Special Report
Issues in the Assessment of Children's Coping in the Context of Mass Trauma
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- Betty Pfefferbaum, Mary A. Noffsinger, Leslie H. Wind
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- Published online by Cambridge University Press:
- 13 June 2012, pp. 272-279
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Exposure to mass trauma has contributed to increasing concern about the well-being of children, families, and communities. In spite of global awareness of the dramatic impact of mass trauma on youth, little is known about how children and adolescents cope with and adapt to disasters and terrorism. While coping has yet to be fully conceptualized as a unified construct, the process of responding to stress includes recognized cognitive, emotional, and behavioral components. Unfortunately, research on the complex process of adaptation in the aftermath of mass trauma is a relatively recent focus. Further study is needed to build consensus in terminology, theory, methods, and assessment techniques to assist researchers and clinicians in measuring children's coping, both generally and within the context of mass trauma. Advancements are needed in the area of coping assessment to identify internal and external factors affecting children's stress responses. Additionally, enhanced understanding of children's disaster coping can inform the development of prevention and intervention programs to promote resilience in the aftermath of traumatic events. This article examines the theoretical and practical issues in assessing coping in children exposed to mass trauma, and includes recommendations to guide assessment and research of children's coping within this specialized context.
Pfefferbaum B, Noffsinger MA, Wind LH. Issues in the assessment of children's coping in the context of mass trauma. Prehosp Disaster Med. 2012;27(3):1-8.
Original Research
The Ethics of Resuscitation: How Do Paramedics Experience Ethical Dilemmas when Faced with Cancer Patients with Cardiac Arrest?
- Halvor Nordby, Øyvind Nøhr
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- 19 March 2012, pp. 64-70
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Introduction: Research on prehospital emergency work traditionally has focused on medical issues, but paramedics often have to make ethical choices. The goal of this exploratory study was to understand how paramedics experience difficult ethical dilemmas regarding resuscitation of cancer patients.
Methods: Paramedics from ambulance services in Norway were interviewed about resuscitation of cancer patients with cardiac arrest. The qualitative study included naturalistic, semi-structured interviews and a cognitive-emotional, interpretive approach.
Results: All study participants believed that it ethically can be correct not to resuscitate if the patient is expected to survive for only a short time with a very low quality of life and severe negative illness experiences. However, this belief sometimes failed to match formal or informal guidelines and contextual factors such as expectations of relatives. When confronting these challenges, the majority of the paramedics relied heavily on the advice of medical experts, but some had to make more autonomous decisions.
Discussion: The concept of a double pressure situation can be used to analyze the ethical dilemmas regarding resuscitation of cancer patients. The pressure from “below” is grounded in individual caring frameworks, and in the belief that it can be wrong to resuscitate. The pressure from “above” is objective and system-related, related to uncertainty, and grounded in the fundamental and irreducible value of human life.
Conclusions: The findings of this qualitative, exploratory study suggest that ethical concepts and analyses of double pressure situations should have an important role in education and training designed to prepare emergency personnel for difficult life and death choices. More research is needed to shed light on how ethical dilemmas arise in prehospital work.
Differences in Medical Care Usage between Two Mass-Gathering Sporting Events
- James O. Burton, Stephen J. Corry, Gareth Lewis, William S. Priestman
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- Published online by Cambridge University Press:
- 13 August 2012, pp. 458-462
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Background
Event planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.
MethodsA retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.
ResultsMedical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.
ConclusionsThese two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.
,Burton JO ,Corry SJ ,Lewis G .Priestman WS Differences in Medical Care Usage between Two Mass-Gathering Sporting Events . Prehosp Disaster Med.2012 ;27 (4 ):1 -5 .
Medical Priority Dispatch System Breathing Problems Protocol Key Question Combinations are Associated with Patient Acuity
- Jeff Clawson, Tracey Barron, Greg Scott, A. Niroshan Siriwardena, Brett Patterson, Christopher Olola
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- 24 July 2012, pp. 375-380
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Introduction
The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.
HypothesisThe hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.
MethodsThis was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.
ResultsForty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients with abnormal breathing and clammy conditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and the difficulty speaking between breaths (DSBB) condition was the most prevalent (50.3%). Ineffective breathing and not alert conditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had the not alert condition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher in DSBB plus not alert; DSBB plus not alert plus changing color; and DSBB plus not alert plus clammy conditions cases, compared to asthmatic abnormal breathing cases.
ConclusionsThe study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.
Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity. Prehosp Disaster Med. 2012;27(4):1-6.
A Public Health Enforcement Initiative to Combat Underage Drinking Using Emergency Medical Services Call Data
- Daniel L. Lemkin, Michael C. Bond, Donald W. Alves, Richard A. Bissell
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- 17 May 2012, pp. 167-171
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Objective
The objective of this study was to determine whether Emergency Medical Services (EMS) records can identify bars that serve a disproportionate number of minors, and if government officials will use this data to direct underage drinker enforcement efforts.
MethodsEmergency Medical Services call logs to all bars in the study area were cross-referenced with a local hospital's records. The records of patients with alcohol-related complaints were analyzed. Outlier bars were identified, and presented to government officials who completed a survey to assess if this information would prompt new enforcement efforts.
ResultsEmergency Medical Services responded to 149 establishments during the study period. Eighty-four responses were distributed across six bars, and 78 were matched with the hospital's records. Fifty-one patients, 18 (35%) of whom were underage, were treated for alcohol intoxication, with 46% of the cases originating from four bars. Government officials found the information useful, and planned to initiate new operations based on the information.
ConclusionsAlcohol consumption by minors can lead to life-long abuse, with high personal, financial, and societal costs. Emergency Medical Services response data and hospital records can be used to identify bars that allow underage drinking, which is useful in directing law enforcement efforts.
Lemkin DL, Bond MC, Alves DW, Bissell RA. A public health enforcement initiative to combat underage drinking using emergency medical services call data. Prehosp Disaster Med. 2012;27(2):1-5.
Comprehensive Review
Factors Associated with the Willingness of Health Care Personnel to Work During an Influenza Public Health Emergency: An Integrative Review
- Mahesh Devnani
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- Published online by Cambridge University Press:
- 02 October 2012, pp. 551-566
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Introduction
The first decade of the 21st century has witnessed three major influenza public health emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009 H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health emergency planning.
MethodsA systemic literature review of relevant, peer-reviewed, quantitative, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic.
ResultsThirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family.
ConclusionsUnderstanding the factors that contribute to the willingness of HCP to report to work during an influenza public health emergency is critical to emergency planning and preparedness. Information from this review can guide emergency policy makers, planners, and implementers in both understanding and influencing the willingness of HCP to work during an influenza public health emergency.
. .Devnani M Factors Associated with the Willingness of Health Care Personnel to Work During an Influenza Public Health Emergency: An Integrative Review . Prehosp Disaster Med.2012 ;27 (6 ):1-16
Framework for Research on Children's Reactions to Disasters and Terrorist Events
- Betty Pfefferbaum, Mary A. Noffsinger, Kathleen Sherrieb, Fran H. Norris
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- 04 October 2012, pp. 567-576
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Clinical work and research relative to child mental health during and following disaster are especially challenging due to the complex child maturational processes and family and social contexts of children's lives. The effects of disasters and terrorist events on children and adolescents necessitate diligent and responsible preparation and implementation of research endeavors. Disasters present numerous practical and methodological barriers that may influence the selection of participants, timing of assessments, and constructs being investigated. This article describes an efficient approach to guide both novice and experienced researchers as they prepare to conduct disaster research involving children. The approach is based on five fundamental research questions: “Why?, Who?, When?, What?, and How?” Addressing each of the “four Ws” will assist researchers in determining “How” to construct and implement a study from start to finish. A simple diagram of the five questions guides the reader through the components involved in studying children's reactions to disasters. The use of this approach is illustrated with examples from disaster mental health studies in children, thus simultaneously providing a review of the literature.
. ,Pfefferbaum B ,Noffsinger MA ,Sherrieb K ,Fran H. .Norris FH. Framework for Research on Children's Reactions to Disasters and Terrorist Events . Prehosp Disaster Med.2012 ;27 (6 ):1-10
Original Research
Medical Care at Mass Gatherings: Emergency Medical Services at Large-Scale Rave Events
- Jan Krul, Björn Sanou, Eleonara L Swart, Armand R J Girbes
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- 17 April 2012, pp. 71-74
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Objective: The objective of this study was to develop comprehensive guidelines for medical care during mass gatherings based on the experience of providing medical support during rave parties.
Methods: Study design was a prospective, observational study of self-referred patients who reported to First Aid Stations (FASs) during Dutch rave parties. All users of medical care were registered on an existing standard questionnaire. Health problems were categorized as medical, trauma, psychological, or miscellaneous. Severity was assessed based on the Emergency Severity Index. Qualified nurses, paramedics, and doctors conducted the study after training in the use of the study questionnaire. Total number of visitors was reported by type of event.
Results: During the 2006–2010 study period, 7,089 persons presented to FASs for medical aid during rave parties. Most of the problems (91.1%) were categorized as medical or trauma, and classified as mild. The most common medical complaints were general unwell-being, nausea, dizziness, and vomiting. Contusions, strains and sprains, wounds, lacerations, and blisters were the most common traumas. A small portion (2.4%) of the emergency aid was classified as moderate (professional medical care required), including two cases (0.03%) that were considered life-threatening. Hospital admission occurred in 2.2% of the patients. Fewer than half of all patients presenting for aid were transported by ambulance. More than a quarter of all cases (27.4%) were related to recreational drugs.
Conclusions: During a five-year field research period at rave dance parties, most presentations on-site for medical evaluation were for mild conditions. A medical team of six healthcare workers for every 10,000 rave party visitors is recommended. On-site medical staff should consist primarily of first aid providers, along with nurses who have event-specific training on advanced life support, event-specific injuries and incidents, health education related to self-care deficits, interventions for psychological distress, infection control, and disaster medicine. Protocols should be available for treating common injuries and other minor medical problems, and for registration, triage, environmental surveillance and catastrophe management and response.
Brief Report
In the Line of Duty: A Study of Ambulance Drivers During the 2010 Conflict in Kashmir
- Shabir Ahmed Dhar, Tahir Ahmed Dar, Sharief Ahmed Wani, Shahid Hussain, Reyaz Ahmed Dar, Zaid Ahmed Wani, Shah Aazad, Suhail Yaqoob, Imtiyaz Mansoor, Murtaza Fazal Ali, Muzaffar Ahmed, Imran Mumtaz, Idrees Azhar
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- 26 July 2012, pp. 381-384
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Purpose
The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone.
MethodsThis study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes.
ResultsA total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs.
ConclusionsThe atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.
Dhar SA, Dar TA, Wani SA, Hussain S, Wani ZA, Aazad S, Yaqoob S, Mansoor I, Ali MF, Ahmed M, Mumtaz I, Azhar I. In the line of duty: a study of ambulance drivers during the 2010 conflict in Kashmir. Prehosp Disaster Med. 2012;27(4):1-4.
Original Research
Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams
- Martin J. Dutch, Kristy B. Austin
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- 19 July 2012, pp. 463-467
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Introduction
Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.
ObjectiveTo describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.
MethodsRetrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011.
Main outcome measuresClinical presentation, medical interventions and discharge destination.
ResultsSixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.
ConclusionsThe deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.
,Dutch MJ .Austin KB Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams . Prehosp Disaster Med.2012 ;27 (4 ):1 -5 .
Special Report
Requirements for Independent Community-Based Quality Assessment and Accountability Practices in Humanitarian Assistance and Disaster Relief Activities
- Thomas D. Kirsch, Paul Perrin, Frederick M. Burkle, William Canny, Susan Purdin, William Lin, Lauren Sauer
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- Published online by Cambridge University Press:
- 13 June 2012, pp. 280-285
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During responses to disasters, the credibility of humanitarian agencies can be threatened by perceptions of poor quality of the responses. Many initiatives have been introduced over the last two decades to help address these issues and enhance the overall quality of humanitarian response, often with limited success. There remain important gaps and deficiencies in quality assurance efforts, including potential conflicts of interest. While many definitions for quality exist, a common component is that meeting the needs of the “beneficiary” or “client” is the ultimate determinant of quality. This paper examines the current status of assessment and accountability practices in the humanitarian response community, identifies gaps, and recommends timely, concise, and population-based assessments to elicit the perspective of quality performance and accountability to the affected populations. Direct and independent surveys of the disaster-affected population will help to redirect ongoing aid efforts, and generate more effective and comparable methods for assessing the quality of humanitarian practices and assistance activities.
Kirsch TD, Perrin P, Burkle FM Jr, Canny W, Purdin S, Lin W, Sauer L. Requirements for independent community-based quality assessment and accountability practices in humanitarian assistance and disaster relief activities. Prehosp Disaster Med. 2012;27(3):1-6.
Original Research
Portable Handheld Ultrasound in Austere Environments: Use in the Haiti Disaster
- Meghan Shorter, Darryl J. Macias
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- 17 May 2012, pp. 172-177
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Introduction
A 7.0 magnitude earthquake struck Haiti on January 12, 2010, resulting in 222,000 deaths and 300,000 injuries. Three weeks after the initial quake, the New Mexico Disaster Medical Assistance Team (NM DMAT-1) was deployed to Haiti for ongoing medical relief. During this deployment, a portable handheld ultrasound machine was tested for usefulness in aiding with patient care decisions.
ObjectiveThe utility of portable ultrasound to help with triage and patient management decisions in a major disaster setting was evaluated.
MethodsRetrospective observational non-blinded images were obtained on 51 patients voluntarily presenting to the Gheskio Field clinic at Port-au-Prince. Ultrasound was used for evaluation of undifferentiated hypotension, torso trauma, pregnancy, non-traumatic abdominal pain, deep venous thrombosis and pulmonary embolism, and dyspnea-chest pain, as well as for assisting with procedures. Scans were obtained using a Signos personal handheld ultrasound machine with images stored on a microSD card. Qualitative data were reviewed to identify whether ultrasound influenced management decisions, and results were categorized in terms of percent of scans that influenced management.
ResultsFifty-one ultrasound scans on 50 patients were performed, with 35% interpreted as positive, 41% as negative, and 24% as equivocal. The highest yields of information were for abdominal ultrasound and ultrasound related to pregnancy. Ultrasound influenced decisions on patient care in 70% of scans. Most of these decisions were reflected in the clinician's confidence in discharging a patient with or without non-emergent follow-up.
ConclusionThe use of a handheld portable ultrasound machine was effective for patient management decisions in resource-poor settings, and decreased the need to triage selected patients to higher levels of care. Ultrasound was very useful for evaluation of non-traumatic abdominal pain. Dynamic capability is necessary for ultrasound evaluation of undifferentiated hypotension and cardiac and lung examinations. Ultrasound also was useful for guidance during procedural applications, and for aiding in the diagnosis of parasitic diseases.
Shorter M, Macias D. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehosp Disaster Med. 2012;27(2):1-6.
Special Report
Emergency Surgery Data and Documentation Reporting Forms for Sudden-Onset Humanitarian Crises, Natural Disasters and the Existing Burden of Surgical Disease
- Frederick M. Burkle, Jr., Jason W. Nickerson, Johan von Schreeb, Anthony D. Redmond, Kelly A. McQueen, Ian Norton, Nobhojit Roy
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- Published online by Cambridge University Press:
- 24 September 2012, pp. 577-582
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Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.
,Burkle FM Jr ,Nickerson JW ,von Schreeb J ,Redmond AD ,McQueen KA ,Norton I .Roy N Emergency Surgery Data and Documentation Reporting Forms for Sudden-Onset Humanitarian Crises, Natural Disasters and the Existing Burden of Surgical Disease . Prehosp Disaster Med.2012 ;27 (6 ):1-6.
Comprehensive Review
Literature Review of Disaster Health Research in Japan: Focusing on Disaster Nursing Education
- Mayumi Kako, Satoko Mitani, Paul Arbon
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- 17 May 2012, pp. 178-183
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Introduction
Japan has a long history of disaster due to its location on the “Pacific Ring of Fire.” The frequency of earthquakes experienced in recent years has had significant influence on disaster health research in Japan. This paper describes disaster health research trends in Japan, with an emphasis on disaster nursing research.
MethodA systematic literature review of disaster health research in Japan from 2001 through 2007 was conducted for this study. The most commonly used database in Japan, Ichushi (version 4.0), was used for this literature review. The keywords and sub-keywords used were: disaster, disaster nursing, practice, education, ability, response, emergency, licensure, capability, function, prevention, planning and research. These keywords were sometimes used in combination to identify relevant literature.
ResultsA total of 222 articles were reviewed. The number of research papers available increased gradually from 2001 through 2007. The most common articles used were found using the search category of “disaster nursing and research.” Among the search categories, “disaster nursing and education” also had a high number of publications. This category also peaked in 2007.
ConclusionThe recent experiences of natural disaster in Japan accelerated the impetus to explore and implement a disaster nursing concept into practice and nursing curricula. Further evidence-based studies to develop methodology and other areas of studies in disaster nursing, including other language databases are to be expected in the future.
Kako M, Mitani S, Arbon P. Literature review of disaster health research in Japan: focusing on disaster nursing education. Prehosp Disaster Med. 2012;27(2):1-6.
Other
Reports and Session Summaries of the 17th World Congress on Disaster and Emergency Medicine: May 31 to June 3, 2011Beijing, China
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- 05 July 2012, pp. 286-296
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This section of Prehospital and Disaster Medicine (PDM) presents reports and summaries of the 17th World Congress on Disaster and Emergency Medicine (WCDEM) held in Beijing, China in May and June of 2011. Included are reports and summaries that were submitted for publication in PDM.
Abstracts of Congress oral and poster presentations were published on September 1, 2011 as a supplement to PDM (Volume 26, Supplement 1). The 17th WCDEM was attended by 1,600 representatives from more than 57 nations, and the Congress included 315 oral and 211 poster presentations.
The editorial staff of PDM is pleased to present the following reports and session summaries of the Beijing 17th WCDEM.
Reports and session summaries of the 17th World Congress on Disaster and Emergency Medicine. Prehosp Disaster Med. 2012;27(3):1-11.
Original Research
Pandemic Influenza Extension Areas in an Urban Pediatric Hospital
- Rachel L. Charney, Eric S. Armbrecht, Brian R. Kennedy, Robert G. Flood
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- 25 April 2012, pp. 75-80
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Introduction The 2009 H1N1 influenza pandemic created a surge of patients with low-acuity influenza-like-illness (ILI) to hospital Emergency Departments (EDs). The development and results of a tiered surge plan to care for these patients at a Pediatric Emergency Department (PED) were studied.
Hypothesis/Problem By providing standard assessment and treatment algorithms within physically separate ILI Extension Areas, it was hypothesized that patient care could be streamlined and the quality of care maintained.
Methods Hospital administrators created the tiered H1N1 surge plan within the framework of the existing emergency operations plan (EOP). After the initial expansion of space and staff utilization within the existing PED footprint, ILI Extension Areas were opened and staffed by non-ED physicians and nursing to provide care rapidly for ILI patients after Registered Nurse (RN) screening. Volumes, length of stay (LOS), left without being seen (LWBS) rates, patient satisfaction, and costs were tracked and measured.
Results Significantly elevated volumes of patients were seen in the months of September and October of 2009 (42.0% and 32.7% increase over 2008). During this time, 612 patients were triaged to the ILI Extension Areas. The LOS was similar to that experienced in prior years. The LWBS rates in September (4.8%) and October (3.4%) were slightly elevated over the 2009 yearly average (3.2%), but remained lower than during a prior, high-volume month. Satisfaction, measured as patients’ “likelihood to recommend,” remained within the range observed during other parts of the year. Cost estimates indicate favorable financial performance for the institution.
Conclusion The tiered surge response plan represented a success in managing large volumes of low-acuity patients during an extended period of time. This design can be utilized effectively in the future during times of patient surge.
Special Report
Explosions and Human Health: The Long-Term Effects of Blast Injury
- Sarah E. Finlay, Michelle Earby, David J. Baker, Virginia S.G. Murray
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- 17 July 2012, pp. 385-391
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The immediate patterns of injury from explosions are well documented, from both military and civil experience. However, few studies have focused on less immediately apparent health consequences and latent effects of explosions in survivors, emergency responders and the surrounding community. This review aimed to analyze the risks to health following an explosion in a civil setting.
A comprehensive review of the open literature was conducted, and data on 10 relevant military, civilian and industrial events were collected. Events were selected according to availability of published studies and involvement of large numbers of people injured. In addition, structured interviews with experts in the field were conducted, and existing national guidelines reviewed.
The review revealed significant and potentially long-term health implications affecting various body systems and psychological well-being following exposure to an explosion. An awareness of the short- and long-term health effects of explosions is essential in screening for blast injuries, and identifying latent pathologies that could otherwise be overlooked in stressful situations with other visually distracting injuries and, often, mass casualties. Such knowledge would guide responsible medical staff in implementing early appropriate interventions to reduce the burden of long-term sequelae. Effective planning and response strategies would ensure accessibility of appropriate health care resources and evidence-based information in the aftermath of an explosion.
Finlay SE, Earby M, Baker DJ, Murray VSG. Explosions and human health: the long-term effects of blast injury. Prehosp Disaster Med. 2012;27(4):1-7.
Comprehensive Review
Intraosseous Access in the Prehospital Setting: Literature Review
- Alexander Olaussen, Brett Williams
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- 09 August 2012, pp. 468-472
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Background
Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.
ObjectivesReview the literature regarding the use of intraosseous (IO) devices in the prehospital setting.
MethodsSelected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.
FindingsThe search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients’ vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.
ConclusionWhile manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.
,Olaussen A .Williams B Intraosseous Access in the Prehospital Setting: Literature Review . Prehosp Disaster Med.2012 ;27 (5 ):1 -5 .
The Clinical Application of Mobile Technology to Disaster Medicine
- Timothy Case, Cecily Morrison, Alain Vuylsteke
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- Published online by Cambridge University Press:
- 14 August 2012, pp. 473-480
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Mobile health care technology (mHealth) has the potential to improve communication and clinical information management in disasters. This study reviews the literature on health care and computing published in the past five years to determine the types and efficacy of mobile applications available to disaster medicine, along with lessons learned.
Five types of applications are identified: (1) disaster scene management; (2) remote monitoring of casualties; (3) medical image transmission (teleradiology); (4) decision support applications; and (5) field hospital information technology (IT) systems. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Deployments of teleradiology and field hospital IT systems to disaster zones suggest that mHealth can improve resource allocation and patient care. The key problems include suitability of equipment for use in disaster zones and providing sufficient training to ensure staff familiarity with complex equipment. Future research should focus on providing unbiased observations of the use of mHealth in disaster medicine.
,Case T ,Morrison C .Vuylsteke A The Clinical Application of Mobile Technology to Disaster Medicine . Prehosp Disaster Med.2012 ;27 (5 ):1 -9 .
Systematic Review
Surgical Care during Humanitarian Crises: A Systematic Review of Published Surgical Caseload Data from Foreign Medical Teams
- Jason W. Nickerson, Smita Chackungal, Lisa Knowlton, Kelly McQueen, Frederick M. Burkle, Jr.
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- Published online by Cambridge University Press:
- 17 May 2012, pp. 184-189
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Objective
Humanitarian surgery is often organized and delivered with short notice and limited time for developing unique strategies for providing care. While some surgical pathologies can be anticipated by the nature of the crisis, the role of foreign medical teams in treating the existing and unmet burden of surgical disease during crises is unclear. The purpose of this study was to examine published data from crises during the years 1990 through 2011 to understand the role of foreign medical teams in providing surgical care in these settings.
MethodsA literature search was completed using PubMed, MEDLINE, and EMBASE databases to locate relevant manuscripts published in peer-reviewed journals. A qualitative review of the surgical activities reported in the studies was performed.
ResultsOf 185 papers where humanitarian surgical care was provided by a foreign medical team, only 11 articles met inclusion criteria. The reporting of surgical activities varied significantly, and pooled statistical analysis was not possible. The quality of reporting was notably poor, and produced neither reliable estimates of the pattern of surgical consultations nor data on the epidemiology of the burden of surgical diseases. The qualitative trend analysis revealed that the most frequent procedures were related to soft tissue or orthopedic surgery. Procedures such as caesarean sections, hernia repairs, and appendectomies also were common. As length of deployment increased, the surgical caseload became more reflective of the existing, unmet burden of surgical disease.
ConclusionsThis review suggests that where foreign medical teams are indicated and requested, multidisciplinary surgical teams capable of providing a range of emergency and essential surgical, and rehabilitation services are required. Standardization of data collection and reporting tools for surgical care are needed to improve the reporting of surgical epidemiology in crisis-affected populations.
Nickerson JW, Chackungal S, Knowlton L, McQueen K, Burkle FM Jr. Surgical care during humanitarian crises: a systematic review of published surgical caseload data from foreign medical teams. Prehosp Disaster Med. 2012;27(2):1-6.