Comprehensive Review
Clinical Skill and Knowledge Requirements of Health Care Providers Caring for Children in Disaster, Humanitarian and Civic Assistance Operations: An Integrative Review of the Literature
- Heather L. Johnson, Susan W. Gaskins, Diane C. Seibert
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- Published online by Cambridge University Press:
- 14 November 2012, pp. 61-68
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Introduction
Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care.
PurposeThe purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations.
Data SourcesA systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches.
ConclusionsInfectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations.
Implications for PracticeThe information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.
,Johnson HL ,Gaskins SW .Seibert DC Clinical Skill and Knowledge Requirements of Health Care Providers Caring for Children in Disaster, Humanitarian and Civic Assistance Operations: An Integrative Review of the Literature . Prehosp Disaster Med.2013 ;28 (1 ):1 -8 .
Original Research
Addressing the Gaps in Preparation for Quarantine
- Rita Nathawad, Patricia M. Roblin, Darrin Pruitt, Bonnie Arquilla
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- Published online by Cambridge University Press:
- 28 January 2013, pp. 132-138
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Introduction
In the event of an outbreak of a communicable respiratory illness, quarantine may become necessary. The New York Institute for All Hazard Preparedness (NYIAHP) of the State University of New York (SUNY) Downstate Medical Center, in cooperation with the New York City Department of Health and Mental Hygiene's Healthcare Emergency Preparedness Program, (NYC DOHMH-HEPP) quarantine working group, has developed a series of clinical protocols to help health care facilities respond to such an event.
ProblemTwo full-scale exercises (FSEs) were designed and conducted a year apart in the quarantine unit at Kings County Hospital Center (KCHC) to test the efficacy and feasibility of these quarantine protocols. The goal of these exercises was to identify the gaps in preparedness for quarantine and increase hospital readiness for such an event.
MethodsEvaluators monitored for efficient management of critical physical plants, personnel and material resources. Players were expected to integrate and practice emergency response plans and protocols specific to quarantine. In developing the exercise objectives, five activities were selected for evaluation: Activation of the Unit, Staffing, Charting/Admission, Symptom Monitoring and Infection Control, and Client Management.
ResultsThe results of the initial FSE found that there were incomplete critical tasks within all five protocols: These deficiencies were detailed in an After Action Report and an Improvement Plan was presented to the KCHC Disaster Preparedness Committee a month after the initial FSE. In the second FSE a year later, all critical tasks for Activation of the unit, Staffing and Charting/Admission were achieved. Completion of critical tasks related to Symptom Monitoring and Infection Control and Client Management was improved in the second FSE, but some tasks were still not performed appropriately.
ConclusionIn short, these exercises identified critical needs in disaster preparedness of the KCHC Quarantine Unit. The lessons learned from this logistical exercise enabled the planning group to have a better understanding of leadership needs, communication capabilities, and infection control procedures. Kings County Hospital Center performed well during these exercises. It was clear that performance in the second exercise was improved, and many problems noted in the first exercise were corrected. Staff also felt better prepared the second time. This supports the idea that frequent exercises are vital to maintain disaster readiness.
. ,Nathawad R ,Roblin PM ,Pruitt D .Arquilla B Addressing the Gaps in Preparation for Quarantine . Prehosp Disaster Med.2013 ;28 (2 ):1 -7
Crew and Patient Safety in Ambulances: Results of a Personnel Survey and Experimental Side Impact Crash Test
- Marc Fournier, Hichem Chenaitia, Catherine Masson, Pierre Michelet, Michel Behr, Jean-Pierre Auffray
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- Published online by Cambridge University Press:
- 07 May 2013, pp. 370-375
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Introduction
Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment.
MethodFirstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality.
ResultsForty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G.
ConclusionThe crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the “patient” substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.
. ,Fournier M ,Chenaitia H ,Masson C ,Michelet P ,Behr M .Auffray JP Crew and Patient Safety in Ambulances: Results of a Personnel Survey and Experimental Side Impact Crash Test . Prehosp Disaster Med.2013 ;28 (4 ):1 -6
A Comparative Study of the Effect of Triage Training by Role-Playing and Educational Video on the Knowledge and Performance of Emergency Medical Service Staffs in Iran
- Hamidreza Aghababaeian, Soheila Sedaghat, Noorallah Tahery, Ali Sadeghi Moghaddam, Mohammad Maniei, Nosrat Bahrami, Ladan Araghi Ahvazi
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- Published online by Cambridge University Press:
- 12 November 2013, pp. 605-609
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Introduction
Educating emergency medical staffs in triage skills is an important aspect of disaster preparedness. The aim of the study was to compare the effect of role-playing and educational video presentation on the learning and performance of the emergency medical service staffs in Khozestan, Iran
MethodsA total of 144 emergency technicians were randomly classified into two groups. A researcher trained the first group using an educational video method and the second group with a role-playing method. Data were collected before, immediately, and 15 days after training using a questionnaire covering the three domains of demographic information, triage knowledge, and triage performance. The data were analyzed using defined knowledge and performance parameters.
ResultsThere was no significant difference between the two training methods on performance and immediate knowledge (P = .2), lasting knowledge (P=.05) and immediate performance (P = .35), but there was a statistical advantage for the role-playing method on lasting performance (P = .02).
ConclusionThe two educational methods equally increase knowledge and performance, but the role-playing method may have a more desirable and lasting effect on performance.
. ,Aghababaeian H ,Sedaghat S ,Tahery N ,Sadeghi Moghaddam A ,Maniei M ,Bahrami N .Araghi Ahvazi L A Comparative Study of the Effect of Triage Training by Role-Playing and Educational Video on the Knowledge and Performance of Emergency Medical Service Staffs in Iran . Prehosp Disaster Med.2013 ;28 (6 ):1 -5
Video Self-instruction for Police Officers in Cardiopulmonary Resuscitation and Automated External Defibrillators
- Amer Z. Aldeen, Nicholas D. Hartman, Adriana Segura, Amit Phull, Diane M. Shaw, George T. Chiampas, D. Mark Courtney
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- Published online by Cambridge University Press:
- 26 July 2013, pp. 471-476
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Introduction
Police officers often serve as first responders during out-of-hospital cardiac arrests (OHCA). Current knowledge and attitudes about resuscitation techniques among police officers are unknown.
Hypothesis/problemThis study evaluated knowledge and attitudes about cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) among urban police officers and quantified the effect of video self-instruction (VSI) on these outcomes.
MethodsUrban police officers were enrolled in this online, prospective, educational study conducted over one month. Demographics, prior CPR-AED experience, and baseline attitudes were queried. Subjects were randomized into two groups. Each group received a slightly different multiple-choice test of knowledge and crossed to the alternate test after the intervention, a 10-minute VSI on CPR and AEDs. Knowledge and attitudes were assessed immediately before and after the intervention. The primary attitude outcome was entering “very likely” (5-point Likert) to do chest compressions (CC) and use an AED on a stranger. The primary knowledge outcomes were identification of the correct rate of CC, depth of CC, and action in an OHCA scenario.
ResultsA total of 1616 subjects responded with complete data (63.6% of all electronic entries). Randomization produced 819 participants in group 1, and 797 in group 2. Groups 1 and 2 did not differ significantly in any background variable. After the intervention, subjects “very likely” to do CC on a stranger increased by 17.2% (95% CI, 12.5%-21.8%) in group 1 and 21.2% (95% CI, 16.4%-25.9%) in group 2. Subjects “very likely” to use an AED on a stranger increased by 20.0% (95% CI, 15.3%-24.7%) in group 1 and 25.0% (95% CI, 20.2%-29.6%) in group 2. Knowledge of correct CC rate increased by 59.0% (95% CI, 55.0%-62.8%) in group 1 and 64.8% (95% CI, 60.8%-68.3%) in group 2. Knowledge of correct CC depth increased by 44.8% (95% CI, 40.5%-48.8%) in group 1 and 54.4% (95% CI, 50.3%-58.3%) in group 2. Knowledge of correct action in an OHCA scenario increased by 27.4% (95% CI, 23.4%-31.4%) in group 1 and 27.2% (95% CI, 23.3%-31.1%) in group 2.
ConclusionVideo self-instruction can significantly improve attitudes toward and knowledge of CPR and AEDs among police officers. Future studies can assess the impact of VSI on actual rates of CPR and AED use during real out-of-hospital cardiac arrests.
,Aldeen AZ ,Hartman ND ,Sequra A ,Phull A ,Shaw DM ,Chiampas GT .Courtney DM Video Self-instruction for Police Officers in Cardiopulmonary Resuscitation and Automated External Defibrillators . Prehosp Disaster Med.2013 ;28 (5 ):1 -6 .
Injuries and Fatalities among Emergency Medical Technicians and Paramedics in the United States
- Brian J. Maguire, Sean Smith
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- Published online by Cambridge University Press:
- 09 May 2013, pp. 376-382
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Introduction
Emergency medical services personnel treat 22 million patients a year, yet little is known of their risk of injury and fatality.
ProblemWork-related injury and fatality rates among US paramedics and emergency medical technicians (EMTs) are higher than the national average for all occupations.
MethodsData collected by the Department of Labor (DOL) Bureau of Labor Statistics were reviewed to identify injuries and fatalities among EMTs and paramedics from 2003 through 2007. The characteristics of fatal injuries are described and the rates and relative risks of the non-fatal injuries were calculated and compared to the national average.
ResultsOf the 21,749 reported cases, 21,690 involved non-fatal injuries or illnesses that resulted in lost work days among EMTs and paramedics within the private sector. Of the injuries, 3,710 (17%) resulted in ≥31 days of lost work time. A total of 14,470 cases (67%) involved sprains or strains; back injury was reported in 9,290 of the cases (43%); and the patient was listed as the source of injury in 7,960 (37%) cases. The most common events were overexertion (12,146, 56%), falls (2,169, 10%), and transportation-related (1,940, 9%). A total of 530 assaults were reported during the study period. Forty-five percent of the cases occurred among females (females accounted for 27% of employment in this occupation during 2007). In 2007, EMTs and paramedics suffered 349.9 injuries with days away from work per 10,000 full-time workers, compared to an average of 122.2 for all private industry occupations (Relative risk = 2.9; 95% CI: 2.7–3.0). During the study period, 59 fatalities occurred among EMTs and paramedics in both the private industry and in the public sector. Of those fatalities, 51 (86%) were transportation-related and five (8%) were assaults; 33 (56%) were classified as “multiple traumatic injuries.”
ConclusionsData from the DOL show that EMTs and paramedics have a rate of injury that is about three times the national average for all occupations. The vast majority of fatalities are secondary to transportation related-incidents. Assaults are also identified as a significant cause of fatality. The findings also indicate that females in this occupational group may have a disproportionately larger number of injuries. Support is recommended for further research related to causal factors and for the development, evaluation and promulgation of evidence-based interventions to mitigate this problem.
. ,Maguire BJ .Smith S Injuries and Fatalities among Emergency Medical Technicians and Paramedics in the United States . Prehosp Disaster Med.2013 ;28 (4 ):1 -7
Prehospital Mass-Casualty Triage Training—Written Versus Moulage Scenarios: How Much Do EMS Providers Retain?
- Brian L. Risavi, Mark A. Terrell, William Lee, Donald L. Holsten, Jr
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- Published online by Cambridge University Press:
- 14 March 2013, pp. 251-256
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Introduction
The aim of this study was to assess the effectiveness of written and moulage scenarios using video instruction for mass-casualty triage by evaluating skill retention at six months post intervention.
MethodsPrehospital personnel were instructed in the START method of mass-casualty triage using a video. Moulage and written testing were completed by each participant immediately after instruction and at six months post instruction.
ResultsThere was a significant decrease in performance between initial and six-month testing, indicating skill decay and loss of retention of triage skills after an extended nonuse period. There were no statistically significant differences between written and moulage testing results at either initial testing or at six months. Prior skill level did not influence test performance on the type of testing conducted or long-term retention of triage skills.
ConclusionThese data confirm the skill deterioration associated with an infrequently used triage method. Further research to more precisely define triage criteria, as well as the ability to apply the criteria in a clinical setting and to rapidly identify patients at risk for morbidity/mortality is needed.
. ,Risavi BL ,Terrell MA ,Lee W .Holsten DL Jr Prehospital Mass-Casualty Triage Training—Written Versus Moulage Scenarios: How Much Do EMS Providers Retain? . Prehosp Disaster Med.2013 ;28 (3 ):1 -6
Conference Report
Reports and Session Summaries of the 17th World Congress on Disaster and Emergency Medicine: May 31 to June 3, 2011 Beijing, China
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- 21 November 2012, pp. 69-75
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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.
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.
Certain reports and summaries from the Beijing 17th World Congress were published in Volume 27, Issue 3 of PDM. The editorial staff of PDM is pleased to present the following additional reports and session summaries.
.Reports and Session Summaries of the 17th World Congress on Disaster and Emergency Medicine . Prehosp Disaster Med.2013 :28 (1 ):1-7
Original Research
Physiological Responses of Medical Team Members to a Simulated Emergency in Tropical Field Conditions
- Matt B. Brearley, Michael F. Heaney, Ian N. Norton
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- 29 January 2013, pp. 139-144
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Introduction
Responses to physical activity while wearing personal protective equipment in hot laboratory conditions are well documented. However less is known of medical professionals responding to an emergency in hot field conditions in standard attire. Therefore, the purpose of this study was to assess the physiological responses of medical responders to a simulated field emergency in tropical conditions.
MethodsTen subjects, all of whom were chronically heat-acclimatized health care workers, volunteered to participate in this investigation. Participants were the medical response team of a simulated field emergency conducted at the Northern Territory Emergency Services training grounds, Yarrawonga, NT, Australia. The exercise consisted of setting up a field hospital, transporting patients by stretcher to the hospital, triaging and treating the patients while dressed in standard medical response uniforms in field conditions (mean ambient temperature of 29.3°C and relative humidity of 50.3%, apparent temperature of 27.9°C) for a duration of 150 minutes. Gastrointestinal temperature was transmitted from an ingestible sensor and used as the index of core temperature. An integrated physiological monitoring device worn by each participant measured and logged heart rate, chest temperature and gastrointestinal temperature throughout the exercise. Hydration status was assessed by monitoring the change between pre- and post-exercise body mass and urine specific gravity (USG).
ResultsMean core body temperature rose from 37.5°C at the commencement of the exercise to peak at 37.8°C after 75 minutes. The individual peak core body temperature was 38.5°C, with three subjects exceeding 38.0°C. Subjects sweated 0.54 L per hour and consumed 0.36 L of fluid per hour, resulting in overall dehydration of 0.7% of body mass at the cessation of exercise. Physiological strain index was indicative of little to low strain.
ConclusionsThe combination of the unseasonably mild environmental conditions and moderate work rates resulted in minimal heat storage during the simulated exercise. As a result, low sweat rates manifested in minimal dehydration. When provided with access to fluids in mild environmental conditions, chronically heat-acclimatized medical responders can meet their hydration requirements through ad libitum fluid consumption. Whether such an observation is replicated under a harsher thermal load remains to be investigated.
. ,Brearley MB ,Heaney MF .Norton IN Physiological Responses of Medical Team Members to a Simulated Emergency in Tropical Field Conditions . Prehosp Disaster Med.2013 ;28 (2 ):1 -6
Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation
- Erin L. Downey, Knox Andress, Carl H. Schultz
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- 21 February 2013, pp. 257-263
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Introduction
Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place.
MethodsThis observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals’ initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey.
ResultsSeven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation.
ConclusionHospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient care for prolonged periods.
. ,Downey EL ,Andress K .Schultz CH Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation . Prehosp Disaster Med.2013 ;28 (3 ):1 -7
Measurement of Empathy Levels in Undergraduate Paramedic Students
- Brett Williams, Mal Boyle, Tracy Earl
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- 29 January 2013, pp. 145-149
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Introduction
Paramedics rely on establishing a health provider-patient relationship with patients that promotes two-way communication, patient satisfaction, and facilitates appropriate patient assessment and treatment. Paramedics also must have an ability to empathize with patients and their family members in order to develop a successful health provider-patient relationship. The objective of this study was to assess paramedics’ empathy and attitudes toward patients with specific conditions.
MethodsThis was a cross-sectional study using a convenience sample of first-, second-, and third-year, Australian undergraduate paramedic students. Student empathy levels were assessed using two standardized self-reporting instruments: the Jefferson Scale of Physician Empathy (JSPE) Health Professional (HP) version and the Medical Condition Regard Scale (MCRS).
ResultsA total of 94 paramedic students participated in the study. The JSPE demonstrated that male paramedic students had higher mean empathy scores than did female paramedic students (113.25 and 107.5, respectively; P = .042). The JSPE empathy level scores were lowest among first-year paramedic students (mean = 107.53); age was not found to be a significant variable on empathy scores. The Medical Condition Regard Scale revealed lowest scores in compassion towards substance abuse (mean = 46.42).
ConclusionsThe results of this study provide the discipline of paramedic health care with useful data, and provide students, academics, and other educators with important information regarding the improvement of the health provider-patient relationship and paramedic education curriculum development.
. ,Williams B ,Boyle M .Earl T Measurement of Empathy Levels in Undergraduate Paramedic Students . Prehosp Disaster Med.2013 ;28 (2 ):1 -5
Case Report
Using a Cloud-based Electronic Health Record During Disaster Response: A Case Study in Fukushima, March 2011
- Takashi Nagata, John Halamka, Shinkichi Himeno, Akihiro Himeno, Hajime Kennochi, Makoto Hashizume
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- Published online by Cambridge University Press:
- 26 April 2013, pp. 383-387
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Following the Great East Japan Earthquake on March 11, 2011, the Japan Medical Association deployed medical disaster teams to Shinchi-town (population: approximately 8,000), which is located 50 km north of the Fukushima Daiichi nuclear power plant. The mission of the medical disaster teams sent from Fukuoka, 1,400 km south of Fukushima, was to provide medical services and staff a temporary clinic for six weeks. Fear of radiation exposure restricted the use of large medical teams and local infrastructure. Therefore, small volunteer groups and a cloud-hosted, web-based electronic health record were implemented. The mission was successfully completed by the end of May 2011. Cloud-based electronic health records deployed using a “software as a service” model worked well during the response to the large-scale disaster.
. ,Nagata T ,Halamka J ,Kennochi H ,Himeno S ,Himeno A .Hashizume M Using a Cloud-based Electronic Health Record During Disaster Response: A Case Study in Fukushima, March 2011 . Prehosp Disaster Med.2013 ;28 (4 ):1 -5
Brief Report
A Prospective Observational Analysis of Ambulation After Motor Vehicle Collisions
- Mark A. Merlin, Colleen Ciccosanti, Matthew D. Saybolt, Olivia Bockoff, Michael Mazzei, Adam Shiroff
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- Published online by Cambridge University Press:
- 19 October 2012, pp. 76-78
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Objectives
Predicting injury patterns of patients based only on mechanism of injury is difficult and is well described in the literature. Characteristics of patients on-scene immediately following injury(ies) may lead to predicting injury patterns. Although reported frequently, the significance of victim ambulation after a motor vehicle crash is poorly understood. It was hypothesized that ambulation at the scene is not predictive of injury severity following a motor vehicle crash (MVC).
MethodsA prospective, cohort study of 117 consecutive injured patients who were ambulatory after MVCs were enrolled. Paramedics in a large urban Emergency Medical Services (EMS) system were mandated to document “ambulatory” or “nonambulatory” for motor vehicle collisions in order to complete their prehospital electronic medical records. This assured accuracy and completeness in the data collection. All charts were abstracted for trauma-induced injury and imaging results.
ResultsA total of 608 (10.9%) persons were ambulatory at the scene, of which 284 had an injury pattern documented in the prehospital or emergency department record. The average age was 35.9 (SD = 16.8) years, and 158 (55.6%) were male. A total of 707 injuries were identified in the 284 patients who had sustained injuries.
ConclusionsAmbulation after motor vehicle collisions appears to be only infrequently associated with major injuries, although this population still may present with significant injuries. A larger, prospective study is warranted.
,Merlin MA ,Ciccosanti C ,Saybolt MD ,Bockoff O ,Mazzei M .Shiroff A A Prospective Observational Analysis of Ambulation After Motor Vehicle Collisions . Prehosp Disaster Med.2013 ;28 (1 ):1 -3 .
Original Research
The Impact of Heat Waves on Transport Volumes in an Urban Emergency Medical Services System: A Retrospective Review
- Ricky C. Kue, K. Sophia Dyer
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- Published online by Cambridge University Press:
- 22 October 2013, pp. 610-615
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Introduction
Heat waves pose a serious public health risk to particular patient populations, especially in urban areas. Emergency Medical Services (EMS) in many urban areas constitute the first line of regional preparation and response to major heat wave events; however, little is known on heat wave operational impact to the EMS system, such as call volume or demand.
ObjectiveTo examine the effect of heat wave periods on overall urban EMS system call volume and transport volume as well as the nature of the call types.
MethodsRetrospective review of all emergency medical calls to an urban, two-tiered EMS system performed over a 5-year period from 2006–2010. Heat wave days (HWD) defined as two or more consecutive days of hot weather >32.2°C (90°F) were compared with similar non-heat wave days (nHWD) of the previous year to also include two calendar days prior to and after the heat wave. National Weather Service (NWS) temperature data, daily EMS call volume data, and call type codes were collected and underwent descriptive analysis.
ResultsThirty-one HWD were identified and compared with 93 nHWD. The mean maximum temperature for HWD was 34°C (93.2°F) compared with 25.3°C (77.6°F) for nHWD (P < .001). Average daily medical emergency calls (318.4 vs 296.3, P < .001) and actual patients transported per day (247.5 vs 198.3, P < .001) were significantly higher during HWD. There was no difference in daily medical emergency call volume or EMS transports between weekdays or weekend days. No significant differences on various call types were observed between HWD and nHWD except for “heat” related calls (7.7 vs 0.5, P < .001).
ConclusionEmergency Medical Services call volumes were significantly increased during heat waves, however there was minimal change in the types of calls received.
. ,Kue RC .Dyer KS The Impact of Heat Waves on Transport Volumes in an Urban Emergency Medical Services System: A Retrospective Review . Prehosp Disaster Med.2013 ;28 (6 ):1 -6
Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension
- Brian M. Clemency, Jeffrey J. Thompson, Gina N. Tundo, Heather A. Lindstrom
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- Published online by Cambridge University Press:
- 21 August 2013, pp. 477-481
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Introduction
High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure (CHF) with hypertension. Intravenous (IV) nitroglycerin administration is impractical in the prehospital setting. In 2011, a new regional Emergency Medical Services (EMS) protocol was introduced allowing advanced providers to treat CHF with high-dose oral nitroglycerin. The protocol calls for patients to be treated with two sublingual tabs (0.8 mg) when systolic blood pressure (SBP) was >160 mm Hg, or three sublingual tabs (1.2 mg) when SBP was >200 mm Hg, every five minutes as needed.
Hypothesis/ProblemTo assess the protocol's safety, the incidence of hypotension following prehospital administration of multiple simultaneous nitroglycerin (MSN) tabs by EMS providers was studied.
MethodsThis study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period. Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing.
ResultsOne hundred case-patients had at least one MSN administration by an advanced provider during the study period. Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis. There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. The mean change in SBP following MSN was -14.7 mm Hg (SD = 30.7; range, +59 to -132). Three administrations had documented systolic hypotension in the post-administration vital signs (97/71, 78/50 and 66/47). All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least 100. The incidence of hypotension following MSN administration was 3.2%.
DiscussionHigh-dose oral nitroglycerin administration is a practical alternative to IV nitroglycerin in the prehospital setting when administered by advanced providers. The prehospital protocol for high dose oral nitroglycerin was demonstrated to be safe in the cohort of patients studied. Limitations of the study include the relatively small sample size and the inability to identify hypotension that may have occurred following the cessation of data collection in the field.
ConclusionHypotension was rare and self-limited in prehospital patients receiving MSN.
,Clemency B ,Thompson J ,Tundo G .Lindstrom H Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension . Prehosp Disaster Med.2013 ;28 (5 ):1 -4 .
Letter to the Editor
Plagiarism and Copyright Violation: Two Things in Common
- Viroj Wiwanitkit
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- Published online by Cambridge University Press:
- 09 November 2012, p. 79
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Original Research
The Effect of Heat Waves on Ambulance Attendances in Brisbane, Australia
- Lyle R. Turner, Des Connell, Shilu Tong
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- Published online by Cambridge University Press:
- 28 August 2013, pp. 482-487
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Introduction
Heat waves have significant impacts on mortality and morbidity. However, little is known regarding effects on pre-admission health outcomes such as ambulance attendances, particularly in subtropical regions.
ProblemThis study investigated both main temperature effects and the added effects of heat waves on ambulance attendances in Brisbane, a subtropical city in Australia.
MethodsDaily data relating to 783,935 ambulance attendances, along with data on meteorological variables and air pollutants, were collected for the period 2000-2007. Ambient temperature (main) effects were assessed using a distributed lag nonlinear approach that accounted for delayed effects of temperature, while added heat wave effects were incorporated separately using a local heat wave definition. Effect estimates were obtained for total, cardiovascular and respiratory attendances, and different age groups.
ResultsMain effects of temperature were found for total attendances, which increased by 50.6% (95% CI, 32.3%-71.4%) for a 9.5°C increase above a reference temperature of 29°C. An added heat wave effect on total attendances was observed (18.8%; 95% CI, 6.5%-32.5%). Significant effects were found for both respiratory and cardiovascular attendances, particularly for those aged 65 and above.
ConclusionAmbulance attendances can be significantly impacted by sustained periods of high temperatures, and are a valid source of early detection of the effects of extreme temperatures on the population. The planning of ambulance services may need to be adapted as a consequence of increasing numbers of heat waves in the future. Ambulance attendance data also should be utilized in the development of heat warning systems and climate change adaptation strategies.
. ,Turner LR ,Connell D .Tong S The Effect of Heat Waves on Ambulance Attendances in Brisbane, Australia . Prehosp Disaster Med.2013 ;28 (5 ):1 -6
Special Report
Disasters and Women's Health: Reflections from the 2010 Earthquake in Haiti
- Christina M. Bloem, Andrew C. Miller
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- Published online by Cambridge University Press:
- 04 January 2013, pp. 150-154
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Introduction
Increasing attention is being focused on the needs of vulnerable populations during humanitarian emergency response. Vulnerable populations are those groups with increased susceptibility to poor health outcomes rendering them disproportionately affected by the event. This discussion focuses on women's health needs during the disaster relief effort after the 2010 earthquake in Haiti.
ReportThe Emergency Department (ED) of the temporary mobile encampment in L'Hôpital de l'Université d'Etat d'Haïti (HUEH) was the site of the team's disaster relief mission. In February 2010, most of the hospital was staffed by foreign physicians and nurses, with a high turnover rate. Although integration with local Haitian staff was encouraged, implementation of this practice was variable. Common presentations in the ED included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up care of post-earthquake injuries and infections. Women-specific complaints included vaginal infections, breast pain or masses, and pregnancy-related concerns or complications. Women were also targets of gender-based violence.
DiscussionRecent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced health care in suboptimal environments. Much room for improvement remains. Although the assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level of care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions.
ConclusionSimple, inexpensive modifications to disaster relief health care settings can dramatically reduce barriers to care for vulnerable populations.
. ,Bloem CM .Miller AC Disasters and Women's Health: Reflections from the 2010 Earthquake in Haiti . Prehosp Disaster Med.2013 ;28 (2 ):1 -5
Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay
- Sarah M. Dougherty, Jennifer Leaning, P. Gregg Greenough, Frederick M. Burkle, Jr.
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- Published online by Cambridge University Press:
- 30 September 2013, pp. 616-624
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Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO.
. ,Dougherty SM ,Leaning J ,Greenough PG .Burkle FM Jr Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay . Prehosp Disaster Med.2013 ;28 (6 ):1 -9
Original Research
External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness
- Erin L. Downey, Knox Andress, Carl H. Schultz
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- Published online by Cambridge University Press:
- 14 March 2013, pp. 264-271
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Introduction
The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.
MethodsThis study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.
ResultsInvestigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.
ConclusionHospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.
. ,Downey EL ,Andress K .Schultz CH External Factors Impacting Hospital Evacuations Caused by Hurricane Rita: The Role of Situational Awareness . Prehosp Disaster Med.2013 ;28 (3 ):1 -8