Mock Code Training is an exercise designed to develop competency in emergency responsiveness. The objectives for this educational intervention were: (1) demonstrate basic airway maneuvers (2) demonstrate basic life support-cardiopulmonary resuscitation (BLS-CPR); (3) demonstrate when and how to call a Code; (4) recognize life-threatening cardiac arrhythmias; (5) initiate relevant cardiac monitoring; and (6) initiate relevant resuscitation based on algorithms.

Drills were conducted monthly on various inpa-tient and outpatient nursing units at the University of Wisconsin Hospital and Clinics. The following data was collected: (1) chime sounded; (2) basic patient assessment; (3) universal precautions; (4) compressions; (5) automated external defibrillator (AED) arrival; (6) unit emergency cart arrival; (7) oxygen administration; (8) code team arrival; (9) Advanced Cardiac Life Support (ACLS) Guidelines; (10) presence of recorder; (11) monitor initiation; (12) advanced airway; (13) intravenous (IV) access; (14) medications; (15) and time resuscitation ended.

The mean results were: (1) action for delivery of compressions = 1 minute, 10 seconds; (2) unit emergency cart arrival = 2 minutes, 15 seconds; (3) oxygen-bag valve mask = 3 minutes, 10 seconds; (4) defibrillation = 7 minutes; (5) code team arrival = 3 minutes, 33 seconds; (6) ACLS Guidelines Initiated = 6 minutes, 13 seconds; (7) monitor initiation = 5 minutes, 33 seconds; (8) advanced airway = 6 minutes; (9) IV access = 3 minutes, 15 seconds; and (10) medication administration = 6 minutes, 30 seconds.

Universities have fallen victim to many disasters over the years, ranging from those caused by natural hazards to campus violence. Most institutions have disaster plans in place and attempt to update those plans on a regular basis. Yet historically, universities do a poor job in testing those emergency operation plans as part of their routine preparation and mitigation practices. In July 2008, Philadelphia University participated in a full-scale, multi-agency exercise in order to test their disaster plan. The purpose of this study was to examine the lessons learned from the drill, analyze the benefits of the drill, and determine if the drill brought value to the university.

Interviews were conducted with 21 of the 25 university personnel who participated in the exercise. The interviews were taped and analyzed with the use of qualitative methods and content analysis techniques.

The emerging themes from the study included the benefits and values of the drill, the lessons learned, how perceptions were changed after the drill, views about the current level of disaster preparedness, and recommendations for improving disaster management practices.

The results demonstrated that the disaster drill was a valuable learning experience for the participants. The university benefited from the drill in multiple ways, learned many lessons, and discovered ways to begin improving their disaster management practices.

Physicians practicing internationally provide comprehensive health care and often prepare with global health courses. These can be limited by timing and do not provide primary care training to sub-specialists. It is hypothesized that Oregon physicians are interested in global health education and want an accessible course that reviews skills used in international medicine.

A survey-based needs assessment was conducted of licensed Oregon physicians that determined the level of interest in global health training. A total of 6,099 surveys were mailed to physicians in June 2007. The surveys included questions regarding demographics (age, gender, years of clinical practice, and practice specialty), international background (volunteer work, disaster relief), global health education interest (obtaining training, specialties desired), and course specifics (length, format, and cost).

A total of 624 surveys were returned for a 10.6% response rate. Of that group, 88.1% expressed interest in global health and 75.8% in a training course. Data analysis of this group showed that it consisted largely of physicians practicing for 15–34 years (mean = 23.8) and 45–64 years of age (mean = 55.8). Answers to course-specific questions indicated physician concerns about course time and educational interests based on differing clinical background.

Oregon physicians are interested in international healthcare education. To meet this need, a global health course has been developed at the Oregon Health and Science University (OHSU).

Emergency medicine continues to grow as an international specialty. With >30 countries developing emergency medicine training, supporting international physician education is imperative. The proposed Emergency Medicine International (EMI) observational fellowship is a systematic model for the academic and experiential training of future leaders.

This program is a result of interest in academic emergency medicine and the responsibility of the educational institution. A literature review on the international development of emergency medicine was performed and the weaknesses were assessed. Based on this review, the goals for EMI are providing: (1) leadership; (2) exposure to education training models; and (3) research instruction. The EMI structure consists of four blocks: (1) emergency medicine clinical rotations; (2) emergency medical services (EMS) experience; (3) medical toxicology exposure; and (4) emergency medicine operations/administration. All blocks are tailored to the training background and interests of participants such as focusing on education methodology (conference organization, simulation) or departmental operations (quality improvement, faculty development). Overlapping all blocks is crucial to education in research methodology and evidence-based practice of medicine.

Assessment of the program includes pre-/post-survey completion by participants and yearly post-fellowship contact tracking the development of emergency medicine in their country.

While different types of organizations can assist in other ways, only academic emergency medicine can help grow and mentor faculty to expand the specialty worldwide.

Following the response to the devastating 2004 tsunami, Medical Teams International's (MTI) Emergency Medical Services (EMS) program has worked directly with the Government of Sri Lanka to develop a comprehensive EMS system. In September and October 2008, a delegation of eight Sri Lankan EMS instructors visited Oregon and Washington for advanced instructor training in EMS skills and observation of local and governmental EMS agencies. The delegation participated in > 1,300 hours of combined classroom education and direct provider observation experiences. Following the visit, the delegation was given a 10-question post-event survey to measure their perception of the effectiveness of this type educational exchange.

A Web-based survey tool was utilized to elicit responses from the participants. Questions consisted of open-ended and ranked questions. The survey period was 30 days and there was a 60% response rate.

The participants felt this opportunity was useful and beneficial to the ongoing development of the EMS system in Sri Lanka. Additionally, participants indicated that the classroom experience was the most important aspect of the visit. An unanticipated response was that the participants were impressed with the concept of collaborative teamwork and unity that exists within US fire departments and EMS agencies.

Future exchange programs should focus more on classroom experiences and less on ride-along type experiences. Additionally smaller groups may allow for greater one-on-one peer education opportunities. This exchange provided participants with opportunities that are not currently available in Sri Lanka. The participants in this exchange will utilize the knowledge from this exchange for many years to come.

Education of graduate students in international disaster relief (IDR) is important. The authors introduced this practical education in Saga University in Japan.

The authors performed a mass casualty disaster exercise involving the simulated IDR from 06 October to 08 December 2008 (every Monday, for two hours/week, for a total of 12 hours). The exercise was designed to simulate the medical relief operation of the Indian Ocean tsunami that occurred in December 2004. Logistical functions also were involved. Thirteen students participated the exercise, and they were assigned to one of two groups. Each group included one Indonesian doctor who was a PhD candidate, while die remaining students were achieving a Masters in nursing. The official language used during the exercise was English. This study reports on the experience and evaluation of the students.

More than 90% of the students answered that this exercise was very instructive and interesting. They rated the simulation exercise very favorably and believed that the knowledge gained through the exercise would be beneficial in the near future.

This kind of practical education is valuable in disaster medicine and disaster nursing training for graduate students in Japan.

Predisaster Drill Activities (PDAs) may act as predictors of preparedness, but have been studied inadequately. To address this gap, a descriptive study of PDAswas conducted at two large hospitals.

A longitudinal study was conducted at two large academic hospitals (A: a tertiary care university hospital, and B: an urban, municipal, Level-1 Trauma Center) in Brooklyn, New York. Both were equipped with disaster plans. Over a period of five weeks preceding a full-scale drill of a simulated pandemic influenza outbreak, eight sequential public health alerts were issued. Hospital responses to pre-identified components were recorded: (1) training; (2) equipment; (3) communications; (4) incident command centers; (5) supplies; (6) staffing; (7) infection control measures; and (8) miscellaneous. A descriptive statistical analysis was performed.

The overall response rate to all die alerts for Hospital A was 67%, while that for Hospital B was 40% (p <0.009).The median delay in responding to alerts for Hospital A was six days (range = 0–19 days), and B was seven days (range = 0–21 days). Training was die most frequendy cited component (n = 20), however the median delays (days) were two (range = 0–13), and nine (range = 4–21) for hospitals A and B, respectively. Responses to communications, supplies and incident command center components were delayed or inadequate. Some additional unexpected responses such as supplemental meetings (n = 4) and additional infection control measures (n = 3) were elicited at both hospitals.

There were disparate responses to identical triggers at similar sites. Pre-disaster Drill Activities may help identify emergency response preparedness gaps and augment available resources for optimal utilization.

The selection and training of medical specialists for field activities in emergencies requires a set of methods for providing professional capacities. The complex psycho-physiological approach allows a new system for the selection and preparedness on the psychological and professional level to be applied.

The objective of this study was to mobilize psycho-physiological instruments for the staff selection procedure, and to follow an approach of psycho-physologically based methods for staff mental preparedness.

The battery of quantitative evaluation methods for study and practice for use in laboratory and field conditions is proposed. The methods are underlined by complicated, bilateral, sensorial reactions in modeled conditions of ipsi- and contra-lateral visual deprivation and conditioned environments on the computer screen. In processing experimental conditions, the mechanisms of integrative factors regulating the characteristics of hemisphere asymmetry have been evaluated and managed as a result of the influence of specific procedures. The conditions of selection and ultimate correction, if necessary, are determined as a result of preliminary professional preparedness and initial mental status. The methods are completely objective based on the quantitative criteria. The selection procedure does not include any subjective evaluation.

The method battery is registered in the national registry of patents and inventions. The results and conclusions could be included in the training of search-and-rescue teams, medical emergency teams, and other hazard staff.

The Pan-American Trauma Society (PTS) developed a Trauma and Emergency Ultrasound Course (USET) in response to the requirement for trauma ultrasound training for low- and middle-income countries. The objective of this study was to evaluate the efficiency of this course.

Pre- and post-course tests were used. An interval estimation of proportions was calculated at 95% CI. Theoretical and practical pre- and post-course knowledge were assessed with the Wilcoxon Signed Rank test at a 0.05 level of statistical significance.

Between 2005 and 2007, 114 students, including general surgeons, emergency medicine physicians, anesthesiologists, critical care physicians, and residents of these specialties, were trained in seven countries (Uruguay, Peru, Mexico, Venezuela, Aruba, Colombia, and Ecuador). The difference on complete knowledge ranked scores before and after the course was statistically significant (p <0.001). After the course, almost all participants (97.4%) demonstrated complete knowledge in final evaluation.

The USET course is an effective approach for trauma ultrasound training. Specific training programs for trauma care providers that work in low- and middle-income countries are necessary and could be performed with low-cost training programs.

The aim of this project was to develop a Web-based, inter-professional education program on chemical, biological, radiological, or nuclear (CBRN) disasters, focusing on making cooperative, on-site efforts during the initial 15 minutes after the event more effective. The program should secure that intervening personnel from the police, health, medical, and rescue services have knowledge and understanding of the initial tasks and strategies of each respective organization in case of CBRN disasters.

Using tabletop seminars based on five scenarios, the strengths and weaknesses regarding accomplishing tasks in case of the CBRN disaster were identified for each organization. Putting further strain on each scenario, the critical levels for satisfactory accomplishment were crystallized. Based on this vital information, all cooperating authorities have, in consensus, decided on the on-site organization.

The project has promoted the development of a profound national cooperation between the police, rescue, medical, and health services. The Web-based program has made the on-site efforts more efficient, focusing on personal and third-party security, on-site organization, zoning, levels of protection, and life-saving decontamination.

This program provides an increased interprofessional understanding of the responsibilities, authority, and capacities of different sectors. This pedagogical program is cost-efficient, applicable at all levels within organizations, secures that everyone receives the same information, available whenever and wherever it is needed, and adjustable. When a participant passes a level, they attain a certificate, thus providing a secure evaluation system where die employer can appreciate the employee's competence.

This paper reports on an Australian experience with the MicroSim software used for the preparation of undergraduate, inter-professional paramedic nurses. The paramedic nurse course focuses on preparing graduates for practice in rural communities where there are opportunities to enhance the productivity and skill retention of the local emergency health workforce.

The students were introduced to the software during their second year of a four-year, double-degree programs to enhance their ability to conduct primary and secondary surveys and respond in a timely and clinically appropriate manner. Their responses were required to be relevant to the nursing, paramedic, and inter-professional preparation for nursing as reviewed by the course thus far. The students were assessed as individuals and teams and were invited to describe observations of their own responses and those of the broader inter-professional team.

Aggregate results will be reported. The students were highly enthusiastic about their participation and assessment, and the method continued its third year in 2009. Examples of student responses to cardiac and trauma clinical scenarios will be demonstrated as two of the most frequent presentation types to the emergency department calls to the ambulance service.

The combination of the use of interactive software and teamwork in simulations that paramedic nurses may experience in rural Victoria was highly successful in promoting confidence, competence, communication, critique, and team-building in this already high achieving group of students.

In an effort to create uniformity in job-critical knowledge and skill sets among hospital emergency coordinators throughout Georgia, yielding improved emergency preparedness and interagency cooperation, the Georgia Department of Human Resources Division of Public Health and the Medical College of Georgia's Center of Operational Medicine created the Certified Hospital Emergency Coordinator (CHEC) Program.

A focus group of emergency management, public health, and emergency medicine experts was convened. Twenty-seven critical and important tasks, skills, and areas of knowledge imperative to professionals were identified. Based on these, two novel courses were developed. The completion of these and other established courses available through the US government and the National Disaster Life Support Foundation, in addition to job experience, form the basis of the newly created three-level certification program.

Approximately 125 hospital emergency managers from all regions of Georgia have been trained thus far, and another four courses are scheduled for 2009 with an average of 30 students per course expected. Attendance at both the Basic and Level II courses has created valuable interpersonal relationships, professional familiarity, and a common educational baseline amongst the state's hospital emergency coordinators.

Georgia's CHEC program represents a novel approach to training and preparedness at the hospital level. Coordination between public health and academia has allowed for the sharing of knowledge and resources in an unprecedented way. This has created enhanced preparedness throughout the state and has emboldened interpersonal and interagency cooperation within the realm of emergency management.

In 2005, a seven-car commuter express train collided with an apartment building in Japan. The crash left 107 passengers dead and 549 injured. This paper highlights confined space medicine mat was provided for three survivors and introduces the current approach for training Japan Disaster Medical Teams (JDMATs) and/or rescue professionals.

A retrospective analysis of confined space medicine provided after the train crash and a study of training of JDMATs and/or rescue teams.

Three medical teams and search-and-rescue teams rescued three survivors whose bodies were trapped in the tangled wreckage of the first car. The medical teams secured intravenous lines and provided oxygen and approximately 4L of fluid before extrication. A 46-year-old woman was extricated in 14 hours, a 19-year-old man in 16.5 hours, and an 18-year-old man 22 hours after the crash. All three worsened at the final moment of extrication. Their crush syndrome required resuscitation at the scene, and intensive care such as hemodialysis and limb amputation in hospitals. Two patients survived and one patient died on me fifth day due to multiple organ dysfunctions.

Now, the curriculum of the JDMAT training course includes lectures and introductory exercises with rescue teams to learn the importance and difficulties of confined space medicine at the scene.

Confined space medicine was provided successfully after the train crash. Knowledge of confined-space medicine is essential to medical and rescue teams. Further education and training curriculum must be created.

The possibility of natural disasters and public health emergencies, coupled with the possibility of terrorism, support the need to incorporate emergency preparedness into the curricula for every health professional school.

A survey methodology was employed to assess attitudes toward and knowledge of emergency preparedness among health profession students including schools of medicine, nursing, dentistry, and public health. The survey was targeted to graduating students, administered prior to the institution of an emergency preparedness curriculum, and then repeated as an annual survey.

The survey found that 51.8% had been present at a disaster site as non-responders, while only 12.1% ever had been present as a responder. With regard to baseline class room exposure, >50% reported no exposure to such key concepts as incident command, triage, all-hazards planning, surge, and aspects of terrorism. In addition, at the baseline, most students felt they had no competency in emergency preparedness. For example, only 10% of students felt competent with personal protective equipment. While exposure both as a responder and student was low, 82.5% of students felt that emergency preparedness should be a mandatory topic in their education. Lastly, with a minimal curriculum change students showed statistically significant increases on knowledge testing.

While exposure was low for emergency preparedness topics and most did not recognize how information they had been taught might be applicable to emergency preparedness, there was a strong desire for additional training. In addition, simple curricular adjustments can lead to significant improvements in knowledge.

Traditionally, emergency care in Pakistan has not been a priority because of lacking primary care. Resources and trained personnel are scarce. Cultural barriers often supersede the urgency of medical conditions. Despite these challenges, the value of emergency care is gaining significance. The objective of this study is to explore the breadth of emergency medicine training in Pakistan, through an analysis of a teaching hospital with an emergency medicine residency. Aga Khan University Hospital in Karachi is a teaching institution with the only emergency medicine residency program in the region. It was started in 2000, led by US-trained physicians, and laid the foundation for emergency medicine in the country.

A review and analysis of the curriculum and clinical duties will be conducted to illustrate the specific roles and training of emergency medicine physicians. A chart review of patients seen in the emergency department during a two-week period will be conducted to determine if the current training is appropriate for the patient population and diseases seen.

This study will provide a view of a curriculum in development and report on unique aspects of the program in relation to other established emergency medicine programs throughout the world. Furthermore, different roles emergency medicine physicians may play in this particular hospital setting will be identified.

Aga Khan University Hospital is a pioneer in establishing emergency medicine as an official discipline in the region. Through an examination of how a program is developing in Pakistan, an invaluable look of how emergency medical care is gaining significance in developing nations will be provided. This will help other nations that are interested in developing such programs to do so.