at mass gatherings.

A retrospective, observational, case-series design was used to examine all cases treated by two Divisions of St John Ambulance (Queensland) in the greater metropolitan Brisbane region over a three-year period (01 January 2002–31 December 2004). Data were obtained from routinely collected patient treatment forms completed by St John officers at the time of treatment. Event-related data (e.g., weather, event size) were obtained from event forms designed for this study. Outcome measures include: total and average number of patient presentations for each event; event type; and event size category. Descriptive analyses were conducted using chi-square tests, and mean presentations per event and event type were investigated using Kruskal-Wallis tests. Logistic regression analyses were used to identify variables independently associated with injury presentation (compared with non-injury presentations).

Over the three-year study period, St John Ambulance officers treated 705 patients over 156 separate events. The mean number of patients who presented with any medical condition at small events (≤2,000 attendees) did not differ significantly from that of large (>2,000 attendees) events (4.44 vs. 4.67, F = 0.72, df = 1, 154, p = 0.79). Logistic regression analyses indicated that presentation with an injury compared with non-injury was independently associated with male gender, winter season, and sporting events, even after adjusting for relevant variables.

In this study of low-volume mass gatherings, a similar number of patients sought medical treatment at small (<2,000 patrons) and large (>2,000 patrons) events. This demonstrates that for low-volume mass gatherings, planning based solely on anticipated event size may be flawed, and could lead to inappropriate levels of first-aid coverage. This study also highlights the importance of considering other factors, such as event type and patient characteristics, when determining appropriate first-aid resourcing for low-volume events. Additionally, identification of factors predictive of injury presentations at mass gatherings has the potential to significantly enhance the ability of event coordinators to plan effective prevention strategies and response capability for these events.

The consequences of a major incident at a sporting event could be catastrophic. Therefore, there should be an estimation of the healthcare resources at such events as part of the planning. Although there are National guidelines (e.g., Planning Safe Public Events: Practical Guidelines in Australia) defining the role of the healthcare system at sporting events, these guidelines either lack a simple calculating method to estimate the need for healthcare resources or the methods are complex and impractical to use. The objective of this study was to find a safe and easy method for the estimation of healthcare resources at sporting events.

A model for the estimation of healthcare resources at music events recently has been approved in Sweden. After minor adjustments, this model was used at sport events by a number of planning officers. The models' accuracy and usability was evaluated by analyzing its outcome in a pilot and a controlled study using different sporting and non-sporting scenarios.

The pilot study showed that the model was valid and easily could be used for various sporting events. The obtained estimations were consistent with the methods used by experienced planning officers in 97% of cases. The results of the controlled study showed that by using this model, the minimum amount of resources required easily could be calculated at sporting events and by people with different backgrounds.

This model safely can be used at sporting events.

At a large public event, or mass gathering, various factors influence patient presentations that brings challenges to patient care. The chain of survival has been investigated in the prehospital setting. However, this has not explicitly included the mass-gathering environment.

This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.

This case-series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.

The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.

This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.

In October 2007, San Diego County experienced a severe firestorm resulting in the burning of more than 368,000 acres, the destruction of more than 1,700 homes, and the evacuation of more than 500,000 people.

The goal of this study was to assess the impact of the 2007 San Diego Wildfires, and the acute change in air quality that followed, on the patient volume and types of complaints in the emergency department.

A retrospective review was performed of a database of all patients presenting to the Emergency Departments of University of California, San Diego (UCSD) hospitals for a six-day period both before (14–19 October 2007) and after (21–26 October 2007) the start of the 2007 firestorm. Charts were abstracted for data, including demographics, chief complaints, past medical history, fire-related injuries and disposition status. As a measure of pollution, levels of 2.5 micron Particulate Matter (PM 2.5) also were calculated from data provided by the San Diego Air Pollution Control District.

Emergency department volume decreased by 5.8% for the period following the fire. A rapid rise in PM2.5 levels coincided with the onset of the fires. The admission rate was higher in the period following the fires (19.8% vs. 15.2%) from the baseline period. Additionally, the Left Without Being Seen (LWBS) rate doubled to 4.6% from 2.3%. There was a statistically significant increase in patients presenting with a chief complaint of shortness of breath (6.5% vs. 4.2% p = 0.028) and smoke exposure (1.1% vs. 0% p = 0.001) following the fires. Patients with significant cardiac or pulmonary histories were no more likely to present to the emergency department during the fires.

Despite the decreased volume, the admission and LWBS rate did increase following the onset of the firestorm. The cause of this increase is unclear. Despite a sudden decline in air quality, patients with significant cardiac and pulmonary morbidity did not vary their emergency department utilization rate. Based on the experience at UCSD, it appears that significant wildfires like that seen in 2007, only may marginally affect emergency department operations, and may not require significant changes to normal staffing levels.