Brief Report
Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment
- Marie Mullen, Gianluca Cerri, Ryan Murray, Angela Talbot, Alexandra Sanseverino, Peter McCahill, Virginia Mangolds, Jesse Volturo, Chad Darling, Marc Restuccia
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- Published online by Cambridge University Press:
- 19 March 2014, pp. 200-203
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Introduction
Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care.
HypothesisThe investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement.
MethodsCritically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test.
ResultsPatients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction.
ConclusionPrehospital aeromedical point-of-care lactate measurement levels ≥4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.
. ,Mullen M ,Cerri G ,Murray R ,Talbot A ,Sanseverino A ,McCahill P ,Mangolds V ,Volturo J ,Darling C .Restuccia M Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment . Prehosp Disaster Med.2014 ;29 (1 ):1 -4
Securing the Second Front: Achieving First Receiver Safety and Security through Competency-based Tools
- Jamal Jones, Judith Staub, Andrew Seymore, Lancer A. Scott
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- Published online by Cambridge University Press:
- 14 October 2014, pp. 643-647
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Introduction
Limited research has focused on the safety and security of First Responders and Receivers, including clinicians, hospital workers, public safety officials, community volunteers, and other lay personnel, during public health emergencies. These providers are, in some cases, at greater peril during large-scale disasters due to their lack of training and inadequate resources to handle major influxes of patients. Exemplified in the 1995 Tokyo sarin gas attacks and the 2008 Wenchuan earthquakes, lack of training results in poor outcomes for both patients and First Receivers.
ObjectiveThe improvement of knowledge and comfort level of First Receivers preparing for a medical disaster via an affordable, repeatable emergency preparedness training (EPT) curriculum.
MethodsA 5-hour EPT curriculum was developed including nine learning objectives, 18 competencies, and 34 performance objectives. Following brief didactic and small group sessions, interprofessional teams of four to six trainees were observed in a large patient simulator designed to recreate environmentally challenging (ie, flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors. Trained observers assessed successful completion of 16 individual and 18 team performance objectives. Prior to training, team members completed a 24-question knowledge assessment, a demographic survey, and a comfort level self-assessment. Following training, trainees repeated the 24 questions, self-assessment, and course assessment.
ResultsOne hundred ninety-five participants completed the course between November 2012 and August 2013. One hundred ninety-one (98.5%), 150 (76.9%), and 66 (33.8%) participants completed the pretest, post-test, and course assessment, respectively. The mean (SD) percentage of correct answers between the pretest and post-test increased from 46.3 (13.4) to 75.3 (12.2), P < .0001. Thirty-eight participants (19.5%) reported more than three hours of disaster EPT each year while 157 participants (80.5%) reported three hours or less of yearly EPT. Sixty-six (100%) reported the course relevant to care providers and 61 (92.4%) highly recommended the course. Comfort level increased from 37.0/100 (n = 192) before training to 76.3/100 (n = 145) after training.
ConclusionThe Center for Health Professional Training and Emergency Response's (CHPTER's) 5-hour EPT curriculum for patient care providers recreates simultaneous multi-actor disasters, measures EPT performance, and improves trainee knowledge and comfort level to save patient and provider lives during a disaster, via an affordable, repeatable EPT curriculum. A larger-scale study, or preferably a multi-center trial, is needed to further study the impact of this curriculum and its potential to enhance the safety and security of the “Second Front.”
. ,Jones J ,Staub J ,Seymore A .Scott LA Securing the Second Front: Achieving First Receiver Safety and Security through Competency-based Tools . Prehosp Disaster Med.2014 ;29 (6 ):1 -5
Gastrointestinal Symptoms and Food/Nutrition Concerns after the Great East Japan Earthquake in March 2011: Survey of Evacuees in a Temporary Shelter
- Tomoko Inoue, Atsunori Nakao, Kazutoshi Kuboyama, Atsunori Hashimoto, Motomaru Masutani, Takahiro Ueda, Joji Kotani
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- Published online by Cambridge University Press:
- 19 March 2014, pp. 303-306
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On March 11, 2011, a 9.1 magnitude earthquake occurred in the eastern Pacific Ocean off the coast of northern Japan. A resulting tsunami struck the Japan Pacific coast, causing >20,000 deaths, injuries and missing persons.
Survivors’ post-tsunami health and nutritional status were surveyed one month after the disaster in a school shelter in Ishinomaki City. Hyogo College of Medicine's disaster relief team observations and survivors’ questionnaires were used to assess the disaster's effects on survivors’ lifestyles and gastrointestinal symptoms while residing in temporary shelters. Of 236 disaster evacuees 9-88 years of age (mean age 52 years), 23% lost weight and 28% reported decreased food intake one month after the earthquake. Up to 25% of the participants presented with gastrointestinal symptoms, including constipation (10%), appetite loss (6.4%), vomiting (6.4%), and nausea (2.1%). Although the victims preferred more vegetables (44%) or fruit (33%), most food aid received, such as rice balls or bread, was carbohydrate-based, possibly because of easy provision and abundance in emergency food pantries. The authors asked the volunteers and the Japan Self-Defense Forces to provide a more balanced diet, including vegetables and fruit. Consumption of imbalanced diets may have caused more gastrointestinal symptoms for the survivors. Because of the victims’ hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.
,Inoue T ,Nakao A ,Kuboyama K ,Hashimoto A ,Masutani M ,Ueda T .Kotani J Gastrointestinal Symptoms and Food/Nutrition Concerns after the Great East Japan Earthquake in March 2011: Survey of Evacuees in a Temporary Shelter . Prehosp Disaster Med.2014 ;29 (3 ):1 -4 .
Special Report
Clinical Characteristics of the Inhabitants of an Internally Displaced Persons Camp in Brazzaville, Republic of Congo After the Arms Dump Blast on March 4, 2012
- Inge Roggen, Gerlant van Berlaer, Geert Gijs, Ives Hubloue
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- Published online by Cambridge University Press:
- 27 August 2014, pp. 516-520
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Background
On March 4, 2012, an arms dump exploded in a densely populated area in Brazzaville, Republic of the Congo. At least 250 people were killed, 2,500 wounded, and 13,800 left homeless, of which 5,000 were relocated to a newly constructed internally displaced person (IDP) camp.
AimTo describe the medical complaints of persons presenting to the IDP camp for medical evaluation.
Patients and MethodsAll patients seen and treated by the Belgian First Aid and Support Team (B-FAST) in the IDP camp on March 10 and 11, 2012 were included. A unique number, age, gender, and inventory of complaints were registered on standard World Health Organization (WHO) forms.
ResultsOut of 245 presenting patients, 242 files were processed. One in two patients were minors (<18 years-old), the male/female ratio was 50/50 in minors and 28/72 in adults; median (range) age in minors was three years (0-17) and for adults was 32.5 years (18-68). Twenty percent of the children were determined to be malnourished. Signs and symptoms related to infectious diseases were present in 75% of minors and 53% of adults. Trauma was present in 12% of minors and 21% of adults.
ConclusionsOne week following the disaster event, after people had relocated to IDP camps, infectious diseases became the predominate reason for seeking medical evaluation. Less than one in five people presenting to the medical post had injuries directly related to the event. Demographic data showed that around 50% of people in the IDP camp presenting for medical care were children, of which one in five was malnourished.
. ,Roggen I ,van Berlaer G ,Gijs G .Hubloue I Clinical Characteristics of the Inhabitants of an Internally Displaced Persons Camp in Brazzaville, Republic of Congo After the Arms Dump Blast on March 4, 2012 . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
Brief Report
Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake
- Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Yoshiko Abe, Toshikatsu Washio, Tatsuhiko Arafune, Dai Sato, Satoshi Yamanouchi, Sae Ochi, Teiji Tominaga, Shigeki Kushimoto
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- Published online by Cambridge University Press:
- 21 February 2014, pp. 204-208
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Introduction
Telecommunication systems are important for sharing information among health institutions to successfully provide medical response following disasters.
Hypothesis/ProblemThe aim of this study was to clarify the problems associated with telecommunication systems in the acute phase of the Great East Japan Earthquake (March 11, 2011).
MethodsAll 72 of the secondary and tertiary emergency hospitals in Miyagi Prefecture were surveyed to evaluate the telecommunication systems in use during the 2011 Great Japan Earthquake, including satellite mobile phones, multi-channel access (MCA) wireless systems, mobile phones, Personal Handy-phone Systems (PHS), fixed-line phones, and the Internet. Hospitals were asked whether the telecommunication systems functioned correctly during the first four days after the earthquake, and, if not, to identify the cause of the malfunction. Each telecommunication system was considered to function correctly if the hospital staff could communicate at least once in every three calls.
ResultsValid responses were received from 53 hospitals (73.6%). Satellite mobile phones functioned correctly at the highest proportion of the equipped hospitals, 71.4%, even on Day 0. The MCA wireless system functioned correctly at the second highest proportion of the equipped hospitals. The systems functioned correctly at 72.0% on Day 0 and at 64.0% during Day 1 through Day 3. The main cause of malfunction of the MCA wireless systems was damage to the base station or communication lines (66.7%). Ordinary (personal or general communication systems) mobile phones did not function correctly at any hospital until Day 2, and PHS, fixed-line phones, and the Internet did not function correctly at any area hospitals that were severely damaged by the tsunami. Even in mildly damaged areas, these systems functioned correctly at <40% of the hospitals during the first three days. The main causes of malfunction were a lack of electricity (mobile phones, 25.6%; the Internet, 54.8%) and damage to the base stations or communication lines (the Internet, 38.1%; mobile phones, 56.4%).
ConclusionResults suggest that satellite mobile phones and MCA wireless systems are relatively reliable and ordinary systems are less reliable in the acute period of a major disaster. It is important to distribute reliable disaster communication equipment to hospitals and plan for situations in which hospital telecommunications systems do not function.
. ,Kudo D ,Furukawa H ,Nakagawa A ,Abe Y ,Washio T ,Arafune T ,Sato D ,Yamanouchi S ,Ochi S ,Tominaga T .Kushimoto S Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake . Prehosp Disaster Med.2014 ;29 (1 ):1 -5
Special Report
Emergency Medicine Systems Advancement through Community-based Development
- Martha M. Bloem, Christina M. Bloem, Juliana Rosentsveyg, Bonnie Arquilla
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- Published online by Cambridge University Press:
- 16 January 2014, pp. 75-79
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Humanitarian health programs frequently focus on immediate relief and are supply side oriented or donor driven. More emphasis should be placed on long-term development projects that engage local community leaders to ensure sustainable change in health care systems. With the Emergency Medicine Educational Exchange (EMEDEX) International Rescue, Recover, Rebuild initiative in Northeast Haiti as a model, this paper discusses the opportunities and challenges in using community-based development to establish emergency medical systems in resource-limited settings.
,Bloem MM ,Bloem CM ,Rosentsveyg J .Arquilla B Emergency Medicine Systems Advancement through Community-based Development . Prehosp Disaster Med.2014 ;29 (1 ):1 -5 .
Special Reports
Mass-gathering Health Research Foundational Theory: Part 1 - Population Models for Mass Gatherings
- Adam Lund, Sheila A. Turris, Ron Bowles, Malinda Steenkamp, Alison Hutton, Jamie Ranse, Paul Arbon
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- Published online by Cambridge University Press:
- 17 November 2014, pp. 648-654
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Background
The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events.
ProcessA critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings.
Findings and InterpretationReporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event.
A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations.
ConclusionsConsistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.
. ,Lund A ,Turris SA ,Bowles R ,Steenkamp M ,Hutton A ,Ranse J .Arbon P Mass-gathering Health Research Foundational Theory: Part 1 - Population Models for Mass Gatherings . Prehosp Disaster Med.2014 ;29 (6 ):1 -7
Special Report
Emergency Medical Services in India: The Present and Future
- Mohit Sharma, Ethan S. Brandler
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- Published online by Cambridge University Press:
- 10 April 2014, pp. 307-310
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India is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.
. ,Sharma M .Brandler ES Emergency Medical Services in India: The Present and Future . Prehosp Disaster Med.2014 ;29 (3 ):1 -4
Using Poison Center Data for Postdisaster Surveillance
- Amy Wolkin, Amy H. Schnall, Royal Law, Joshua Schier
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- Published online by Cambridge University Press:
- 10 September 2014, pp. 521-524
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The role of public health surveillance in disaster response continues to expand as timely, accurate information is needed to mitigate the impact of disasters. Health surveillance after a disaster involves the rapid assessment of the distribution and determinants of disaster-related deaths, illnesses, and injuries in the affected population. Public health disaster surveillance is one mechanism that can provide information to identify health problems faced by the affected population, establish priorities for decision makers, and target interventions to meet specific needs. Public health surveillance traditionally relies on a wide variety of data sources and methods. Poison center (PC) data can serve as data sources of chemical exposures and poisonings during a disaster. In the US, a system of 57 regional PCs serves the entire population. Poison centers respond to poison-related questions from the public, health care professionals, and public health agencies. The Centers for Disease Control and Prevention (CDC) uses PC data during disasters for surveillance of disaster-related toxic exposures and associated illnesses to enhance situational awareness during disaster response and recovery. Poison center data can also be leveraged during a disaster by local and state public health to supplement existing surveillance systems. Augmenting traditional surveillance data (ie, emergency room visits and death records) with other data sources, such as PCs, allows for better characterization of disaster-related morbidity and mortality. Poison center data can be used during a disaster to detect outbreaks, monitor trends, track particular exposures, and characterize the epidemiology of the event. This timely and accurate information can be used to inform public health decision making during a disaster and mitigate future disaster-related morbidity and mortality.
. ,Wolkin A ,Schnall AH ,Law R .Schier J Using Poison Center Data for Postdisaster Surveillance . Prehosp Disaster Med.2014 ;29 (5 ):1 -4
Brief Report
Does Self-reporting Facilitate History Taking in Food Poisoning Mass-casualty Incidents?
- Ya-I Hsu, Ying C. Huang
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- Published online by Cambridge University Press:
- 28 July 2014, pp. 417-420
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Introduction
Medical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response.
Hypothesis/ProblemIn some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information.
MethodsTwo resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students’ t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics.
ResultsThere were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the questions were scored “good” in comprehensibility.
ConclusionSelf-reporting of symptoms can shorten the time of history taking during a food poisoning mass-casualty event without sacrificing the completeness of information.
. ,Hsu Y .Huang YC Does Self-reporting Facilitate History Taking in Food Poisoning Mass-casualty Incidents? Prehosp Disaster Med.2014 ;29 (4 ):1 -4
Special Report
Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda
- Sarah Stewart de Ramirez, Jacob Doll, Sarah Carle, Trisha Anest, Maya Arii, Yu-Hsiang Hsieh, Martins Okongo, Rachel Moresky, Sonia Ehrlich Sachs, Michael Millin
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- Published online by Cambridge University Press:
- 16 April 2014, pp. 311-316
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Introduction
The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries.
ProblemThe objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda.
MethodsAn EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed.
ResultsIn total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $89.95 per life saved with an estimated $0.93/capita to establish the system and $0.09/capita/year to maintain the system.
ConclusionContrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.
. ,Stewart De Ramirez S ,Doll J ,Carle S ,Anest T ,Arii M ,Hsieh YH ,Okongo M ,Moresky R ,Sachs SE .Millin M Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda . Prehosp Disaster Med.2014 ;29 (3 ):1 -6
Case Report
3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence
- Allen W. Autrey, John L. Hick, Kurtis Bramer, Jeremy Berndt, Jonathan Bundt
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- Published online by Cambridge University Press:
- 09 June 2014, pp. 421-428
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This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.
. ,Autrey AW ,Hick JL ,Bramer K ,Berndt J .Bundt J 3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence . Prehosp Disaster Med.2014 ;29 (4 ):1 -8
Early Diagnosis and Treatment of a Posttraumatic Pseudoaneurysm/Dissection of the Innominate Artery
- Fernando Azarcon, Melhelm Ghaleb
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- Published online by Cambridge University Press:
- 04 February 2014, pp. 209-211
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A 25-year-old male developed a traumatic intimo-medial dissection and saccular pseudoaneurysm at the origin of the innominate artery following a motorcycle accident. On physical examination there was no perceivable trauma to the chest. In addition, there were no clinical symptoms that suggested this serious injury. The patient was managed with successful stent-graft placement on an elective basis.
. ,Azarcon F .Ghaleb M Early Diagnosis and Treatment of a Posttraumatic Pseudoaneurysm/Dissection of the Innominate Artery . Prehosp Disaster Med.2014 ;29 (1 ):1 -3
Special Reports
Mass-gathering Health Research Foundational Theory: Part 2 - Event Modeling for Mass Gatherings
- Sheila A. Turris, Adam Lund, Alison Hutton, Ron Bowles, Elizabeth Ellerson, Malinda Steenkamp, Jamie Ranse, Paul Arbon
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- Published online by Cambridge University Press:
- 17 November 2014, pp. 655-663
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Background
Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning “MG event model,” complimenting the “MG population model” reported elsewhere.
MethodsExisting descriptions of “MGs” were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion.
FindingsEmbedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events.
InterpretationThe development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.
. ,Turris SA ,Lund A ,Hutton A ,Bowles R ,Ellerson E ,Steenkamp M ,Ranse J .Arbon P Mass-gathering Health Research Foundational Theory: Part 2 - Event Modeling for Mass Gatherings . Prehosp Disaster Med.2014 ;29 (6 ):1 -9
Special Report
A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident
- Daniel J. Blumenthal, Judith L. Bader, Doran Christensen, John Koerner, John Cuellar, Sidney Hinds, John Crapo, Erik Glassman, A. Bradley Potter, Lynda Singletary
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- Published online by Cambridge University Press:
- 12 February 2014, pp. 80-86
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The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.
. ,Blumethal D ,Bader J ,Christensen D ,Koerner J ,Cuellar J ,Hinds S ,Crapo J ,Glassman ES ,Potter AB .Singletary L A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident . Prehosp Disaster Med.2014 ;29 (1 ):80 -86
Conceptualizing the Impact of Special Events on Community Health Service Levels: An Operational Analysis
- Adam Lund, Sheila A. Turris, Ron Bowles
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- Published online by Cambridge University Press:
- 04 September 2014, pp. 525-531
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Mass gatherings (MG) impact their host and surrounding communities and with inadequate planning, may impair baseline emergency health services. Mass gatherings do not occur in a vacuum; they have both consumptive and disruptive effects that extend beyond the event itself. Mass gatherings occur in real geographic locations that include not only the event site, but also the surrounding neighborhoods and communities. In addition, the impact of small, medium, or large special events may be felt for days, or even months, prior to and following the actual events. Current MG reports tend to focus on the events themselves during published event dates and may underestimate the full impact of a given MG on its host community.
In order to account for, and mitigate, the full effects of MGs on community health services, researchers would benefit from a common model of community impact. Using an operations lens, two concepts are presented, the “vortex” and the “ripple,” as metaphors and a theoretical model for exploring the broader impact of MGs on host communities. Special events and MGs impact host communities by drawing upon resources (vortex) and by disrupting normal, baseline services (ripple). These effects are felt with diminishing impact as one moves geographically further from the event center, and can be felt before, during, and after the event dates. Well executed medical and safety plans for events with appropriate, comprehensive risk assessments and stakeholder engagement have the best chance of ameliorating the potential negative impact of MGs on communities.
. ,Lund A ,Turris SA .Bowles R Conceptualizing the Impact of Special Events on Community Health Service Levels: An Operational Analysis . Prehosp Disaster Med.2014 ;29 (5 ):1 -7
Case Report
An Analysis of Patient Presentations at a 2-Day Mass-participation Cycling Event: The Ride to Conquer Cancer Case Series, 2010-2012
- Adam Lund, Sheila A. Turris, Peter Wang, Justin Mui, Kerrie Lewis, Samuel J. Gutman
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- Published online by Cambridge University Press:
- 01 August 2014, pp. 429-436
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Objective
To analyze the unique factors involved in providing medical support for a long-distance, cross-border, cycling event, and to describe patient presentations and event characteristics for the British Columbia (BC) Ride to Conquer Cancer from 2010 through 2012.
MethodsThis study was a 3-year, descriptive case series report. Medical encounters were documented, prospectively, from 2010-2012 using an online registry. Data for event-related variables also were reported.
ResultsProviding medical support for participants during the 2-day ride was complicated by communication challenges, weather conditions, and cross-border issues. The total number of participants for the ride increased from 2,252 in 2010 to 2,879 in 2011, and 3,011 in 2012. Patient presentation rates (PPRs) of 125.66, 155.26, and 198.93 (per 1,000 participants) were documented from 2010 through 2012. Over the course of three years, and not included in the PPR, an additional 3,840 encounters for “self-treatment” were documented.
ConclusionsThe Ride to Conquer Cancer Series has shown that medical coverage at multi-day, cross-national cycling events must be planned carefully to face a unique set of circumstances, including legislative issues, long-distance communication capabilities, and highly mobile participants. This combination of factors leads to potentially higher PPRs than have been reported for noncycling events. This study also illuminates the additional workload “self-treatment” visits place on the medical team.
. ,Lund A ,Turris SA ,Wang P ,Mui J ,Lewis K .Gutman SJ An Analysis of Patient Presentations at a 2-Day Mass-participation Cycling Event: The Ride to Conquer Cancer Case Series, 2010-2012 . Prehosp Disaster Med.2014 ;29 (4 ):1 -8
Special Report
Solastalgia: Living With the Environmental Damage Caused By Natural Disasters
- Sri Warsini, Jane Mills, Kim Usher
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- 17 January 2014, pp. 87-90
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Forced separation from one's home may trigger emotional distress. People who remain in their homes may experience emotional distress due to living in a severely damaged environment. These people experience a type of ‘homesickness’ similar to nostalgia because the land around them no longer resembles the home they knew and loved. What they lack is solace or comfort from their home; they long for the home environment to be the way it was before. “Solastalgia” is a term created to describe feelings which arise in people when an environment changes so much that it negatively affects an individual's quality of life. Such changed environments may include drought-stricken areas and open-cut mines. The aim of this article is to describe how solastalgia, originally conceptualized as the result of man-made environmental change, can be similarly applied to the survivors of natural disasters. Using volcanic eruptions as a case example, the authors argue that people who experience a natural disaster are likely to suffer from solastalgia for a number of reasons, which may include the loss of housing, livestock and farmland, and the ongoing danger of living in a disaster-prone area. These losses and fears challenge people's established sense of place and identity and can lead to feelings of helplessness and depression.
. ,Warsini S ,Mills J .Usher K Solastalgia: Living With the Environmental Damage Caused By Natural Disasters . Prehosp Disaster Med.2014 :29 (1 );1 -4
Emergency Medical Support for a Manned Stratospheric Balloon Test Program
- Rebecca S. Blue, Sean C. Norton, Jennifer Law, James M. Pattarini, Erik L. Antonsen, Alejandro Garbino, Jonathan B. Clark, Matthew W. Turney
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- Published online by Cambridge University Press:
- 05 September 2014, pp. 532-537
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Introduction
Red Bull Stratos was a commercial program that brought a test parachutist, protected by a full-pressure suit, in a stratospheric balloon with pressurized capsule to over 127,582 ft (38,969 m), from which he free fell and subsequently parachuted to the ground. Given that the major risks to the parachutist included ebullism, negative Gz (toe-to-head) acceleration exposure from an uncontrolled flat spin, and trauma, a comprehensive plan was developed to recover the parachutist under nominal conditions and to respond to any medical contingencies that might have arisen. In this report, the project medical team describes the experience of providing emergency medical support and crew recovery for the manned balloon flights of the program.
MethodsThe phases of flight, associated risks, and available resources were systematically evaluated.
ResultsSix distinct phases of flight from an Emergency Medical Services (EMS) standpoint were identified. A Medical Support Plan was developed to address the risks associated with each phase, encompassing personnel, equipment, procedures, and communications.
DiscussionDespite geographical, communications, and resource limitations, the medical team was able to implement the Medical Support Plan, enabling multiple successful manned balloon flights to 71,615 ft (21,828 m), 97,221 ft (29,610 m), and 127,582 ft (38,969 m). The experience allowed refinement of the EMS and crew recovery procedures for each successive flight and could be applied to other high altitude or commercial space ventures.
. ,Blue RS ,Norton SC ,Law J ,Pattarini JM ,Antonsen EL ,Garbino A ,Clark JB .Turney MW Emergency Medical Support for a Manned Stratospheric Balloon Test Program . Prehosp Disaster Med.2014 ;29 (5 ):1 -6
Front Cover (OFC, IFC) and matter
PDM volume 29 issue 6 Cover and Front matter
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- Published online by Cambridge University Press:
- 17 December 2014, pp. f1-f8
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