Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs.

The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis.

A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people.

Anthropometric data were collected among children 6–59 months of age. In addition, crude mortality rates (crude mortality rates), under five mortality rates (under 5 mortality rate), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI) = 6.2–9.8%) for acute malnutrition, 26.9% (95% CI = 24.0–29.9%) for being underweight, and 37.0% (95% CI = 33.8–40.2%) for chronic malnutrition. Boys were more likely to be under-weight than were girls (odds ratio (OR) = 1.34; 95% CI = 1.00, 1.82;p <0.05) after controlling for a, household size, and food aid beneficiary status. Similarly, children 30–59 months of age were significantly less likely to suffer from acute malnutrition (OR = 0.45; 95% CI = 0.26, 0.79; p <0.01) and less likely to be underweight (OR = 0.37; 95% CI = 0.27, 0.51;p <0.01) than children 6–29 months of a, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI = 4.5–11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10,000/day (95% CI = 1.08–1.38), and an under 5 mortality rate was 1.03/10,000/day (95% CI = 0.71–1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths.

The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies.The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid program objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

In recent years, the perceived threat of chemical terrorism has increased. It is hoped that teaching civilians how to behave during a chemical incident will decrease the number of “worried well” patients at hospitals, reduce secondary contamination, and increase compliance with the instructions of emergency services. The governments of the United Kingdom and Israel sent booklets to every household in their respective countries. In Israel, the civilian population was issued chemical personal protective equipment (chemical personal protective equipment).

The effectiveness of these public education programs was assessed using a scenario-based questionnaire that was distributed to 100 respondents in Birmingham, UK and Jerusalem, Israel. Respondents were asked how they would behave in three deliberate chemical release scenarios and how they would seek information and help.

Only 33% of the UK respondents and 22% of the Israeli respondents recalled reading the government booklets. When asked what they would do after being contaminated in a deliberate release, approximately half of the respondents ranked seeking medical care at a hospital as the most appropriate action.

The preferred sources of information in the wake of a chemical strike were (in descending order): radio, television, and the Internet. Approximately half of the respondents would call emergency services for information. Forty-one percent of the UK respondents and 33% of Israeli respondents stated that they either would call or go to the nearest hospital to seek information.

The public information campaigns in both countries have had a limited impact. Many citizens claimed they would self-present to the nearest hospital following a chemical attack rather than waiting for the emergency services. A similar response was witnessed in the Sarin attacks in Tokyo and the 1991 Scud missile attacks in Israel.

Current UK doctrine mandates that specialist decontamination teams be deployed to the scene of a chemical release. However, this takes >1 hour, and it requires at least 30 minutes to don hospital chemical personal protective equipment. Therefore, it is imperative that hospitals are equipped to cope with unannounced self-presenters after a chemical attack. This requires chemical personal protective equipment and protocols that are easier to use.

This is an exploratory study of nursing home preparedness in South Carolina intended to: (1) examine nursing home administrators' perceptions of disaster preparedness in their facility in the absence of an immediate emergency or disaster, and changes in their views about preparedness following a large disaster; (2) study whether administrators' knowledge of shortcomings in preparedness leads them to change their views about planning; and (3) suggest ways to enhance preparedness.

A descriptive survey based on interviews with public officials responsible for nursing home safety was developed and mailed to all 192 licensed nursing homes in South Carolina in July 2005, and an extensive literature review was performed. As responses to the baseline survey were received, Hurricane Katrina devastated the Gulf Coast.Two weeks after Katrina, a brief, post-Katrina survey was mailed, asking administrators if Katrina had influenced their preparedness plans. Quantitative responses were analyzed using descriptive statistics. Three researchers coded the qualitative data and conducted a thematic analysis.

One hundred twelve baseline surveys and 50 post-Katrina surveys were completed (response rates 58.3% and 26%, respectively). A large number of respondents reported a high level of satisfaction with the overall ability of their facilities to protect residents during an emergency or disaster. However, many were less satisfied with their preparedness in specific, important areas, including: (1) providing shelter to evacuees from other nursing homes; (2) transportation; and (3) staffing. In the post-Katrina survey, 54% of respondents were re-evaluating their disaster plans; only 36% felt well-prepared. Those re-evaluating their plans specifically mentioned evacuation, transportation, supplies, staffing, and communication.

Transportation, communication, supplies, staffing, and the ability to provide shelter to evacuees are important domains to consider when evaluating nursing home preparedness. Administrators believe their nursing homes need to improve in all of these areas. Recommendations include developing improved transportation arrangements, redundant communication systems, and stronger linkages with local emergency preparedness systems.

A large number of firefighters retired after 11 September 2001. These retirees were confronted with multiple challenges, including grief, trauma- related physical injuries and psychological distress, difficulties related to the transition of their roles, and deterioration of social support.

The Fire Department of NewYork (FDNY) Counseling Service Unit's “Stay Connected” Program designed and implemented after 11 September 2001 is described in this report. This unique program was designed to usea combination of peer outreach and professional counseling to address the mental health needs of retiring firefighters and their families.

Descriptive information about the intervention program was gathered through semi-structured interviews with Counseling Service Unit staff. Client satisfaction surveys were collected during three six-week periods.

Quantitative data indicate that clients rated their overall satisfaction with the clerical and counseling staff a perfect 4 out of 4. The report of their overall satisfaction with the services also was nearly at ceiling (3.99 out 4).The perceived helpfulness of the services in resolving the problems experienced by the clients increased significantly over time.Qualitative data indicate that peer involvement and intensive community outreach, i.e., social events, wellness activities, and classes, were integral to the success of the intervention.

This project provided valuable lessons about how to develop and implement a “culturally competent”intervention program for public safety workers retiring after a disaster. Creative, proactive, non-traditional outreach efforts and leveraging peers for credibility and support were particularly important.

Poison Control Centers (PCCs) play an integral role in the preparation for and management of poison emergencies. Large-scale public health disasters, caused by both natural and human factors, may result in a drastic increase in the number of inquiries received and handled by Poison Control Centers (PCCs) in short periods of time. In order to plan and prepare for such public health emergencies, it is important for PCCs to assess their ability tohandle the surge in call volume and to examine how the unusually large number of calls could affect the level of services. On 26 January 2006, the New York City Poison Center experienced a sudden loss of telephone service.The disruption in telephone service led to the need to reroute calls from that geographical catchment area to the New Jersey Poison Information and Education System (NJPIES) for several hours.

Data from the New Jersey Poison Information and Education System was abstracted from the telephone switch's internal reporting system and the New Jersey Poison Information and Education System's electronic record system and processed with a standard spreadsheet application.

Compared to the same time and day in the previous week, the total number of calls received by the New Jersey Poison Information and Education System during the four hours after the disruption increased by 148%. A substantial rise in the number of calls was observed in almost every 15-minute increment during this four-hour (h) time period (with some of these increments increasing as much as 525%). Meanwhile, the percentage of calls answered by the New Jersey Poison Information and Education System decreased, and the percentage of calls abandoned during a 15-minute increment reached as high as 62%. Furthermore, the average time for handling calls was longer than usual in most of these 15-minute increments.

Limitations of the telephone technology, which impacted the ability of the New Jersey Poison Information and Education System to respond to the surge of calls, were observed. While the New Jersey Poison Information and Education System was able to handle the unusual increase of incoming calls using available poison specialists and staff, the experience gained from this natural experiment demonstrates the need for Poison Control Centres to have a pre-planned surge capacity protocol that can be implemented rapidly during a public health emergency. A number of challenges that Poison Control Centres must meet in order to have adequate surge capacity during such events were identified.

Mass-casualty incidents (MCIs) can occur outside of major metropolitan areas. In such circumstances, the nearest hospital seldom is a Level-1 Trauma Center. Moreover, emergency medical services (EMS) capabilities in such areas tend to be limited, which may compromise prehospital care and evacuation speed. The objective of this study was to extract lessons learned from the medical response to a terrorist event that occurred in the marketplace of a small Israeli town on 26 October 2005. The lessons pertain to the management of primary and secondary evacuation and the operational practices by the only hospital in the town, which is designated as a Level-2 Trauma Center.

Data were collected during the event by Home Front Command Medical Department personnel. After the event, formal and informal debriefings were conducted with emergency medical services personnel, the hospitals involved, and the Ministry of Health.The medical response components, interactions (mainly primary triage and secondary distribution), and the principal outcomes were analyzed.The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.

The suicide bomber and four victims died at the scene, and two severely injured patients later died in the hospital. A total of 58 wounded persons were evacuated, including eight severely injured, two moderately injured, and 48 mildly injured. Forty-nine of the wounded arrived to the nearby Hillel Yafe Hospital, including all eight of the severely injured victims, the two moderately injured, and 39 of the mildly injured. Most of the mildly injured victims were evacuated in private cars by bystanders.

Five other area hospitals were alerted, three of which primarily received the mildly injured victims. Twodistant, Level-1 Trauma Centers also were alerted; each received one severely injured patient from Hillel Yafe Hospital during the secondary distribution process.

Emergency medical services personnel were able to treat and evacuate all severely and moderately injured patients within 17 minutes of the explosion. A total of 12 of the 21 ambulances arriving on-scene within the first 20 minutes were staffed by emergency medical services volunteers or off-duty workers.

When a mass-casualty incident occurs in a small town that is in the vicinity of a Level-2 Trauma Center, and located a >40 minute drive from Level-1 Trauma Centers, the Level-2 Trauma Center is a critical component in medical management of the event. All severely and moderately injured patients initially should be evacuated to the Level-2 Trauma Center, and given advanced, hospital-based resuscitation. The patients needing care beyond the capabilities of this facility should be distributed secondarily to Level-1 Trauma Centers.To alleviate the burden placed on the local hospital, some of the mildly injured victims can be evacuated primarily to more distant hospitals.The ability to control the flow of mildly injured patients is limitedby the large percentage of them arriving by private cars. The availability of emergency medical services in small towns can be augmented significantly by enrolling off-duty emergency medical services workers and volunteers to the rescue effort. Level-2 hospitals in small towns should be prepared and drilled to operate in a “selective evacuation” mode during mass-casualty incidents.

The differences between pediatric (≤17 years of age) and adult clinical field encounters were analyzed from four deployments of Disaster Medical Assistance Teams(DMATs).

A retrospective cohort review of all patients who presented to DMAT field clinics during two hurricanes, one earthquake, and one flood was conducted. Descriptive statistics were used to analyze: (1) age; (2) gender; (3) severity category level; (4) chief complaint; (5) treatments provided; (6) discharge diagnosis; and (7) disposition. Five subsets of pediatric patients were analyzed further.

Of the 2,196 patient encounters reviewed, 643 (29.5%) encounters were pediatric patients. Pediatric patients had a greater number of blank severity category levels than adults. Pediatric patients also were: (1) more likely to present with chief complaints of upper respiratory infections or wounds; (2) less likely to present with musculoskeletal pain or abdominal pain; and (3) equally likely to present with rashes. Pediatric patients were more likely to receive antibiotics, pain medication, and antihistamines, but were equally likely to need treatment for wounds. Dispositions to the hospital were less frequent for pediatric patients than for adults.

Pediatric patients represent a substantial proportion of disaster victims at DMAT field clinics. They often necessitate special care requirements different from their adult counterparts. Pediatric-specific severity category criteria, treatment guidelines, equipment/medication stocks, and provider training are warranted for future DMAT response preparations.

Trauma is a leading cause of death in most countries. Different patterns of trauma deaths are recorded in different countries. The purpose of this study was to evaluate retrospectively the pattern of trauma deaths in the emergency unit of a University Teaching Hospital in Nigeria.

This is a descriptive, retrospective study. The data were obtained from patient case files and nurses'records. The data abstracted included age, sex, cause of trauma/death, parts of the body injured, time of death, andthe duration of stay in the Accident and Emergency Unit (AEU).

A total of 5,537 cases presented to the AEU of the University of Benin Teaching Hospital between 01 January 2001 and 31 December 2004. Of these, 5,446 were due to trauma (98.4%). A total of 127 patients died (case fatality rate: 2.3%). Of the deaths, 81.9% were males. Motor vehicle crashes were the most frequent cause (54.3%), and drowning was the least common cause of trauma (0.8%). The most frequently injured region of the body was the head and neck (53.4%). A total of 67.4% of the deaths occurred within six hours of presentation to the AEU.

There is a great need for improved road safety, adequate pre-hospital medical care, and prompt transfer services for victims of trauma.