Evidence suggests that regular disaster exercises have beneficial effects on subsequent mock and actual disaster responses. The purpose of this report is to describe a multiple hospital, bioterrorism exercise, evaluated by independent observers who used an evaluation template.

The overall tabletop exercise design included participation from 23 Joint Commission Accreditation of Healthcare Organizations hospitals, four health departments, and a representative from one federal agency. The exercise was evaluated by trained exercise observers utilizing an independently prepared, evaluation protocol.

All exercise sites successfully identified the bio-agent involved and answered after-exercise debriefing questions without much difficulty. Evaluations, in the form of an after-action report by the independent observers, commented upon the many limitations to the construct of the exercise.

Having an independent observer group at the exercise appeared to provide a value-added benefitfor capturing subjective information and data. However, these data were not in a form conducive to statisticalanalysis. Further work is needed to create an evaluation tool that would allow for statistical analysis so that exercises can be compared and improvements can be objective.

Mass-gathering events are dynamic and challenge traditional medical management systems. To improve the system for the provision of first aid at mass-gathering events, an evaluation of two models that assist in forecasting the number of patients presenting for first-aid services was conducted.

A prospective evaluation of a recurrent, mass-gathering event was undertaken comparing predicted patient presentations and ambulance transfers generated by a predictive model developed by Arbon et al and a retrospective review of seven years of historical, event data as described by Zeitz et al.

Patient presentation rate (per 1,000 patrons) for this event was 1.6 and the transport to hospital rate (per 1,000 patrons) was 0.07. The retrospective review closely predicted the actual overall attendance.Both methods forecast the number of patients presenting on a daily basis. The prediction proved to be more accurate, on a day-by-day basis, using the Zeitz method.

The Arbon method is particularly useful for events where there is no or limited information about previous medical work. Retrospective review of data generated from specific events (Zeitz method) considers the unique and individual variability that can occur from event to event and is more accurate at predicting patient presentations when the data are available. Both methods have the potential to be used more frequently to adequately and efficiently plan for the resources required for specific events.

Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualtyincident.

To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.

Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient.

A total of 1,741 assessments of 788 patients by 82 nurse managers aabnd 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than werenurse managers to send patients to such a facility or discharge them, but less likely to transfer patients outof the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses.

A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.

In response to the 11 September 2001 terrorist attacks on the World Trade Center (WTC), the United States Public Health Service (USPHS) deployed Disaster Medical Assistance Teams (DMATs) and the Commissioned Corps to provide on-site, primary medical care to anyone who presented. Patients included rescue and recovery workers, other responders, and some members of the general public.

A descriptive analysis of WTC-USPHS patient records was conducted in order to better understandthe short-term impact of the WTC site on the safety and health of individuals who were at or near the site from 14 September–20 November 2001.

The Patient Treatment Record forms that were completed for each patient visit to these USPHS stations over the 10-week deployment period were reviewed.

Patient visits numbered 9,349, with visits peaking during Week 2 (21–27 September). More than one-quarter of the visits were due to traumatic injuries not including eye injuries (n = 2,716; 29%). Respiratory problems comprised more than one-fifth of the complaints (n = 2,011; 22%). Eye problems were the third most frequent complaint (n = 1,120; 12%). With respect to the triage class, the majority of visits fell into the lowest category of severity (n = 6,237; 67%).

USPHS visits probably were skewed to milder complaints when compared to analyses of employer medical department reports or hospital cases; however, given the close proximity of the USPHS stations to the damage, analysis of the USPHS forms provides a more complete picture of the safety and health impact on those who were at or near the WTC site.

The purpose of this study was to ascertain information about emergency medical technicians' (EMTs') attitudes towards their training, comfort, and roles when a patient dies on-scene.

A sample of 136 EMTs (all levels) from 14 different states participated in a survey prior to completing a continuing education program. About 40% (n = 54) of the EMTs were attending a training program related to death based on the Emergency Death Education and Crisis Training Curriculum,1 while 60% (n = 82) were attending an EMT training program not related to death. Each participant answered questions about their attitudestowards a death on-scene using a five-point Likert scale. The EMTs were compared by level of training (EMT-B/EMT-I and EMT-P), and by type of educational program attended (death-related education and nondeath-related education).

Most (82%) participants reported that an EMT's actions impact the grief process of a bereaved family. About half (54%) reported that an EMT's role should include notifying the family of the death. However, three-quarters (76%) reported that they had not been trained adequately to make a death notification or help the family with their grief. Many (40%) felt uncomfortable making a death notification. Differences were present in EMTs enrolled in the death education courses as compared to those attending an educational program not related to death. Differences also were found in the levels of EMTs (EMT-B/EMT-I versus EMT-Paramedics).

This study provides new insights about EMTs' attitudes towards death and the death-related training they receive.

On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the “F Scale”) struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris.

A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck.

Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate= 79.2%).While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were lesssevere (median injury severity score (ISS) 1 versus 4).

For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.

To identify and describe the key communication and health protection issues surrounding a flooding emergency.

A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major floodin February 2004. This was supplemented by key informant interviews and a newspaper content analysis.

A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The majorsources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but “health” only was mentioned in 46 (7%) of the 664 flood-related articles.

Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk ofwater contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems.

Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this floodaffected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.

The number of deaths due to trauma from road traffic accidents (RTAs), and from the use of firearms either for homicide or armed robbery, ethnic conflicts, and other events, such as flooding, explosions from petroleum products, and religious violence, is on the rise in Nigeria. This preliminary study is a comparative analysis of the frequency of deaths caused by RTAs and the deaths caused by the use of firearms during armed robbery. The study sought to identify the number of traumatic deaths caused by RTAs or armed robbery as well as the number of victims who sustained injuries in the process of RTA or armed robberies.

An indigenous, non-governmental organization (NGO) network was used to abstract data for the frequency of RTAs associated with death or injuries and for deaths caused by armed robberies and was supplemented with data obtained from the Nigerian police.

For RTAs, the victims included drivers, passengers, and pedestrians. In 3,032 cases of RTAs, the total number of deaths was 1,239 (29.1%): one Nigerian dies for every three to four crashes. The total number of deaths due to RTAs was significantly higher than was the number of deaths due to the use of firearms in commission of robbery.

Police reports relative to the use of firearms during armed robberies indicate that of a total of the 652 victims who were killed, 348 (68.1%) were the armed robbers, 134 (26.2%) were bystanders, and 29 (5.7%) were policemen.

The enormity of the problems of traumatic deaths from RTAs and armed robberies in a developing country has been highlighted.