Original Research
Fire Engine Support and On-scene Time in Prehospital Stroke Care – A Prospective Observational Study
- Tuukka Puolakka, Taneli Väyrynen, Elja-Pekka Erkkilä, Markku Kuisma
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- Published online by Cambridge University Press:
- 28 March 2016, pp. 278-281
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Introduction
On-scene time (OST) previously has been shown to be a significant component of Emergency Medical Services’ (EMS’) operational delay in acute stroke. Since stroke patients are managed routinely by two-person ambulance crews, increasing the number of personnel available on the scene is a possible method to improve their performance.
HypothesisUsing fire engine crews to support ambulances on the scene in acute stroke is hypothesized to be associated with a shorter OST.
MethodsAll patients transported to hospital as thrombolysis candidates during a one-year study period were registered by the ambulance crews using a case report form that included patient characteristics and operational EMS data.
ResultsSeventy-seven patients (41 [53%] male; mean age of 68.9 years [SD=15]; mean Glasgow Coma Score [GCS] of 15 points [IQR=14-15]) were eligible for the study. Forty-five cases were managed by ambulance and fire engine crews together and 32 by the ambulance crews alone. The median ambulance response time was seven minutes (IQR=5-10) and the fire engine response time was six minutes (IQR=5-8). The number of EMS personnel on the scene was six (IQR=5-7) and two (IQR=2-2), and the OST was 21 minutes (IQR=18-26) and 24 minutes (IQR=20-32; P =.073) for the groups, respectively. In a following regression analysis, using stroke as the dispatch code was the only variable associated with short (<22 minutes) OST with an odds ratio of 3.952 (95% CI, 1.279-12.207).
ConclusionDispatching fire engine crews to support ambulances in acute stroke care was not associated with a shorter on-scene stay when compared to standard management by two-person ambulance crews alone. Using stroke as the dispatch code was the only variable that was associated independently with a short OST.
,Puolakka T ,Väyrynen T ,Erkkilä E-P .Kuisma M Fire Engine Support and On-scene Time in Prehospital Stroke Care – A Prospective Observational Study . Prehosp Disaster Med.2016 ;31 (3 ):278 –281 .
Barriers and Facilitators to Community CPR Education in San José, Costa Rica
- Kristin M. Schmid, Nee-Kofi Mould-Millman, Andrew Hammes, Miranda Kroehl, Raquel Quiros García, Manrique Umaña McDermott, Steven R. Lowenstein
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- Published online by Cambridge University Press:
- 05 August 2016, pp. 509-515
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Background
Bystander cardiopulmonary resuscitation (CPR) improves survival after prehospital cardiac arrest. While community CPR training programs have been implemented across the US, little is known about their acceptability in non-US Latino populations.
ObjectivesThe purpose of this study was to identify barriers to enrolling in CPR training classes and performing CPR in San José, Costa Rica.
MethodsAfter consulting 10 San José residents, a survey was created, pilot-tested, and distributed to a convenience sample of community members in public gathering places in San José. Questions included demographics, CPR knowledge and beliefs, prior CPR training, having a family member with heart disease, and prior witnessing of a cardiac arrest. Questions also addressed barriers to enrolling in CPR classes (cost/competing priorities). The analysis focused on two main outcomes: likelihood of registering for a CPR class and willingness to perform CPR on an adult stranger. Odds ratios and 95% CIs were calculated to test for associations between patient characteristics and these outcomes.
ResultsAmong 371 participants, most were male (60%) and <40 years old (77%); 31% had a college degree. Many had family members with heart disease (36%), had witnessed a cardiac arrest (18%), were trained in CPR (36%), and knew the correct CPR steps (70%). Overall, 55% (95% CI, 50-60%) indicated they would “likely” enroll in a CPR class; 74% (95% CI, 70-78%) would perform CPR on an adult stranger. Cardiopulmonary resuscitation class enrollment was associated with prior CPR training (OR: 2.6; 95% CI, 1.6-4.3) and a prior witnessed cardiac arrest (OR: 2.0; 95% CI, 1.1-3.5). Willingness to perform CPR on a stranger was associated with a prior witnessed cardiac arrest (OR: 2.5; 95% CI, 1.2-5.4) and higher education (OR: 1.9; 95% CI, 1.1-3.2). Believing that CPR does not work was associated with a higher likelihood of not attending a CPR class (OR: 2.4; 95% CI, 1.7-7.9). Fear of performing mouth-mouth, believing CPR is against God’s will, and fear of legal risk were associated with a likelihood of not attending a CPR class and not performing CPR on a stranger (range of ORs: 2.4-3.9).
ConclusionMost San José residents are willing to take CPR classes and perform CPR on a stranger. To implement a community CPR program, barriers must be considered, including misgivings about CPR efficacy and legal risk. Hands-only CPR programs may alleviate hesitancy to perform mouth-to-mouth.
,Schmid KM ,Mould-Millman NK ,Hammes A ,Kroehl M ,Quiros García R ,Umaña McDermott M .Lowenstein SR Barriers and Facilitators to Community CPR Education in San José, Costa Rica . Prehosp Disaster Med.2016 ;31 (5 ):509 –515 .
Research Article
Public Perception of Emergency Medical Services in the United States
- Remle P. Crowe, Roger Levine, Severo Rodriguez, Ashley D. Larrimore, Ronald G. Pirrallo
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- Published online by Cambridge University Press:
- 25 November 2016, pp. S112-S117
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Objective
The objective of this study was to assess the public’s experience, expectations, and perceptions related to Emergency Medical Services (EMS).
MethodsA population-based telephone interview of adults in the United States was conducted. The survey instrument consisted of 112 items. Demographic variables including age, race, political beliefs, and household income were collected. Data collection was performed by trained interviewers from Kent State University’s (Kent, Ohio USA)Social Research Laboratory. Descriptive statistics were calculated. Comparative analyses were conducted between those who used EMS at least once in the past five years and those who did not use EMS using χ2 and t tests.
ResultsA total of 2,443 phone calls were made and 1,348 individuals agreed to complete the survey (55.2%). There were 297 individuals who requested to drop out of the survey during the phone interview, leaving a total of 1,051 (43.0%) full responses. Participants ranged in age from 18 to 94 years with an average age of 57.5 years. Most were Caucasian or white (83.0%), married (62.8%), and held conservative political beliefs (54.8%). Three-fourths of all respondents believed that at least 40% of patients survive cardiac arrest when EMS services are received. Over half (56.7%) believed that Emergency Medical Technician (EMT)-Basics and EMT-Paramedics provide the same level of care. The estimated median hours of training required for EMT-Basics was 100 hours (IQR: 40-200 hours), while the vast majority of respondents estimated that EMT-Paramedics are required to take fewer than 1,000 clock hours of training (99.3%). The majority believed EMS professionals should be screened for illegal drug use (97.0%), criminal background (95.9%), mental health (95.2%), and physical fitness (91.3%). Over one-third (37.6%) had used EMS within the past five years. Of these individuals, over two-thirds (69.6%) rated their most recent experience as “excellent.” More of those who used EMS at least once in the past five years reported a willingness to consent to participate in EMS research compared with those who had not used EMS (69.9% vs. 61.4%, P=.005).
ConclusionsMost respondents who had used EMS services rated their experience as excellent. Nevertheless, expectations related to survival after cardiac arrest in the out-of-hospital setting were not realistic. Furthermore, much of the public was unaware of the differences in training hour requirements and level of care provided by EMT-Basics and EMT-Paramedics.
,Crowe RP ,Levine R ,Rodriguez S ,Larrimore AD .Pirrallo RG Public Perception of Emergency Medical Services in the United States . Prehosp Disaster Med.2016 ;31 (Suppl.1 ):s112 –s117 .
Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model
- Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke, Jennifer Kushner
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- Published online by Cambridge University Press:
- 02 February 2016, pp. 181-194
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Disaster-related interventions are actions or responses undertaken during any phase of a disaster to change the current status of an affected community or a Societal System. Interventional disaster research aims to evaluate the results of such interventions in order to develop standards and best practices in Disaster Health that can be applied to disaster risk reduction. Considering interventions as production functions (transformation processes) structures the analyses and cataloguing of interventions/responses that are implemented prior to, during, or following a disaster or other emergency. Since currently it is not possible to do randomized, controlled studies of disasters, in order to validate the derived standards and best practices, the results of the studies must be compared and synthesized with results from other studies (ie, systematic reviews). Such reviews will be facilitated by the selected studies being structured using accepted frameworks. A logic model is a graphic representation of the transformation processes of a program [project] that shows the intended relationships between investments and results. Logic models are used to describe a program and its theory of change, and they provide a method for the analyzing and evaluating interventions. The Disaster Logic Model (DLM) is an adaptation of a logic model used for the evaluation of educational programs and provides the structure required for the analysis of disaster-related interventions. It incorporates a(n): definition of the current functional status of a community or Societal System, identification of needs, definition of goals, selection of objectives, implementation of the intervention(s), and evaluation of the effects, outcomes, costs, and impacts of the interventions. It is useful for determining the value of an intervention and it also provides the structure for analyzing the processes used in providing the intervention according to the Relief/Recovery and Risk-Reduction Frameworks.
,Birnbaum ML ,Daily EK ,O’Rourke AP .Kushner J Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model . Prehosp Disaster Med.2016 ;31 (2 ):181 –194 .
Original Research
Paramedic Checklists do not Accurately Identify Post-ictal or Hypoglycaemic Patients Suitable for Discharge at the Scene
- Hideo Tohira, Daniel Fatovich, Teresa A. Williams, Alexandra Bremner, Glenn Arendts, Ian R. Rogers, Antonio Celenza, David Mountain, Peter Cameron, Peter Sprivulis, Tony Ahern, Judith Finn
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- Published online by Cambridge University Press:
- 30 March 2016, pp. 282-293
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Objectives
The objective of this study was to assess the accuracy and safety of two pre-defined checklists to identify prehospital post-ictal or hypoglycemic patients who could be discharged at the scene.
MethodsA retrospective cohort study of lower acuity, adult patients attended by paramedics in 2013, and who were either post-ictal or hypoglycemic, was conducted. Two self-care pathway assessment checklists (one each for post-ictal and hypoglycemia) designed as clinical decision tools for paramedics to identify patients suitable for discharge at the scene were used. The intention of the checklists was to provide paramedics with justification to not transport a patient if all checklist criteria were met. Actual patient destination (emergency department [ED] or discharge at the scene) and subsequent events (eg, ambulance requests) were compared between patients who did and did not fulfill the checklists. The performance of the checklists against the destination determined by paramedics was also assessed.
ResultsTotals of 629 post-ictal and 609 hypoglycemic patients were identified. Of these, 91 (14.5%) and 37 (6.1%) patients fulfilled the respective checklist. Among those who fulfilled the checklist, 25 (27.5%) post-ictal and 18 (48.6%) hypoglycemic patients were discharged at the scene, and 21 (23.1%) and seven (18.9%) were admitted to hospital after ED assessment. Amongst post-ictal patients, those fulfilling the checklist had more subsequent ambulance requests (P=.01) and ED attendances with seizure-related conditions (P=.04) within three days than those who did not. Amongst hypoglycemic patients, there were no significant differences in subsequent events between those who did and did not meet the criteria. Paramedics discharged five times more hypoglycemic patients at the scene than the checklist predicted with no significant differences in the rate of subsequent events. Four deaths (0.66%) occurred within seven days in the hypoglycemic cohort, and none of them were attributed directly to hypoglycemia.
ConclusionsThe checklists did not accurately identify patients suitable for discharge at the scene within the Emergency Medical Service. Patients who fulfilled the post-ictal checklist made more subsequent health care service requests within three days than those who did not. Both checklists showed similar occurrence of subsequent events to paramedics’ decision, but the hypoglycemia checklist identified fewer patients who could be discharged at the scene than paramedics actually discharged. Reliance on these checklists may increase transportations to ED and delay initiation of appropriate treatment at a hospital.
,Tohira H ,Fatovich D ,Williams TA ,Bremner A ,Arendts G ,Rogers IR ,Celenza A ,Mountain D ,Cameron P ,Sprivulis P ,Ahern T .Finn J Paramedic Checklists do not Accurately Identify Post-ictal or Hypoglycaemic Patients Suitable for Discharge at the Scene . Prehosp Disaster Med.2016 ;31 (3 ):282 –293 .
Front Cover (OFC, IFC) and matter
PDM volume 31 issue S1 Cover and Front matter
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- Published online by Cambridge University Press:
- 28 December 2016, pp. f1-f6
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Original Research
Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial
- Adam R. Aluisio, Pia Daniel, Andrew Grock, Joseph Freedman, Ajai Singh, Dimitrios Papanagnou, Bonnie Arquilla
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- Published online by Cambridge University Press:
- 05 August 2016, pp. 516-523
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Objective
In resource-constrained environments, appropriately employing triage in disaster situations is crucial. Although both case-based learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching disaster preparedness to adult learners, there is no substantial evidence supporting one as a more efficacious methodology. This randomized controlled trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to standard didactic instruction in knowledge attainment pertaining to disaster triage preparedness.
MethodsThis RCT was performed during a one-day disaster preparedness course in Lucknow, India during October 2014. Following provision of informed consent, nursing trainees were randomized to knowledge assessment after didactic teaching (control group); didactic plus CBL (Intervention Group 1); or didactic plus SE (Intervention Group 2). The educational curriculum used the topical focus of triage processes during disaster situations. Cases for the educational intervention sessions were scripted, identical between modalities, and employed structured debriefing. Trained live actors were used for SEs. After primary assessment, the groups underwent crossover to take part in the alternative educational modality and were re-assessed. Two standardized multiple-choice question batteries, encompassing key core content, were used for assessments. A sample size of 48 participants was calculated to detect a ≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of randomization was evaluated using X2, anova, and t-tests. Mean knowledge attainment scores were compared using one- and two-sample t-tests for intergroup and intragroup analyses, respectively.
ResultsAmong 60 enrolled participants, 88.3% completed follow-up. No significant differences in participant characteristics existed between randomization arms. Mean baseline knowledge score in the control group was 43.8% (standard deviation=11.0%). Case-based learning training resulted in a significant increase in relative knowledge scores at 20.8% (P=0.003) and 10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared to control, SEs did not significantly alter knowledge attainment scores with an average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs were found to result in a 26.0% decrement in mean assessment score (P < .001).
ConclusionsAmong nursing trainees assessed in this RCT, the CBL modality was superior to SEs in short-term disaster preparedness educational translation. Simulation exercises resulted in no detectable improvement in knowledge attainment in this population, suggesting that CBL may be utilized preferentially for adult learners in similar disaster training settings.
,Aluisio AR ,Daniel P ,Grock A ,Freedman J ,Singh A ,Papanagnou D .Arquilla B Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial . Prehosp Disaster Med.2016 ;31 (5 ):516 –523 .
A Qualitative Study of Violence Against Women after the Recent Disasters of Iran
- Sanaz Sohrabizadeh
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- Published online by Cambridge University Press:
- 23 May 2016, pp. 407-412
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Introduction
Violence against women (VAW) is one of the most widespread violations of human rights and a major barrier to achieving gender equality. Violence against women is increased in disaster-stricken communities. Violence experiences, cases, and lessons-learned concerning Iran’s disasters have not been investigated, documented, or shared so far. To fill this knowledge gap, this qualitative study aimed to explore types of VAW and girls after the recent quakes and floods in Iran.
ProblemThe objective for this study was exploring the manifestations of VAW after the natural disasters in Iran.
MethodsA qualitative approach was used for this study. Data were collected by in-depth, unstructured interviews and field observations in three affected regions of Iran, including East Azerbaijan, Bushehr, and Mazandaran. A total of 15 participants, eight damaged women as well as seven key informants, were interviewed. A content analysis using Graneheim approach was performed for analyzing transcribed interviews.
ResultsTwo main themes were extracted from data, including domestic violence and violence within community. The first theme included three categories: physical, psychological, and sexual violence. Psychological violence and sexual harassment were two categories of violence within the community concept.
ConclusionDifferent types of violence emerged from the present research that can be anticipated and integrated into future disaster medicine plans, public health reforms, and national rules of Iran. Improving women’s knowledge on their rights to have a life without violence, and participation of both women and men in violence reduction projects, can be considered in all disaster management phases.
.Sohrabizadeh S A Qualitative Study of Violence Against Women after the Recent Disasters of Iran . Prehosp Disaster Med.2016 ;31 (4 ):407 –412 .
A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders
- Stephanie C. Garbern, Laura G. Ebbeling, Susan A. Bartels
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 635-642
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Introduction
Disaster and humanitarian responders are at-risk of experiencing a wide range of physical and psychological health conditions, from minor injuries to chronic mental health problems and fatalities. This article reviews the current literature on the major health outcomes of responders to various disasters and conflicts in order to better inform individuals of the risks and to inform deploying agencies of the health care needs of responders.
MethodsIn March 2014, an EMBASE search was conducted using pre-defined search criteria. Two reviewers screened the resultant 2,849 abstracts and the 66 full-length manuscripts which are included in the review.
ResultsThe majority of research on health outcomes of responders focused on mental health (57 of 66 articles). Posttraumatic stress disorder (PTSD) and depression were the most studied diagnoses with prevalence of PTSD ranging from 0%-34% and depression from 21%-53%. Physical health outcomes were much less well-studied and included a wide range of environmental, infectious, and traumatic conditions such as heat stroke, insect bites, dermatologic, gastrointestinal, and respiratory diseases, as well as burns, fractures, falls, and other traumatic injuries.
ConclusionsThe prevalence of mental health disorders in responders may vary more and be higher than previously suggested. Overall health outcomes of responders are likely poorly monitored and under-reported. Improved surveillance systems and risk mitigation strategies should be employed in all disaster and conflict responses to better protect individual responders.
,Garbern SC ,Ebbeling LG .Bartels SA A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders . Prehosp Disaster Med.2016 ;31 (6 ):635 –642 .
Comprehensive Review
On the Assessment of Paramedic Competence: A Narrative Review with Practice Implications
- W. Tavares, S. Boet
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- Published online by Cambridge University Press:
- 30 November 2015, pp. 64-73
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Introduction
Paramedicine is experiencing significant growth in scope of practice, autonomy, and role in the health care system. Despite clinical governance models, the degree to which paramedicine ultimately can be safe and effective will be dependent on the individuals the profession deems suited to practice. This creates an imperative for those responsible for these decisions to ensure that assessments of paramedic competence are indeed accurate, trustworthy, and defensible.
PurposeThe purpose of this study was to explore and synthesize relevant theoretical foundations and literature informing best practices in performance-based assessment (PBA) of competence, as it might be applied to paramedicine, for design or evaluation of assessment programs.
MethodsA narrative review methodology was applied to focus intentionally, but broadly, on purpose relevant, theoretically derived research that could inform assessment protocols in paramedicine. Primary and secondary studies from a number of health professions that contributed to and informed best practices related to the assessment of paramedic clinical competence were included and synthesized.
ResultsMultiple conceptual frameworks, psychometric requirements, and emerging lines of research are forwarded. Seventeen practice implications are derived to promote understanding as well as best practices and evaluation criteria for educators, employers, and/or licensing/certifying bodies when considering the assessment of paramedic competence.
ConclusionsThe assessment of paramedic competence is a complex process requiring an understanding, appreciation for, and integration of conceptual and psychometric principles. The field of PBA is advancing rapidly with numerous opportunities for research.
,Tavares W .Boet S On the Assessment of Paramedic Competence: A Narrative Review with Practice Implications . Prehosp Disaster Med.2016 ;31 (1 ):64 –73 .
Back Cover (OBC, IBC) and matter
PDM volume 31 issue S1 Cover and Back matter
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- Published online by Cambridge University Press:
- 28 December 2016, pp. b1-b5
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Original Research
A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters
- Brendan G. Carr, Lauren Walsh, Justin C. Williams, John P. Pryor, Charles C. Branas
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- Published online by Cambridge University Press:
- 25 May 2016, pp. 413-421
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Background
Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters.
ObjectiveA proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events.
MethodsTo demonstrate the model’s potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties.
ResultsAcross all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities.
ConclusionsThe disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed.
,Carr BG ,Walsh L ,Williams JC ,Pryor JP .Branas CC A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters . Prehosp Disaster Med.2016 ;31 (4 ):413 –421 .
Comprehensive Review
Medical Support for Aircraft Disaster Search and Recovery Operations at Sea: the RSN Experience
- Kok Ann Colin Teo, Tse Feng Gabriel Chong, Min Han Lincoln Liow, Kong Choong Tang
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- Published online by Cambridge University Press:
- 28 March 2016, pp. 294-299
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The maritime environment presents a unique set of challenges to search and recovery (SAR) operations. There is a paucity of information available to guide provision of medical support for SAR operations for aircraft disasters at sea. The Republic of Singapore Navy (RSN) took part in two such SAR operations in 2014 which showcased the value of a military organization in these operations. Key considerations in medical support for similar operations include the resultant casualty profile and challenges specific to the maritime environment, such as large distances of area of operations from land, variable sea states, and space limitations. Medical support planning can be approached using well-established disaster management life cycle phases of preparedness, mitigation, response, and recovery, which all are described in detail. This includes key areas of dedicated training and exercises, force protection, availability of air assets and chamber support, psychological care, and the forensic handling of human remains. Relevant lessons learned by RSN from the Air Asia QZ8501 search operation are also included in the description of these key areas.
,Teo KAC ,Chong TFG ,Liow MHL .Tang KC Medical Support for Aircraft Disaster Search and Recovery Operations at Sea: the RSN Experience . Prehosp Disaster Med.2016 ;31 (3 ):294 –299 .
Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework
- Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke
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- Published online by Cambridge University Press:
- 03 February 2016, pp. 195-210
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The principal goal of research relative to disasters is to decrease the risk that a hazard will result in a disaster. Disaster studies pursue two distinct directions: (1) epidemiological (non-interventional); and (2) interventional. Both interventional and non-interventional studies require data/information obtained from assessments of function. Non-interventional studies examine the epidemiology of disasters. Interventional studies evaluate specific interventions/responses in terms of their effectiveness in meeting their respective objectives, their contribution to the overarching goal, other effects created, their respective costs, and the efficiency with which they achieved their objectives. The results of interventional studies should contribute to evidence that will be used to inform the decisions used to define standards of care and best practices for a given setting based on these standards. Interventional studies are based on the Disaster Logic Model (DLM) and are used to change or maintain levels of function (LOFs). Relief and Recovery interventional studies seek to determine the effects, outcomes, impacts, costs, and value of the intervention provided after the onset of a damaging event. The Relief/Recovery Framework provides the structure needed to systematically study the processes involved in providing relief or recovery interventions that result in a new LOF for a given Societal System and/or its component functions. It consists of the following transformational processes (steps): (1) identification of the functional state prior to the onset of the event (pre-event); (2) assessments of the current functional state; (3) comparison of the current functional state with the pre-event state and with the results of the last assessment; (4) needs identification; (5) strategic planning, including establishing the overall strategic goal(s), objectives, and priorities for interventions; (6) identification of options for interventions; (7) selection of the most appropriate intervention(s); (8) operational planning; (9) implementation of the intervention(s); (10) assessments of the effects and changes in LOFs resulting from the intervention(s); (11) determination of the costs of providing the intervention; (12) determination of the current functional status; (13) synthesis of the findings with current evidence to define the benefits and value of the intervention to the affected population; and (14) codification of the findings into new evidence. Each of these steps in the Framework is a production function that facilitates evaluation, and the outputs of the transformation process establish the current state for the next step in the process. The evidence obtained is integrated into augmenting the respective Response Capacities of a community-at-risk. The ultimate impact of enhanced Response Capacity is determined by studying the epidemiology of the next event.
,Birnbaum ML ,Daily EK .O’Rourke AP Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework . Prehosp Disaster Med.2016 ;31 (2 ):195 –210 .
Crew Recovery and Contingency Planning for a Manned Stratospheric Balloon Flight – the StratEx Program
- Anil S. Menon, David Jourdan, Derek M. Nusbaum, Alejandro Garbino, Daniel M. Buckland, Sean Norton, Johnathan B. Clark, Erik L. Antonsen
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- Published online by Cambridge University Press:
- 30 August 2016, pp. 524-531
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The StratEx program used a self-contained space suit and balloon system to loft pilot Alan Eustace to a record-breaking altitude and skydive from 135,897 feet (41,422 m). After releasing from the balloon and a stabilized freefall, the pilot safely landed using a parachute system based on a modified tandem parachute rig. A custom spacesuit provided life support using a similar system to NASA’s (National Aeronautics and Space Administration; Washington, DC USA) Extravehicular Mobility Unit. It also provided tracking, communications, and connection to the parachute system. A recovery support team, including at least two medical personnel and two spacesuit technicians, was charged with reaching the pilot within five minutes of touchdown to extract him from the suit and provide treatment for any injuries. The team had to track the flight at all times, be prepared to respond in case of premature release, and to operate in any terrain. Crew recovery operations were planned and tailored to anticipate outcomes during this novel event in a systematic fashion, through scenario and risk analysis, in order to minimize the probability and impact of injury. This analysis, detailed here, helped the team configure recovery assets, refine navigation and tracking systems, develop procedures, and conduct training. An extensive period of testing and practice culminated in three manned flights leading to a successful mission and setting the record for exit altitude, distance of fall with stabilizing device, and vertical speed with a stabilizing device. During this mission, recovery teams reached the landing spot within one minute, extracted the pilot, and confirmed that he was not injured. This strategy is presented as an approach to prehospital planning and care for improved safety during crew recovery in novel, extreme events.
,Menon AS ,Jourdan D ,Nusbaum DM ,Garbino A ,Buckland DM ,Norton S ,Clark JB .Antonsen EL Crew Recovery and Contingency Planning for a Manned Stratospheric Balloon Flight – the StratEx Program . Prehosp Disaster Med.2016 ;31 (5 ):524 –531 .
Comprehensive Reviews
Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US
- Bhakti Hansoti, Dylan S. Kellogg, Sara J. Aberle, Morgan C. Broccoli, Jeffrey Feden, Arthur French, Charles M. Little, Brooks Moore, Joseph Sabato, Jr., Tara Sheets, R. Weinberg, Pat Elmes, Christopher Kang
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 643-647
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Study Objective
This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.
MethodsA comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.
ResultsA comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.
ConclusionThere is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.
,Hansoti B ,Kellogg DS ,Aberle SJ ,Broccoli MC ,Feden J ,French A ,Little CM ,Moore B ,Sabato J Jr. ,Sheets T ,Weinberg R ,Elmes P .Kang C Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US . Prehosp Disaster Med.2016 ;31 (6 ):643 –647 .
Special Reports
Protecting the Health and Well-being of Populations from Disasters: Health and Health Care in The Sendai Framework for Disaster Risk Reduction 2015-2030
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- Amina Aitsi-Selmi, Virginia Murray
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- Published online by Cambridge University Press:
- 17 December 2015, pp. 74-78
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The Sendai Framework for Disaster Risk Reduction (DRR) 2015-2030 is the first of three United Nations (UN) landmark agreements this year (the other two being the Sustainable Development Goals due in September 2015 and the climate change agreements due in December 2015). It represents a step in the direction of global policy coherence with explicit reference to health, economic development, and climate change. The multiple efforts of the health community in the policy development process, including campaigning for safe schools and hospitals, helped to put people’s mental and physical health, resilience, and well-being higher up the DRR agenda compared with its predecessor, the 2005 Hyogo Framework for Action. This report reflects on these policy developments and their implications and reviews the range of health impacts from disasters; summarizes the widened remit of DRR in the post-2015 world; and finally, presents the science and health calls of the Sendai Framework to be implemented over the next 15 years to reduce disaster losses in lives and livelihoods.
,Aitsi-Selmi A .Murray V Protecting the Health and Well-being of Populations from Disasters: Health and Health Care in The Sendai Framework for Disaster Risk Reduction 2015-2030 . Prehosp Disaster Med.2016 ;31 (1 ):74 –78 .
Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion
- Debra Kreisberg, Deborah S.K. Thomas, Morgan Valley, Shannon Newell, Enessa Janes, Charles Little
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- Published online by Cambridge University Press:
- 22 February 2016, pp. 211-219
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Introduction
As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting.
ObjectiveThis report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study.
MethodsThe framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning.
ConclusionsThe conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.
,Kreisberg D ,Thomas DSK ,Valley M ,Newell S ,Janes E .Little C Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion . Prehosp Disaster Med.2016 ;31 (2 ):211 –219 .
Innovation in Graduate Education for Health Professionals in Humanitarian Emergencies
- Dabney P. Evans, Mark Anderson, Cyrus Shahpar, Carlos del Rio, James W. Curran
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- 05 August 2016, pp. 532-538
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The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public health in humanitarian response. These modest efforts are just the beginning in terms of addressing the global shortage of skilled public health professionals that can coordinate humanitarian response. Evaluating existing programs will allow for refinement of current programs. Ultimately, these programs may influence the development of new programs and inform others interested in this area.
,Evans DP ,Anderson M ,Shahpar C ,del Rio C .Curran JW Innovation in Graduate Education for Health Professionals in Humanitarian Emergencies . Prehosp Disaster Med.2016 ;31 (5 ):532 –538 .
Comprehensive Reviews
Women’s Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review
- Sue Anne Bell, Lisa A. Folkerth
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 648-657
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Introduction
Survivors of natural disasters in the United States experience significant health ramifications. Women particularly are vulnerable to both post-disaster posttraumatic stress disorder (PTSD) and depression, and research has documented that these psychopathological sequelae often are correlated with increased incidence of intimate partner violence (IPV). Understanding the link between these health concerns is crucial to informing adequate disaster response and relief efforts for victims of natural disaster.
PurposeThe purpose of this review was to report the results of a scoping review on the specific mental health effects that commonly impact women following natural disasters, and to develop a conceptual framework with which to guide future research.
MethodsA scoping review of mental and physical health effects experienced by women following natural disasters in the United States was conducted. Articles from 2000-2015 were included. Databases examined were PubMed, PsycInfo, Cochrane, JSTOR, Web of Science, and databases available through ProQuest, including ProQuest Research Library.
ResultsA total of 58 articles were selected for inclusion, out of an original 149 that were selected for full-text review. Forty-eight articles, or 82.8%, focused on mental health outcomes. Ten articles, or 17.2%, focused on IPV.
DiscussionCertain mental health outcomes, including PTSD, depression, and other significant mental health concerns, were recurrent issues for women post-disaster. Despite the strong correlation between experience of mental health consequences after disaster and increased risk of domestic violence, studies on the risk and mediating factors are rare. The specific challenges faced by women and the interrelation between negative mental health outcomes and heightened exposure to IPV following disasters require a solid evidence base in order to facilitate the development of effective interventions. Additional research informed by theory on probable health impacts is necessary to improve development/implementation of emergency relief policy.
,Bell SA .Folkerth LA Women’s Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review . Prehosp Disaster Med.2016 ;31 (6 ):648 –657 .