Guest Editorial
In Memoriam: Victor Semyonovich Koscheyev
- Gloria Leon, Carol Amaratunga, Marvin Birnbaum
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- 11 January 2019, p. 1
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Character Disorders among Autocratic World Leaders and the Impact on Health Security, Human Rights, and Humanitarian Care
- Frederick M. Burkle, Jr.
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- 15 January 2019, pp. 2-7
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The development of autocratic leaders in history reveals that many share severe character disorders that are consistently similar across borders and cultures. Diplomats and humanitarians negotiating for access to populations in-need and security of their programs, especially in health, must understand the limitations placed on the traditional negotiation process. These shared character traits stem from a cognitive and emotional developmental arrest in both childhood and adolescence resulting in fixed, life-long, concrete thinking patterns. They fail to attain the last stage of mental and emotional development, that of abstract thinking, which is necessary for critical reasoning that allows one to consider the broader significance of ideas and information rather than depend on concrete details and impulses alone. These autocratic leaders have limited capacity for empathy, love, guilt, or anxiety that become developmentally permanent and guide everyday decision making. Character or personality traits that perpetuate the lives of autocratic leaders are further distinguished by sociopathic and narcissistic behaviors that self-serve to cover their constant fear of insecurity and the insatiable need for power. Human rights, humanitarian care, and population-based health security are examples of what has consistently been sacrificed under autocratic rule. Today, with the worst global loss of democratic leadership ever seen since WWII, leaders with these character traits now rule in major countries of the world. While history teaches us of battles and conflicts that result from such flawed leadership, it lacks explanations of why autocratic behaviors consistently emerge and dominate many societies. Building multidisciplinary capacity and capability in societies among democracies to limit or cease such authoritarian dominance first begins with a developmental understanding of why autocrats exist and persist in externalizing their pathological behaviors on unsuspecting and vulnerable populations, and the limitations they place on negotiations.
“…once in power, a leader with an Antisocial Personality Disorder thrives on continuing conflict and never seeks peace.” Daedalus Trust, London, 2016
Burkle FM Jr. Character Disorders among Autocratic World Leaders and the Impact on Health Security, Human Rights, and Humanitarian Care . Prehosp Disaster Med.2019 ;34(1):2–7.
Original Research
The Yew Disaster Severity Index: A New Tool in Disaster Metrics
- Ying Ying Yew, Rafael Castro Delgado, David James Heslop, Pedro Arcos González
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- 02 January 2019, pp. 8-19
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Objectives
The Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.
BackgroundAn agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.
MethodsA quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.
ResultsThe findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.
ConclusionBy computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.
,Yew YY ,Castro Delgado R ,Heslop DJ .Arcos González P The Yew Disaster Severity Index: A New Tool in Disaster Metrics . Prehosp Disaster Med.2019 ;34(1):8–19.
Barriers to Breastfeeding in Disasters in the Context of Iran
- Mandana MirMohamadaliIe, Reza Khani Jazani, Sanaz Sohrabizadeh, Alireza Nikbakht Nasrabadi
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- 14 February 2019, pp. 20-24
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Introduction
Natural disasters have many effects on vulnerable groups, especially infants and children. Protecting breastfeeding in disasters is important, because artificial feeding puts a lot of risk to the child. In disasters, artificial nutrition is dangerous to children and its supplementation requires special equipment. There is little information on the nutritional status of infants after disasters in Iran.
ProblemThe purpose of this study was to explore the barriers to appropriate lactation after disasters in Iran.
MethodThis was a qualitative study using a content analysis method. A total of 19 midwives with disaster-relief experiences were approached for interview. Data were collected using semi-structured interviews. Data analysis was performed using the Graneheim’s approach.
ResultsThe categories of maternal factors, neonatal factors, management factors, and context-base factors were extracted from the data.
ConclusionThe challenges of social support, mothers’ self-efficacy, educated staff for disasters, and privacy for breastfeeding can be considered as important barriers to breastfeeding in disasters. Training programs, as well as health system support, can help overcome the breastfeeding barriers in disasters.
,MirMohamadaliIe M ,Khani Jazani R ,Sohrabizadeh S .Nikbakht Nasrabadi A Barriers to Breastfeeding in Disasters in the Context of Iran . Prehosp Disaster Med.2019 ;34(1):20–24.
The Challenges of a Vertical Evacuation Drill
- Richard J. (RJ) Salway, Zachary Adler, Trenika Williams, Francisca Nwoke, Patricia Roblin, Bonnie Arquilla
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- 27 December 2018, pp. 25-29
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Introduction
Recent natural and infrastructural disasters, such as Hurricanes Sandy (2012) and Katrina (2005) and the Northeastern power outage of 2003, have emphasized the need for hospital staff to be trained in disaster management and response. Even an internal hospital disaster may require the safe and efficient evacuation and transfer of patients with varying medical conditions and complications. A notably susceptible population is renal transplant patients, including those with post-transplant complications.
HypothesisThis descriptive study evaluated staff performance of a vertical evacuation drill of renal transplant patients at State University of New York (SUNY) Downstate Medical Center – University Hospital Brooklyn (UHB; Brooklyn, New York USA).
MethodsThirteen standardized patients, 12 of whom received a renal transplant, with varying medical histories, ambulatory ability, and mental status were vertically evacuated by the transplant staff from the eighth floor to the ambulance entrance on the ground floor. Non-ambulatory patients were transported on portable evacuation sleds.
ResultsAll patients were evacuated successfully within 3.5 hours. On a post-drill evaluation form, drill participants self-reported largely positive results concerning their own role in the drill and the evacuation drill itself. Drill evaluators observed very different results, including staff reticence, poor training retention, and lack of leadership.
ConclusionDespite encouraging post-drill evaluation results from the participants, the evacuation drill highlighted several immediate deficiencies. It also demonstrated a significant discrepancy in performance perception between the drill participants and the drill evaluators.
,Salway RJ ,Adler Z ,Williams T ,Nwoke F ,Roblin P .Arquilla B The Challenges of a Vertical Evacuation Drill . Prehosp Disaster Med.2019 ;34(1):25–29.
Disaster Health Management: Do Pharmacists Fit in the Team?
- Kaitlyn E. Watson, Vivienne Tippett, Judith A. Singleton, Lisa M. Nissen
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- 03 January 2019, pp. 30-37
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Background
In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers.
ProblemThe aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters.
MethodsDelegates at the World Association for Disaster and Emergency Medicine’s (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists’ roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded.
ResultsOf the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of “Agree” or “Strongly Agree” by 72.4% or more of the participants. Lack of understanding of a pharmacist’s roles and capabilities was the highest described barrier to pharmacists’ roles in disaster management.
ConclusionsThis multi-disciplinary disaster health “community” agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.
,Watson KE ,Tippett V ,Singleton JA .Nissen LM Disaster Health Management: Do Pharmacists Fit in the Team? Prehosp Disaster Med.2019 ;34(1):30–37.
Emergency Medical Services Experience With Barb Removal After Taser Use By Law Enforcement: A Descriptive National Study
- Mazen El Sayed, Chady El Tawil, Hani Tamim, Aurelie Mailhac, N. Clay Mann
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- 28 December 2018, pp. 38-45
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Background
Conducted electrical weapons (CEWs), including Thomas A. Swift Electric Rifles (TASERs), are increasingly used by law enforcement officers (LEOs) in the US and world-wide. Little is known about the experience of Emergency Medical Service (EMS) providers with these incidents.
ObjectivesThis study describes EMS encounters with documented TASER use and barb removal, characteristics of resulting injuries, and treatment provided.
MethodsThis retrospective study used five combined, consecutive National Emergency Medical Services Information System (NEMSIS; Salt Lake City, Utah USA) public-release datasets (2011-2015). All EMS activations with documented TASER barb removal were included. Descriptive analyses were carried out.
ResultsThe study included 648 EMS activations with documented TASER barb removal, yielding a prevalence rate of 4.55 per 1,000,000 EMS activations. Patients had a mean age of 35.9 years (SD=18.2). The majority were males (80.2%) and mainly white (71.3%). Included EMS activations were mostly in urban or suburban areas (78.3%). Over one-half received Advanced Life Support (ALS)-level of service (58.2%). The most common chief complaint reported by dispatch were burns (29.9%), followed by traumatic injury (16.1%). Patients had pain (45.6%) or wound (17.2%) as a primary symptom, with most having possible injury (77.8%). Reported causes of injury were mainly fire and flames (29.8%) or excessive heat (16.7%). The provider’s primary impressions were traumatic injury (66.3%) and behavioral/psychiatric disorder (16.8%). Only one cardiac arrest (0.2%) was reported. Over one-half of activations resulted in patient transports (56.3%), mainly to a hospital (91.2%). These encounters required routine EMS care (procedures and medications). An increase in the prevalence of EMS activations with documented TASER barb removal over the study period was not significant (P=.27).
ConclusionAt present, EMS activations with documented TASER barb removal are rare. Routine care by EMS is expected, and life-threatening emergencies are not common. All EMS providers should be familiar with local policies and procedures related to TASER use and barb removal.
,El Sayed M ,El Tawil C ,Tamim H ,Mailhac A .Mann NC Emergency Medical Services Experience With Barb Removal After Taser Use By Law Enforcement: A Descriptive National Study . Prehosp Disaster Med.2019 ;34(1):38–45.
Diagnosis Prevalence and Comorbidity in a Population of Mobile Integrated Community Health Care Patients
- Becca M. Scharf, Rick A. Bissell, Jamie L. Trevitt, J. Lee Jenkins
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- 27 December 2018, pp. 46-55
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Introduction
Frequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient’s likelihood of frequent Emergency Medical Services (EMS) use. To provide effective care to eligible individuals, MICH providers must have a working understanding of the common conditions they will encounter.
ObjectiveThe purpose of this descriptive study was to evaluate the diagnosis prevalence and comorbidity among participants in the Queen Anne’s County (Maryland USA) MICH Program. This fundamental knowledge of the most common medical conditions within the MICH Program will inform future mobile integrated health programs and providers.
MethodsThis study examined preliminary data from the MICH Program, as well as 2017 Maryland census data. It involved secondary analysis of de-identified patient records and descriptive statistical analysis of the disease prevalence, degree of comorbidity, insurance coverage, and demographic characteristics among 97 program participants. Diagnoses were grouped by their ICD-9 classification codes to determine the most common categories of medical conditions. Multiple linear regression models and chi-squared tests were used to assess the association between age, sex, race, ICD-9 diagnosis groups, and comorbidity among program enrollees.
ResultsResults indicated the most prevalent diagnoses included hypertension, high cholesterol, esophageal reflux, and diabetes mellitus. Additionally, 94.85% of MICH patients were comorbid; the number of comorbidities per patient ranged from one to 13 conditions, with a mean of 5.88 diagnoses per patient (SD=2.74).
ConclusionOverall, patients in the MICH Program are decidedly medically complex and may be well-suited to additional community intervention to better manage their many conditions. The potential for MICH programs to simultaneously improve patient outcomes and reduce health care costs by expanding into larger public health and addressing the needs of the most vulnerable citizens warrants further study.
,Scharf BM ,Bissell RA ,Trevitt JL Jenkins JL. Diagnosis Prevalence and Comorbidity in a Population of Mobile Integrated Community Health Care Patients Prehosp Disaster Med.2019 ;34(1):46–55.
Paramedic and Emergency Medical Technician Reflections on the Ongoing Impact of the 9/11 Terrorist Attacks
- Erin C. Smith, Frederick M. Burkle, Jr.
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- 14 February 2019, pp. 56-61
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Introduction
In the years following the September 11, 2001 terrorist attacks in New York City (New York USA), otherwise known as 9/11, first responders began experiencing a range of health and psychosocial impacts. Publications documenting these largely focus on firefighters. This research explores paramedic and emergency medical technician (EMT) reflections on the long-term impact of responding to the 9/11 terrorist attacks.
MethodsQualitative methods were used to conduct interviews with 54 paramedics and EMTs on the 15-year anniversary of 9/11.
ResultsResearch participants reported a range of long-term psychosocial issues including posttraumatic stress disorder (PTSD), anxiety, depression, insomnia, relationship breakdowns and impact on family support systems, and addictive and risk-taking behaviors. Ongoing physical health issues included respiratory disorders, eye problems, and cancers.
DiscussionThese findings will go some way to filling the current gap in the 9/11 evidence-base regarding the understanding of the long-term impact on paramedics and EMTs. The testimony of this qualitative research is to ensure that an important voice is not lost, and that the deeply personal and richly descriptive experiences of the 9/11 paramedics and EMTs are not forgotten.
,Smith EC Burkle FM Jr. Paramedic and Emergency Medical Technician Reflections on the Ongoing Impact of the 9/11 Terrorist Attacks . Prehosp Disaster Med.2019 ;34(1):56–61.
Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery
- Amy N. B. Johnston, Jasmine Wadham, Josea Polong-Brown, Michael Aitken, Jamie Ranse, Alison Hutton, Brent Richards, Julia Crilly
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- 07 January 2019, pp. 62-71
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Introduction
Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.
PurposeThe aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).
MethodsA pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.
FindingsImportant structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.
ConclusionsThis in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
,Johnston ANB ,Wadham J ,Polong-Brown J ,Aitken M ,Ranse J ,Hutton A ,Richards B Crilly J. Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery . Prehosp Disaster Med. 2019;34(1):62–71.
On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years
- Sheila A. Turris, Christopher W. Callaghan, Haddon Rabb, Matthew Brendan Munn, Adam Lund
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- Published online by Cambridge University Press:
- 27 December 2018, pp. 72-81
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Introduction
Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have on-site medical care to help reduce the impact on local health care systems. Historically, the literature suggests that patient transfers off-site are frequently related to complications of substance use. However, there is a gap in understanding why patients are transferred to hospital when an on-site medical team, capable of providing first aid services blended with a higher level of care (HLC) team, is present.
ObjectiveThe purpose of this study is to better understand patterns of injuries and illnesses that necessitate transfer when physician-led HLC teams are accessible on-site.
MethodsThis is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.
Results/DiscussionOn-site medical teams that included HLC team members were present for the duration of each festival, so every team was able to “treat and release” when clinically appropriate. Over the course of the combined 34 event days, there were 10,406 patient encounters resulting in 156 individuals being transferred off-site for assessment, diagnostic testing, and/or treatment. A minority of patients seen were transferred off-site (1.5%). The patient presentation rate (PPR) was 16.5/1,000. The ambulance transfer rate (ATR) was 0.12/1,000 attendees, whereas the total transfer-to-hospital rate (TTHR), when factoring in non-ambulance transport, was 0.25/1,000. In contrast to existing literature on transfers from music festivals, the most common reason for transfer off-site was for musculo-skeletal (MSK) injuries (53.8%) that required imaging.
ConclusionThe presence of on-site HLC teams impacted the case mix of patients transferred to hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required specialized imaging and testing that could not be performed in an out-of-hospital setting. These results suggest that a better understanding of the specific effects on-site HLC teams have on avoiding off-site transfers will aid in improving planning for music festivals. The findings also identify areas for further improvement in on-site care, such as integrated on-site radiology, which could potentially further reduce the impact of music festivals on local health services. The role of non-emergency transport vehicles (NETVs) deserves further attention.
,Turris SA ,Callaghan CW ,Rabb H ,Munn MB .Lund A On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years Prehosp Disaster Med.2019 ;34(1):72–81.
Comprehensive Review
Human Stampedes: An Updated Review of Current Literature
- Maria Moitinho de Almeida, Johan von Schreeb
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- 27 November 2018, pp. 82-88
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Human stampedes are a major cause of mortality in mass gatherings, but they have received limited scientific attention. While the number of publications has increased, there is no recent review of new study results. This study compiles and reviews available literature on stampedes, their prevention, preparedness, and response.
A search for peer-reviewed and grey literature in PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Google Scholar (Google Inc.; Mountain View, California USA), Web of Science (Thomson Reuters; New York, New York USA), the World Health Organization Library Database (WHOLIS; World Health Organization; Geneva, Switzerland), and ReliefWeb (UN Office for the Coordination of Humanitarian Affairs; Geneva, Switzerland) was conducted, and papers were selected according to pre-defined eligibility criteria. Included items were read and results were compiled and summarized. A total of 64 publications were included, of which, 34 were published between 2013-2016. The most studied events were Germany’s Love Parade stampede in 2010 (Duisburg, Germany; n = 6) and the United Kingdom (UK) Hillsborough Stadium stampede in 1989 (Sheffield, England; n = 4). Conflicting definitions of human stampedes were found. The common belief that they result from an irrational and panicking crowd has progressively been replaced by studies suggesting that successive systemic failures are main underlying causes. There is a lack of systematic reporting, making news reports often the only source available. Prevention measures are mainly related to crowd management and venue design, but their effectiveness has not been studied. Drills are recommended in the preparedness phase to improve coordination and communication. Delay in decisions, poor triage, or loss of medical records are common problems in the response, which may worsen the outcome.
Stampedes are complex phenomenon that remain incompletely understood, hampering formulation of evidence-based strategies for their prevention and management. Documentation comes mostly from high-profile events and findings are difficult to extrapolate to other settings. More research from different disciplines is warranted to address these gaps in order to prevent and mitigate future events. A start would be to decide on a common definition of stampedes.
,Moitinho de Almeida M .von Schreeb J Human Stampedes: An Updated Review of Current Literature . Prehosp Disaster Med.2019 ;34(1):82–88.
Special Report
Getting the Message Out: Social Media and Word-of-Mouth as Effective Communication Methods during Emergencies
- Amy F. Wolkin, Amy H. Schnall, Nicole K. Nakata, Esther M. Ellis
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- Published online by Cambridge University Press:
- 26 December 2018, pp. 89-94
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Effective communication is a critical part of managing an emergency. During an emergency, the ways in which health agencies normally communicate warnings may not reach all of the intended audience. Not all communities are the same, and households within communities are diverse. Because different communities prefer different communication methods, community leaders and emergency planners need to know their communities’ preferred methods for seeking information about an emergency. This descriptive report explores findings from previous community assessments that have collected information on communication preferences, including television (TV), social media, and word-of-mouth (WoM) delivery methods. Data were analyzed from 12 Community Assessments for Public Health Emergency Response (CASPERs) conducted from 2014-2017 that included questions regarding primary and trusted communication sources. A CASPER is a rapid needs assessment designed to gather household-based information from a community. In 75.0% of the CASPERs, households reported TV as their primary source of information for specific emergency events (range = 24.0%-83.1%). Households reporting social media as their primary source of information differed widely across CASPERs (3.2%-41.8%). In five of the CASPERs, nearly one-half of households reported WoM as their primary source of information. These CASPERs were conducted in response to a specific emergency (ie, chemical spill, harmful algal bloom, hurricane, and flood). The CASPERs conducted as part of a preparedness activity had lower percentages of households reporting WoM as their primary source of information (8.3%-10.4%). The findings in this report demonstrate the need for emergency plans to include hybrid communication models, combining traditional methods with newer technologies to reach the broadest audience. Although TV was the most commonly reported preferred source of information, segments of the population relied on social media and WoM messaging. By using multiple methods for risk communication, emergency planners are more likely to reach the whole community and engage vulnerable populations that might not have access to, trust in, or understanding of traditional news sources. Multiple communication channels that include user-generated content, such as social media and WoM, can increase the timeliness of messaging and provide community members with message confirmation from sources they trust encouraging them to take protective public health actions.
,Wolkin AF ,Schnall AH ,Nakata NK .Ellis EM Getting the Message Out: Social Media and Word-of-Mouth as Effective Communication Methods during Emergencies . Prehosp Disaster Med.2019 ;34(1):89–94.
Brief Report
Health Risk Behaviors after Disaster Exposure Among Older Adults
- Sue Anne Bell, HwaJung Choi, Kenneth M. Langa, Theodore J. Iwashyna
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- Published online by Cambridge University Press:
- 15 January 2019, pp. 95-97
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Objective
The aim of this study was to examine the extent to which an exposure to disaster is associated with change in health behaviors.
MethodsFederal disaster declarations were matched at the county-level to self-reported behaviors for participants in the Health and Retirement Study (HRS), 2000-2014. Multivariable logistic regression was used to evaluate the relationship between disaster and change in physical activity, body mass index (BMI), and cigarette smoking.
ResultsThe sample included 20,671 individuals and 59,450 interviews; 1,451 unique disasters were declared in counties in which HRS respondents lived during the study period. Exposure to disaster was significantly associated with weight gain (unadjusted RRR=1.19; 95% CI, 1.11-1.27; adjusted RRR=1.21; 95% CI, 1.13-1.30). Vigorous physical activity was significantly lower among those who had experienced a disaster compared to those who had not (unadjusted OR=0.89; 95% CI, 0.84-0.95; adjusted OR=0.84; 95% CI, 0.79-0.89). No significant difference in cigarette smoking was found.
ConclusionsThis study found an increase in weight gain and decrease in physical activity among older adults after disaster exposure. Adverse health behaviors such as these can contribute to functional decline among older adults.
,Bell SA ,Choi H ,Langa KM .Iwashyna TJ Health Risk Behaviors after Disaster Exposure Among Older Adults . Prehosp Disaster Med.2019 ;34(1):95–97.
Case Report
Mass-Gathering Medical Care Provided by a Collegiate-Based First Response Service at an Annual College Music Festival and Campus-Wide Celebration
- Nicholas M.G. Friedman, Emily K. O’Connor, Timothy Munro, David Goroff
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- Published online by Cambridge University Press:
- 26 December 2018, pp. 98-103
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Background
There is insufficient research on medical care at mass-gathering events (MGEs) on college and university campuses. Fun Day is an annual celebratory day held at Skidmore College (Saratoga Springs, New York USA), a small liberal arts college in the Northeastern United States. Fun Day is focused around an outdoor music festival; students also congregate and celebrate throughout the surrounding campus. To improve care and alleviate strain on local resources, a model was developed for the provision of emergency care by a collegiate-based, volunteer first-response service – Skidmore College Emergency Medical Services (EMS) – in coordination with a contracted, private ambulance service.
Study/ObjectiveThe aims of this study were to: (1) analyze medical usage rates and case mixes at Fun Day over a four-year period, and to (2) describe the collegiate-based first response model for MGEs.
MethodsData were collected retrospectively from event staff, college administrators, and Skidmore College EMS on event-related variables, patient encounters, and medical operations at Fun Day over a four-year period (2014-2017).
ResultsAnnual attendance at the music festival was estimated at 2,000 individuals. Over four years, 54 patients received emergency medical care on campus on Fun Day, and 18 (33.3%) were transported to the emergency department. On-site contracted ambulances transported 77.8% of patients who were transported to the emergency department; mutual aid was requested for the other 22.2% of transports. The mean (SD) patient presentation rate (PPR) was 7.0 (SD = 1.0) per 1,000 attendees. The mean (SD) transport-to-hospital rate (TTHR) was 2.0 (SD = 1.0) per 1,000 attendees. Thirty (55.6%) patients presented with intoxication, seven (13.0%) with laceration(s), and five (9.3%) with head trauma as the primary concern. Medical command was established by volunteer undergraduate students. Up to 16 volunteer student first responders (including emergency medical technicians [EMTs]) were stationed on campus, in addition to two contracted ambulances at the Basic Life Support (BLS) and Advanced Life Support (ALS) levels. Operational strategies included: mobile first response crews, redundant communication systems, preventative education, and harm reduction.
ConclusionHigh medical usage rates were observed, primarily due to alcohol/illicit substance use and traumatic injuries. The provision of emergency care by a collegiate-based first response service in coordination with a contracted, private ambulance agency serves as an innovative model for mass-gathering medical care on college and university campuses.
,Friedman NMG ,O’Connor EK ,Munro T Goroff D. Mass-Gathering Medical Care Provided by a Collegiate-Based First Response Service at an Annual College Music Festival and Campus-Wide Celebration . Prehosp Disaster Med.2019 ;34(1):98–103.
Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital Intubation
- Adam James Smith, Ken Jackimczyk, Bruce Horwood, Daniel Christenson
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- Published online by Cambridge University Press:
- 10 January 2019, pp. 104-107
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Background
In the prehospital setting, many providers advocate for video laryngoscopy as the initial method of intubation to improve the likelihood of a successful first attempt. However, bright ambient light can worsen visualization of the video laryngoscope liquid crystal display (LCD).
Case ReportA patient involved in a motor vehicle accident was evaluated by an Emergency Medical Services (EMS) crew. Initial endotracheal intubation attempt using video laryngoscopy was aborted after the patient desaturated. The primary reason for the failure was poor visualization of the video laryngoscope LCD, despite attempts to block direct sunlight. Debriefing revealed that the intubating provider was wearing polarized sunglasses.
DiscussionBecause LCDs emit polarized light, use of polarized sunglasses may cause the display to appear dark. Thus, the purpose of this Case Report is to raise awareness of a potential safety issue that is likely under-recognized by prehospital providers but can be easily avoided.
,Smith AJ ,Jackimczyk K ,Horwood B .Christenson D Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital Intubation Prehosp Disaster Med.2019 ;34(1):104–107.
Letter to the Editor
Introduction of a New EMS Protocol Using the Communities of Practice Educational Model
- Kyle A. Fratta, Jennifer N. Fishe, Jennifer F. Anders, Tessa G. Smith
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- Published online by Cambridge University Press:
- 11 January 2019, pp. 108-109
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Emergency Medical Services (EMS) protocol implementation can be a challenging endeavor given the large and diverse provider workforce. These efforts can be even more challenging given training restrictions, career and volunteer combination EMS agencies, and inconsistent work schedules. In an effort to educate as many providers as possible in a relatively short time, the community of practice educational model was used during a new evidence-based EMS protocol implementation. This model identifies providers who are enthusiastic during initial training as advocates. These advocates then continue to educate their peers going forward. This allows for the initial educational effort to continue to propagate during pilot testing and beyond. During this protocol implementation, a total of 17 educational visits were made to EMS stations and 43 providers were identified as advocates.
,Fratta KA ,Fishe JN ,Anders JF .Smith TG Introduction of a New EMS Protocol Using the Communities of Practice Educational Model . Prehosp Disaster Med.2019 ;34(1):108–109.
Front Cover (OFC, IFC) and matter
PDM volume 34 issue 1 Cover and Front matter
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- Published online by Cambridge University Press:
- 14 February 2019, pp. f1-f7
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Back Cover (OBC, IBC) and matter
PDM volume 34 issue 1 Cover and Back matter
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- Published online by Cambridge University Press:
- 14 February 2019, pp. b1-b2
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