The objective of this study was to determine providers' opinions of SALT Triage after receiving training and using it during a simulated mass-casualty incident.

A survey was conducted of trainees in a disaster course. Trainees were given a-30 minute lecture on SALT (sort, assess, life-saving interventions, treatment and/or transport) Triage and then used it during a drill. After the drill, trainees were asked to complete the survey. Results were analyzed using descriptive statistics.

Thirty trainees (11 medical doctors (MDs), six registered nurses (RNs), eight emergency medical technicians (EMTs), one RN/EMTs, four other) participated in the course. Of these participants, 67% had prior drill experience (mean: 10 drills) and 37% had prior mass-casualty incident experience (mean: four experiences). Prior to the drill: 7% reported that they felt very confident using SALT Triage, 33% were confident, 30% were somewhat confident, and 30% were not confident. After the drill: none reported not feeling confident using SALT Triage, 27% were at the same level of confidence, 73% felt more confident, and none felt less confident. Before the drill: 52% of respondents felt SALT Triage was easier to use than their current disaster triage protocol, 44% felt it was similar, and 4% felt it was more difficult. After the drill: 67% did not change how easy they felt SALT Triage was to use, 26% thought it was easier to use, and 3% thought it was similar.

Providers felt confident using SALT triage after a 30-minute training session and found it was similar or easier to use than their current triage protocol. Using SALT Triage during a drill improved confidence.

Triage criteria rely on physiologic, anatomic, and mechanistic indicators of injury to minimize over-triage and under-triage, which remain persistendy high (35%—65%). The Visensia Index Score (VIS) is a proprietary algorithm in a bedside monitor (OBS Medical, IN) mat integrates five vital signs: (1) heart rate; (2) respiratory rate; (3) blood pressure; (4) pulse oximetry; and (5) temperature. It calculates a score ranging from 1 (no abnormality) to 5 (severe abnormalities). The aim of this study was to explore the utility of VIS in identifying trauma patients likely to have a poor prognosis on arrival to the emergency departments.

After Institutional Review Board approval, the trauma registry was used to review 117 patients admitted to a Level-1 Trauma Center over a six month period. The first set of vital signs was obtained upon arrival to the emergency department. An initial VIS and a mean VIS (based on multiple VS) was calculated. The analysis included a multivariate mathematical technique and k-means cluster analysis. Clusters of populations with different Visensia scores were compared and differences in their outcomes were analyzed.

Two major clusters were identified: VIS Scores >3 increased the risk of mortality as compared to those with scores <3; odds ratio 3.3 [1.04–10.3; p <0.001). There was no association with length of intensive care unit stay, hospital days; or Injury Severity Scale (ISS) scores.

Cluster analysis, a novel multidimensional approach, shows association of a higher VIS (>3) as a useful point-of-care parameter to identify trauma patients likely to have a poorer prognosis, much more than retrospectively computed ISS and Trauma and Injury Severity Scores (TRISS).

The Sacco Triage Method (STM) is a mathematical model of resource-constrained triage. The objective of this presentation is to apply STM-Age, an age-augmented version of STM, to blunt trauma victims and compare it to Simple Triage and Rapid Treatment (START) and START-like protocols.

The objective of STM is to maximize the number of expected survivors given constraints on the timing and availability of resources. The STM incorporates estimates of time-dependent victim survival probabilities based on an initial assessment and expected deteriorations.

For the STM-Age application, an “RPM-Age” score (based on respiratory rate, pulse rate, best motor response, and coded age) was used to estimate survival probability. Logistic function-generated survival probability estimates for RPM-Age values were determined from 76,444 patients with blunt injuries from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming.

The STM-Age was compared to START and START-like methods with respect to process and to outcome, as measured by expected number of survivors, in simulated resource-constrained casualty incidents.

The RPM-Age was a more accurate predictor of survivability for blunt trauma than RPM, as measured by calibration and discrimination statistics. In simulations, STM-Age exhibited substantially more expected survivors than START and START-like protocols.

Resource-constrained triage is modeled precisely as an evidence-based, outcome-driven method (STM-Age) that maximizes expected survivors in consideration of resources. The STM-Age offers life-saving and operational advantages over current methods.

The objective of this study was to compare the operational viability and performance of the Sacco Triage Method (STM) to that of the Simple Triage and Rapid Treatment (START) protocol.

Following a 20-minute review of the mandated START protocol and a 20-minute training session of STM, parallel disaster exercises were conducted. Emergency responded used START in the morning and STM in the afternoon on a simulated building collapse involving 99 victims. Data were collected on the accuracy of patient assessment (START) and scoring (STM), the timeliness in clearing the scene, and me prioritization of patients leaving the scene.

The STM scoring was more accurate than START assessments at 91.7% and 71.0%, respectively. The time to clear the scene was 16% less using STM than START (53 minutes and 63 minutes, respectively). The 13 most seriously injured patients left the scene in the first seven ambulances using STM; while only two of the 13 most seriously injured patients left the scene in the first 13 ambulances under START, and the three most serious patients were transported by bus. Surveyed providers preferred START to STM and believed it to be more accurate, faster, and better able to identify the most serious patients.

Emergency responders did not implement START successfully Despite refresher training and 12 years of using START as their statewide protocol, tagging was inaccurate and patient prioritization was poor. In comparison, STM was implemented after 20 minutes of introductory training, was shown to be operationally viable, and outperformed START in all objectives.

Although priority tags are considered important in all training and education, there are few reports on their actual use in real incidents. The aim of this study was to compare attitudes on the use of a simple priority tags to the SMART Tag.

A questionnaire was answered by ambulance personnel and the medical teams from hospitals in Stockholm, Sweden, regarding when the priority tags were supposed to be used or were used in their organization. The second questionnaire was conducted during a large-scale disaster exercise at Stockholm Arlanda- Airport. The second questionnaire focused on their experience of the use of SMART Tags during the exercise. Emergency ward personnel are going to be interviewed on how SMART Tag information is communicated when ambulance crew arrives at the hospital.

In the first questionnaire, 211 out of 409 (51%) answered that they had used priority tags in training situations. Of all 409, only 36 (9%) answered that they had used tags in a real incidents and 142 (35%) replied that they never had used priority tags. The answers revealed some doubtfulness of when to use priority tags. In the second questionnaire, many of the participants stated that priority tags should be used in routine operations compared with how they are used today.

It is necessary that the field personnel applies the triage scheme and uses the priority tags, not only during a disaster, but also during smaller emergencies, to maintain familiarity. This secures that the tags are used correctly in real disasters.

When Cyclone Nargis hit the Ayeyanwadi delta of Myanmar on 03 May 2008 at a speed of 190 km/h, nearly 140,000 people lost their lives and approximately two million were left homeless. As an additional challenge, the military regime of Myanmar denied any relief organizations or workers outside SouuSeast Asia access to the disaster site.

During a one-week mission to the former capital of Yangon beginning one month after the disaster, relief provided to the affected population was studied. The working methods and effectiveness of a small non-governmental organization (NGO) already established in Myanmar were evaluated.

The long visa queues of relief workers gave organizations already working in Myanmar a great advantage. New strategies involved the rapid employment of personnel from Southeast Asia for fieldwork Improved administrative procedures made the field teams work more effectively. The NGO studied 30 rapidly engaged, new, local, health workers, sufficient for five medical teams to work in the field.

In spite of denied access to the disaster field, United Nations organizations and NGOs were able to initiate an effective administration and support to the many teams including >80 medical teams sent to the disaster site. The restricted movement gave more time and resources to relief planning, which is of importance for future incidents. Smaller NGOs were able to benefit from the improved administrative procedures introduced in the process.

The use of a common template for observer studies is a way of structuring the experiences gained (lessons observed and learned) from such studies. This facilitates the comparison of reports within one's own field as well as between different sectors. It also facilitates the implementation of joint observer activities and joint observer reports, promoting more comprehensive and holistic learning from the events.

Using the Utstein method for studying disasters and the Swedish Disaster Medicine study organization (KAMEDO) as an inspiration, a number of Swedish governmental authorities and organizations compiled a template for presenting standardized observer reports. The following tides have been identified to be included: (1) Tide; (2) Preface; (3) Observers and Authors; (4) Summary and Experiences; (5) Introduction/Material and Methods; (6) Hazard; (7) Background (including pre-event status and preparedness); (8) Event; (9) Damage; (10) Disturbances; (11) Responses; (12) Recovery and Development; (13) Discussion; (14) References; (15) Appendices; (16) Keywords; (17) Index; and (18) Abbreviations.

This template has been used successfully for observer studies within the health sector (evacuation of Swedes from the war in Lebanon, 2006, a power supply failure at a major university hospital in Stockholm, 2007), within the food sector (Cryptosporidium contamination of water supply in Ireland, 2007, consequences for water supply from floods in the UK, 2007, sewage contamination of water supply in Finland, 2007) and within crisis management and rescue services sectors (floods in the UK, 2007, sewage contamination of water supply in Finland, 2007, wild fires in California, 2007)

The use of a common, standardized template for the documentation of lessons observed and learned from major disasters/crises has proven useful. In addition to enhancing the completeness and learning value of the reports, it also has proven to be a useful tool for stimulating intra-sectoral cooperation and learning.

An earthquake measuring 6.6 Richter in 2003 devastated the historic Iranian city of Bam. During the response and recovery phases, considerable shortcomings were experienced. Flaws in the management of the various aspects of this disaster were identified to assess what was done or should be done to overcome these shortcomings during future disasters.

A review of the management of the Bam disaster was performed by assessing files and data from 17 multi-center studies from 2003–2008. This assessment included data that related to the: (1) early warning phase; (2) time under rubble; (3) time to reach the scene and evacuate casualties; (4) assessment of rescue operations; (5) coordination of rescue teams; (6) triage; (7) trauma management; (8) transfer of equipment (resource mobilization); (9) rate of Disseminated Intravascular Coagulopathy (DIC), Acute Respiratory Distress Syndrome (ARDS), and Acute Renal Failure (ARF); (10) medical care provided; (11) efficacy of foreign field hospitals; (12) assistance of military forces; (13) rate of psychological distress among survivors; (14) provision of water, power, telephone, and healthcare services; and (15) social issues (opium abuse in survivors).

Data relevant to search-and-rescue operations and disaster management indicated shortcomings in human resources, patient transfer, availability of equipment and facilities, and trauma treatment. One percent of victims had compartment syndrome and needed a below-the-knee amputation, 11.6% were septic, 7.3% experienced DIC, 9.1% had ARDS, and 38.9% needed fasciotomy. The average time under rubble was 1.9 hours and the time from rescue to receipt of first aid time was 3.5 hours.

Comprehensive disaster management must not be limited to the response phase but must include preparedness, recovery, and prevention, improvement of healthcare facilities, and provision of organized communication channels between organizations for running a command system and instituting coordination among relief workers. Continuous education, training of the general population and task forces involved in disaster management, and conducting periodic exercise drills also are important.

The international disaster relief operation (IDR) of Chinese Medical Teams following the earthquake in Indonesia in 2004 is described.

Four medical teams participated the IDR between 31 December 2004 and 06 February 2005. A total of 190 medical staff including 22 doctors and 78 nurses were dispatched from China. They treated 4,483 patients. The authors examined the activities of the medical teams and also described the role of nurses in the IDR.

The role of the medical team was treating surgical wounds and performing surgical operations during the acute phase. After that, the role gradually changed to treating infectious diseases, providing safe drinking water, and preventing infectious diseases. The role of the nurses in the IDR was setting up temporary medical facilities, inside arrangement, providing health care to the medical staff, triage, removing stitches, managing commodities and medical waste, interviewing patients, and assisting with medical treatment.

This was the first Chinese IDR in the 21st Century. The role of nurses in this IDR was important for the success of the IDR.

Floods are the most common type of disasters and cause more deaths and damage than other types of disasters. The health consequences of floods vary according to the nature of the flood, geographical and demographic characteristics, and policy arrangements for preparation and consequence management.

This study involves a comparative analysis of the response to selected floods in China and Australia as an example of diverse geographical, demographic, and policy environments. The study involved an examination of news and government reports, interviews with key players, site visits, and an analysis of the policy and governance arrangements. A framework for the health consequences of floods was developed and utilized to compare the consequences in each location.

The health consequences varied considerably with the nature of the flood and the geographical and demographic environment. Flash flooding caused more immediate injuries and deaths, and less effective immediate management because of its rapid and unpredictable onset.

The variation in resources and preparation between the two countries resulted in a demonstrable difference in health consequence management. The long-term outcomes including mental health problems were difficult to identify.

Effective flood management was shown to reduce the health consequences of floods. These consequences may be immediate, medium-, or long-term, and effective management strategies must address each of these elements.

Australia's highly sophisticated disaster management system minimized the health consequences of floods. Despite its considerable population and other challenges, China has a demonstrated capacity to reduce health impact through improved policy frameworks and resource management.

On 15 August 2007, a 7.0 Richter earthquake struck the southern coast of Peru. The national government reported 519 people dead, >1,500 injured, and 192,492 homes affected (78% of all homes in the eight provinces in the regions of Huancavelica, lea, and Lima).The province of Pisco in the region of lea was the most affected.

The estimation of damages to healthcare facilities was based on a review of the assessment of the national and regional health authorities and recovery projects proposed by the South Reconstruction Fund.

At least 60 primary healthcare facilities were affected (18% of the total in the affected area), as well as four Ministry of Health hospitals. Three Social Security hospitals had moderate and severe structural and non-structural damages. Sixty-two percent (515) of the total number of beds available (834) in three lea provinces were lost in a few minutes after the earthquake.

The effect of the earthquake on hospital services was large. It included damages to the infrastructure and the loss of furniture and biomedicai equipment. Foreign field hospitals and temporary strategies were adopted to assure the continuation of healthcare services and to reduce the risk of public health problems associated with the disaster.

On 15 August 2007, a 7.0 Richter magnitude earthquake struck the southern coast of Peru. Economic resources were invested to help the healthcare facilities affected by the earthquake recover, and to control public health problems in the regions of Huancavelica, lea, and Lima.

The estimation of the economic impact was based on the Economic Commission for Latin America and the Caribbean's methodology on the socioeconomic and environmental impact assessment of disasters. Reports and information about the actions taken by public and non-public health organizations during the response and recovery phases. This information was used to calculate the effect on goods and economic flows in the health sector.

The economic impact of the earthquake reached 139.1 million dollars, of which, 95% was related to damages to healthcare facilities, and 5% was due to losses.

A national safe hospital strategy is needed in order to reduce the monetary investments spent on the recovery of damaged healthcare facilities, as well as to assure that the affected population continues to receive medical attention during the emergency phase.