Editorial
Cholera in Haiti: Redefining Emergency Public Health Philosophy
- Samuel J. Stratton
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- Published online by Cambridge University Press:
- 03 May 2013, pp. 195-196
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Throwing the Baby Out With the Bathwater: Can the Military's Role in Global Health Crises be Redeemed?
- Frederick M. Burkle, Jr.
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- 14 March 2013, pp. 197-199
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For decades, military humanitarian assistance programs have avoided empirical scrutiny, leaving researchers, the humanitarian community and decision makers without proof of outcome. This Editorial highlights the findings of three major studies that disclose deficits in the quality of the performance and reporting of humanitarian missions, and offer guidance for change. The author suggests that, contrary to current plans to limit the military's role in humanitarian assistance, emerging crises actually increase civilian security risks and that it is time for a new partnership of military and civilian humanitarian resources to evolve in the interest of human security.
.Burkle FM Throwing the Baby Out With the Bathwater: Can the Military's Role in Global Health Crises be Redeemed? . Prehosp Disaster Med.2013 ;28 (3 ):1 –3. .
Pandering to Ignorance on Climate Change: Lessons from an Investment Strategist
- Frederick M. Burkle, Jr
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- 10 April 2013, pp. 200-201
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An investment strategist recently published, in the journal Nature, an impassioned plea to all scientists that they must begin to speak out on the resource crisis exacerbated by global warming. In this Editorial response, the author reminds health professionals that they can no longer stay silent and pander to the ignorance of others, and challenges them, along with multidisciplinary partners and stakeholders, to define a strong collaborative and cooperative stance on climate change.
Burkle FM Jr. .Pandering to Ignorance on Climate Change: Lessons from an Investment Strategist . Prehosp Disaster Med.2013 ;28 (4 ):1 -2
Original Research
Increased Incidence of Escherichia Coli Bacteremia Post-Christchurch Earthquake 2011: Possible Associations
- Mona Schousboe, Jania Lynds, Chris Ambrose
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- Published online by Cambridge University Press:
- 21 February 2013, pp. 202-209
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Introduction
Earthquakes are natural events that contribute to the transmission of infectious diseases. The aim of this research was to determine whether the observed increase in Escherichia coli (E. coli) bloodstream infections (BSI) during the period March-June 2011 was associated with the February 2011 Christchurch earthquake.
MethodsDescriptive statistics and spatial distributional analysis techniques were used to quantify patients with E. coli BSI in 2009-2011.
ResultsE. coli BSI acquired from non-catheter related urinary tract infection (UTI) was the predominant infection type, with the greatest increase during March-June 2011. Bacteremia incidence was higher in females than in males for 2009-2011. In 2011, the median age of patients was 75 years, and an increase in males acquiring such infections was noted. Spatial distributional analysis failed to show direct association between bacteremia cases and liquefaction-related land damage or drinking water contamination. A higher incidence of E. coli BSI post-earthquake in the eastern suburbs, which tend towards a higher level of socioeconomic deprivation, was observed.
ConclusionA number of possible factors contributing to the observed increase in E. coli BSI acquired from UTI in 2011 were considered. Individuals with higher deprivation indices, males and the elderly may be particularly vulnerable to the effects of a major disaster with subsequent breakdown of infrastructure. These findings have important implications in natural disaster situations, and justify development of strategies to identify UTI and pyelonephritis risk factors and to manage E. coli bacteremia incidence rates.
. ,Schousboe M ,Lynds J .Ambrose C Increased Incidence of Escherichia Coli Bacteremia Post-Christchurch Earthquake 2011: Possible Associations . Prehosp Disaster Med.2013 ;28 (3 ):1 -8
Effect of Spinal Immobilization on Heart Rate, Blood Pressure and Respiratory Rate
- Stevan R. Bruijns, Henry R. Guly, Lee A. Wallis
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- 25 March 2013, pp. 210-214
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Introduction
Vital signs remain important clinical indicators in the management of trauma. Tissue injury and ischemia cause tachycardia and hypertension, which are mediated via the sympathetic nervous system (SNS). Spinal immobilization is known to cause discomfort, and it is not known how this might influence the SNS and contribute to abnormal vital signs.
HypothesisThis study aimed to establish whether the pain and discomfort associated with spinal immobilization and the maneuvers commonly used in injured patients (eg, log roll) affect the Heart rate (HR), Systolic Blood Pressure (SBP) and Respiratory rate (RR). The null hypothesis was that there are no effects.
MethodsA prospective, unblinded, repeated-measure study of 53 healthy subjects was used to test the null hypothesis. Heart rate, BP and RR were measured at rest (five minutes), after spinal immobilization (10 minutes), following log roll, with partial immobilization (10 minutes) and again at rest (five minutes). A visual analog scale (VAS) for both pain and discomfort were also collected at each stage. Results were statistically compared.
ResultsPain VAS increased significantly during spinal immobilization (3.8 mm, P < .01). Discomfort VAS increased significantly during spinal immobilization, after log roll and during partial immobilization (17.7 mm, 5.8 mm and 8.9 mm, respectively; P < .001). Vital signs however, showed no clinically relevant changes.
DiscussionSpinal immobilization does not cause a change in vital signs despite a significant increase in pain and discomfort. Since no relationship appears to exist between immobilization and abnormal vital signs, abnormal vital signs in a clinical situation should not be considered to be the result of immobilization. Likewise, pain and discomfort in immobilized patients should not be disregarded due to lack of changes in vital signs.
. ,Bruijns S ,Guly H .Wallis L Effect of Spinal Immobilization on Heart Rate, Blood Pressure and Respiratory Rate . Prehosp Disaster Med.2013 ;28 (2 ):1 -5
vTrain: A Novel Curriculum for Patient Surge Training in a Multi-User Virtual Environment (MUVE)
- Laura S. Greci, Rameshsharma Ramloll, Samantha Hurst, Karen Garman, Jaishree Beedasy, Eric B. Pieper, Ricky Huang, Erin Higginbotham, Zia Agha
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- Published online by Cambridge University Press:
- 07 February 2013, pp. 215-222
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Introduction
During a pandemic influenza, emergency departments will be overwhelmed with a large influx of patients seeking care. Although all hospitals should have a written plan for dealing with this surge of health care utilization, most hospitals struggle with ways to educate the staff and practice for potentially catastrophic events.
Hypothesis/ProblemTo better prepare hospital staff for a patient surge, a novel educational curriculum was developed utilizing an emergency department for a patient surge functional drill.
MethodsA multidisciplinary team of medical educators, evaluators, emergency preparedness experts, and technology specialists developed a curriculum to: (1) train novice users to function in their job class in a multi-user virtual environment (MUVE); (2) obtain appropriate pre-drill disaster preparedness training; (3) perform functional team exercises in a MUVE; and (4) reflect on their performance after the drill.
ResultsA total of 14 students participated in one of two iterations of the pilot training program; seven nurses completed the emergency department triage course, and seven hospital administrators completed the Command Post (CP) course. All participants reported positive experiences in written course evaluations and structured verbal debriefings, and self-reported increase in disaster preparedness knowledge. Students also reported improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance.
ConclusionData from this pilot program suggest that the immersive, virtual teaching method is well suited to team-based, reflective practice and learning of disaster management skills.
. ,Greci LS ,Ramloll R ,Hurst S ,Garman K ,Beedasy J ,Pieper EB ,Huang R ,Higginbotham E .Agha Z vTrain: A Novel Curriculum for Patient Surge Training in a Multi-User Virtual Environment (MUVE) . Prehosp Disaster Med.2013 ;28 (3 ):1 -8
WikiLeaks and Iraq Body Count: the Sum of Parts May Not Add Up to the Whole—A Comparison of Two Tallies of Iraqi Civilian Deaths
- Dustin Carpenter, Tova Fuller, Les Roberts
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- 07 February 2013, pp. 223-229
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Introduction
The number of civilians killed in Iraq following the 2003 invasion has proven difficult to measure and contentious in recent years. The release of the Wikileaks War Logs (WL) has created the potential to conduct a sensitivity analysis of the commonly-cited Iraq Body Count's (IBC's) tally, which is based on press, government, and other public sources.
HypothesisThe 66,000 deaths reported in the Wikileaks War Logs are mostly the same events as those previously reported in the press and elsewhere as tallied by iraqbodycount.org.
MethodsA systematic random sample of 2500 violent fatal War Log incidents was selected and evaluated to determine whether these incidents were also found in IBC's press-based listing. Each selected event was ranked on a scale of 0 (no match present) to 3 (almost certainly matched) with regard to the likelihood it was listed in the IBC database.
ResultsOf the two thousand four hundred and nine War Log records, 488 (23.8%) were found to have likely matches in IBC records. Events that killed more people were far more likely to appear in both datasets, with 94.1% of events in which ≥20 people were killed being likely matches, as compared with 17.4% of singleton killings. Because of this skew towards the recording of large events in both datasets, it is estimated that 2035 (46.3%) of the 4394 deaths reported in the Wikileaks War Logs had been previously reported in IBC.
ConclusionsPassive surveillance systems, widely seen as incomplete, may also be selective in the types of events detected in times of armed conflict. Bombings and other events during which many people are killed, and events in less violent areas, appear to be detected far more often, creating a skewed image of the mortality profile in Iraq. Members of the press and researchers should be hesitant to draw conclusions about the nature or extent of violence from passive surveillance systems of low or unknown sensitivity.
. ,Carpenter D ,Fuller T .Roberts L WikiLeaks and Iraq Body Count: the Sum of Parts May Not Add Up to the Whole—A Comparison of Two Tallies of Iraqi Civilian Deaths . Prehosp Disaster Med.2013 ;28 (3 ):1 -7
Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012
- Derek Licina
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- Published online by Cambridge University Press:
- 15 February 2013, pp. 230-238
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Background
United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.
MethodsA systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.
ResultsOf the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant.
DiscussionWithout rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.
.Licina D Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012 . Prehosp Disaster Med.2013 ;28 (3 ):1 –10. .
Holy Shroud Exhibition 2010: Health Services During a 40-Day Mass-Gathering Event
- Michelangelo Bortolin, Marco Ulla, Alessia Bono, Enrico Ferreri, Mariano Tomatis, Sergio Sgambetterra
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- Published online by Cambridge University Press:
- 21 March 2013, pp. 239-244
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Introduction
Mass-gathering events require varying types and amounts of medical resources to deal with patient presentations as well as careful planning for environmental health management. The Holy Shroud Exhibition was hosted in Torino, Italy, between April and May 2010. The venue was a unique mass-gathering event which lasted several weeks. It was held in a limited area in the center of the city and it was attended by a large and heterogeneous population. A dedicated Health Care Service was created for the event.
MethodsThis study is a retrospective analysis of clinical presentations of patients who were managed by the Medical Services during the event. The main study outcomes included Patient Presentation Rate (PPR), type of injuries and illnesses, and the Transport to Hospital Rate (TTHR).
ResultsThe PPR and TTHR were both low (0.27 and 0.039 respectively). The majority of patients presented with low severity codes and no sudden cardiac death (SCD) or cardiac arrest occurred. Cardiac and trauma emergencies were most frequent categories of presentation. A number of pediatric patients (19.37%) were treated by the event Medical Service. Approximately two million persons participated in the 40-day event.
ConclusionThe experience for this 40-day event supported having an on-site, organized, dedicated Medical Service that decreased overcrowding of the local Emergency Medical System and hospitals. It is recommended that, for such events, there be recruitment of emergency physicians with experience in mass-gathering events, recruitment of pediatricians, and training for professionals during the planning process.
. ,Bortolin M ,Ulla M ,Bono A ,Ferreri E ,Tomatis M .Sgambetterra S Holy Shroud Exhibition 2010: Health Services During a 40-Day Mass-Gathering Event . Prehosp Disaster Med.2013 ;28 (3 ):1 -6
Impact of the Christchurch Earthquakes on Hospital Staff
- Pleayo Tovaranonte, Tom J. Cawood
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- 26 March 2013, pp. 245-250
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Introduction
On September 4, 2010 a major earthquake caused widespread damage, but no loss of life, to Christchurch city and surrounding areas. There were numerous aftershocks, including on February 22, 2011 which, in contrast, caused substantial loss of life and major damage to the city. The research aim was to assess how these two earthquakes affected the staff in the General Medicine Department at Christchurch Hospital.
ProblemTo date there have been no published data assessing the impact of this type of natural disaster on hospital staff in Australasia.
MethodsA questionnaire that examined seven domains (demographics, personal impact, psychological impact, emotional impact, impact on care for patients, work impact, and coping strategies) was handed out to General Medicine staff and students nine days after the September 2010 earthquake and 14 days after the February 2011 earthquake.
ResultsResponse rates were ≥ 99%. Sixty percent of responders were <30 years of age, and approximately 60% were female. Families of eight percent and 35% had to move to another place due to the September and February earthquakes, respectively. A fifth to a third of people had to find an alternative route of transport to get to work but only eight percent to 18% took time off work. Financial impact was more severe following the February earthquake, with 46% reporting damage of >NZ $1,000, compared with 15% following the September earthquake (P < .001). Significantly more people felt upset about the situation following the February earthquake than the September earthquake (42% vs 69%, P < .001). Almost a quarter thought that quality of patient care was affected in some way following the September earthquake but this rose to 53% after the February earthquake (12/53 vs 45/85, P < .001). Half believed that discharges were delayed following the September earthquake but this dropped significantly to 15% following the February earthquake (27/53 vs 13/62, P < .001).
ConclusionThis survey provides a measure of the result of two major but contrasting Christchurch earthquakes upon General Medicine hospital staff. The effect was widespread with minor financial impact during the first but much more during the second earthquake. Moderate psychological impact was experienced in both earthquakes. This data may be useful to help prepare plans for future natural disasters.
. ,Tovaranonte P .Cawood TJ Impact of the Christchurch Earthquakes on Hospital Staff . Prehosp Disaster Med.2013 ;28 (3 ):1 -6
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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- 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
Initial Management of Hospital Evacuations Caused by Hurricane Rita: A Systematic Investigation
- Erin L. Downey, Knox Andress, Carl H. Schultz
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- Published online by Cambridge University Press:
- 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
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
Preparedness for and Impact of Tropical Cyclone Yasi in North Queensland, Australia
- Kim Usher, Petra Buettner, Caryn West, Jane Millis, Cindy Woods, Matt Mason, Helen Boon, Jennifer Chamberlain-Salaun
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- Published online by Cambridge University Press:
- 27 March 2013, pp. 272-278
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Introduction
Tropical cyclone (TC) Yasi, thought to be the largest and most severe cyclone to cross the Queensland coast since 1918, made landfall on the southern tropical coast near Mission Beach and continued to track westward across Northern Queensland on February 3, 2011. The warning and response model (WRM) suggests that situational factors, personal characteristics, and social contextual variables influence the degree of threat perceived and protective actions taken.
AimThe aim of this study was to examine preparation for this impending natural disaster by residents of the affected regions, and to identify the residents’ resource losses and symptoms of psychological distress following TC Yasi.
MethodsA cross-sectional survey was conducted 6-12 months after the cyclone using an adapted tool designed to measure preparedness, loss and psychosocial distress. Four hundred and thirty-three responses were received. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS). Categorical characteristics were described using sample size and percentages.
ResultsAlmost all respondents perceived the cyclone warning as serious or very serious, and more than a third started preparing for the cyclone at least three days before it reached landfall. Overall, 115 (26.7%) respondents reported moderate and 59 (13.7%) reported major property damage; 72 (17.1%) reported a moderate and 49 (11.6%) reported a major change in their feeling of whether they have control over their life; 55 (13.1%) reported a major change in their motivation of getting things done; and 33 (7.9%) reported a major change in their perception of feeling valuable to others. Overall, 142 (34.1%) documented at least one of five symptoms of acute distress.
ConclusionThe findings document the experiences of Australians who have lived through tropical cyclone Yasi. The results support the WRM theory which proposes that people with previous experience take threatened disasters seriously.
. ,Usher K ,Buettner P ,West C ,Millis J ,Woods C ,Mason M ,Boon H .Chamberlain-Salaun J Preparedness for and Impact of Tropical Cyclone Yasi in North Queensland, Australia . Prehosp Disaster Med.2013 ;28 (3 ):1 -7
The Impact of Recurrent Disasters on Mental Health: A Study on Seasonal Floods in Northern India
- Tim R. Wind, Pooran C. Joshi, Rolf J. Kleber, Ivan H. Komproe
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- 24 April 2013, pp. 279-285
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Introduction
Very little is known on the impact of recurrent disasters on mental health.
AimThe present study examines the immediate impact of a recurrent flood on mental health and functioning among an affected population in the rural district of Bahraich, Uttar Pradesh, India, compared with a population in the same region that is not affected by floods.
MethodsThe study compared 318 affected respondents with 308 individuals who were not affected by floods. Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25). Psychological and physical functioning was assessed by using the Short Form-12 (SF-12).
ResultsThe affected group showed large to very large differences with the comparison group on symptoms of anxiety (D = .92) and depression (D = 1.22). The affected group scored significantly lower on psychological and physical functioning than the comparison group (respectively D = .33 and D = .80). However, hierarchical linear regressions showed no significant relationship between mental health and the domains of functioning in the affected group, whereas mental health and the domains of functioning were significantly related in the comparison group.
ConclusionThis study found a large negative impact of the recurrent floods on mental health outcomes and psychological and physical functioning. However, in a context with recurrent floods, disaster mental health status is not a relevant predictor of functioning. The findings suggest that the observed mental health status and impaired functioning in this context are also outcomes of another mechanism: Both outcomes are likely to be related to the erosion of the social and environmental and material context. As such, the findings refer to a need to implement psychosocial context-oriented interventions to address the erosion of the context rather than specific mental health interventions.
. ,Wind TR ,Joshi PC ,Kleber RJ .Komproe IH The Impact of Recurrent Disasters on Mental Health: A Study on Seasonal Floods in Northern India . Prehosp Disaster Med.2013 ;28 (3 ):1 -7
Serving Limited English Proficient Callers: A Survey of 9-1-1 Police Telecommunicators
- Lauren N. Carroll, Rebecca E. Calhoun, Cleo C. Subido, Ian S. Painter, Hendrika W. Meischke
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- 28 March 2013, pp. 286-291
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Introduction
The emergency telephone number 9-1-1 serves as a lifeline to the public during emergencies, and first responders rely on information gathered by 9-1-1 telecommunicators who speak with callers. Timely, accurate information from the telecommunicators is essential for providing appropriate care on scene. Language barriers can hamper these efforts and result in less efficient information exchange. Although 9-1-1 telecommunicators may access over-the-phone interpreter (OPI) services to facilitate communication, managing three-way communication during an emergency is challenging.
ProblemThere is little published on the relationship between limited English proficient (LEP) callers and 9-1-1 police telecommunicators, and the role of OPI services during these calls. Further, little is known about effective strategies to manage such calls.
MethodsIn King County, Washington, 9-1-1 police telecommunicators were surveyed about their experiences handling LEP calls and managing three-way communication with OPI services. The survey contained 13 multiple-choice and three open-response questions addressing communication strategies, challenges with LEP callers, and three-way communication with OPI services. Goodman-Kruskal Gamma and chi-square tests were conducted with OPI use as the dependent variable. Additional analyses were conducted using stress levels as the dependent variable.
ResultsOf 123 respondents, 69 (56.5%) 9-1-1 telecommunicators reported utilizing OPI services at least 75% of the time when receiving a call from an LEP caller. Further, 35 (28.7%) of these telecommunicators reported calls with LEP individuals as more stressful than calls with fluent English speakers. Dispatcher stress level during LEP calls compared with stress during calls with fluent English speakers was positively associated with use of OPI services (P < .01). Further, stress level was also positively associated with telecommunicator difficulties in assessing the situation with respect to officer safety (P < .01). Sixty-three (58.3%) of the telecommunicators described difficulties assessing the situation to determine the appropriate response as the biggest challenge with LEP callers. Additionally, 62 (53%) identified knowing their location in English as information LEP callers need to know prior to calling 9-1-1.
ConclusionThese results highlight intervention opportunities for both 9-1-1 telecommunicators and LEP communities. Together, interventions such as working with LEP communities to educate them on best communication practices during 9-1-1 calls, and with 9-1-1 telecommunicators to help them manage three-way communication and reduce stress associated with concern for officer safety may improve emergency communication during 9-1-1 calls.
. ,Carroll LN ,Calhoun RE ,Subido CC ,Painter IS .Meischke HW Serving Limited English Proficient Callers: A Survey of 9-1-1 Police Telecommunicators . Prehosp Disaster Med.2013 ;28 (3 ):1 -6
Comprehensive Review
Exploring Culture: Audience Predispositions and Consequent Effects on Audience Behavior in a Mass-Gathering Setting
- Alison Hutton, Steve Brown, Naomi Verdonk
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- Published online by Cambridge University Press:
- 14 March 2013, pp. 292-297
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Introduction
The purpose of this critical review is to look at the current literature regarding mass gatherings and to create further understanding of this area with a particular focus on what the audience brings with them to the event, particularly in a planned event with a cultural theme or focus. Through an understanding of these predispositions and consequent effects on audience behavior in a mass-gathering setting, a more complete understanding of motivation factors of crowds and audiences can also be found.
MethodsA critical review of mass-gathering literature was undertaken by searching various online academic databases. Peer-reviewed scholarly articles relevant to the cultural aspects associated with religious, sporting and music mass gatherings were also analyzed.
ResultsResults from the review show that the word “culture” is often used to explain what happens at the event without reflecting how the motivations or behaviors of audiences at an event are influenced by the cultural predispositions of the audience.
ConclusionsBy understanding the cultural predispositions of the audience, event planners and designers, event risk managers and event safety personnel are able to better understand the motivation of the audience and how this might impact on audience behavior at the event. Further work needs to be done, however, to investigate the broader range of predispositions. The ultimate aim of developing this understanding is to better inform the health promotion and public health messages that can be developed for a particular type of event based on the likely composition of the audience in attendance.
. ,Hutton A ,Brown S .Verdonk N Exploring Culture: Audience Predispositions and Consequent Effects on Audience Behavior in a Mass-Gathering Setting . Prehosp Disaster Med.2013 ;28 (3 ):1 -6
Special Report
New Information Technology Tools for a Medical Command System for Mass Decontamination
- Akira Fuse, Tetsu Okumura, Jun Hagiwara, Tomohide Tanabe, Reo Fukuda, Tomohiko Masuno, Seiji Mimura, Kaname Yamamoto, Hiroyuki Yokota
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- Published online by Cambridge University Press:
- 07 February 2013, pp. 298-300
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In a mass decontamination during a nuclear, biological, or chemical (NBC) response, the capability to command, control, and communicate is crucial for the proper flow of casualties at the scene and their subsequent evacuation to definitive medical facilities. Information Technology (IT) tools can be used to strengthen medical control, command, and communication during such a response. Novel IT tools comprise a vehicle-based, remote video camera and communication network systems.
During an on-site verification event, an image from a remote video camera system attached to the personal protective garment of a medical responder working in the warm zone was transmitted to the on-site Medical Commander for aid in decision making. Similarly, a communication network system was used for personnel at the following points: (1) the on-site Medical Headquarters; (2) the decontamination hot zone; (3) an on-site coordination office; and (4) a remote medical headquarters of a local government office. A specially equipped, dedicated vehicle was used for the on-site medical headquarters, and facilitated the coordination with other agencies.
The use of these IT tools proved effective in assisting with the medical command and control of medical resources and patient transport decisions during a mass-decontamination exercise, but improvements are required to overcome transmission delays and camera direction settings, as well as network limitations in certain areas.
. ,Fuse A ,Okumura T ,Hagiwara J ,Tanabe T ,Fukuda R ,Masuno T ,Mimura S ,Yamamoto K .Yokota H New Information Technology Tools for a Medical Command System for Mass Decontamination . Prehosp Disaster Med.2013 ;28 (3 ):1 -3
Case Report
Prehospital Synchronized Electrical Cardioversion of a Poorly Perfused SVT Patient by Paramedics
- Gavin Smith, David McD Taylor, Amee Morgans, Peter Cameron
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- Published online by Cambridge University Press:
- 14 March 2013, pp. 301-304
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Synchronized Direct Current Cardioversion (SDC) is an established therapy for the termination of supraventricular tachycardia (SVT – either atrio-ventricular nodal reentry tachycardia (AVNRT) or atrio-ventricular reentrant tachycardia (AVRT)) with poor perfusion. The evidence is extremely limited with regard to the safety and effectiveness of this therapy. In Australia, half of the eight ambulance services include SDC within their clinical practice guidelines for the management of poorly perfused SVT; however the degree of variation in the application of SDC across these guidelines suggests a need to quantify the practice. This case provides a previously unreported example of the safety and effectiveness of prehospital SDC for SVT (with poor perfusion precipitated by a Valsalva Maneuver) by Victorian paramedics, and discusses the available literature regarding the effectiveness and safety of this practice.
. ,Smith G ,Taylor D ,Morgans A .Cameron P Prehospital Synchronized Electrical Cardioversion of a Poorly Perfused SVT Patient by Paramedics . Prehosp Disaster Med.2013 ;28 (3 ):1 -4
Brief Report
A Consensus Process on the Use of Exercises and After Action Reports to Assess and Improve Public Health Emergency Preparedness and Response
- Elena Savoia, Jessica Preston, Paul D. Biddinger
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- Published online by Cambridge University Press:
- 28 March 2013, pp. 305-308
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Introduction
The objective of disaster preparedness is to ensure that appropriate systems, procedures, and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation of services. Disaster preparedness efforts include the identification of possible health scenarios based on the probability of hazards and vulnerability of the population as a basis for creating a disaster plan. Exercises that simulate emergency response, involving the health and other sectors, have been suggested as useful tools to test the plans on a regular basis and measure preparedness efforts; the absence of actual testing is likely to negate even the best of abstract plans.
ProblemExercises and after action reports (AARs) are used to document preparedness activities. However, to date, limited analysis has been performed on what makes an exercise an effective tool to assess public health emergency preparedness (PHEP), and how AARs can be developed and used to support PHEP improvement efforts. The scope of this project was to achieve consensus on: (1) what makes an exercise an effective tool to assess PHEP; and (2) what makes an AAR an effective tool to guide PHEP improvement efforts.
MethodsSixty-one PHEP experts were convened by the use of Nominal Group Techniques to achieve consensus on a series of characteristics that exercises should have when designed to assess PHEP and on the recommendations for developing high-quality AARs.
ResultsThe panelists achieved consensus on a list of recommendations to improve the use of exercises and AARs in PHEP improvement efforts. Such recommendations ranged from the characteristics of the exercise audience to the evaluation methodology being used and the characteristics of the produced AAR such as its structure and content.
ConclusionsThe characteristics of the exercise audience, scenario and scope are among the most important attributes to the effectiveness of an exercise conducted for PHEP evaluation purposes. The evaluation instruments used to gather observations need an appropriate matching between exercise objectives and the response capabilities tested during the exercise, to build the base for the production of a good AAR. Improvements in the design and creation of exercises and AARs could facilitate better reporting and measurement of preparedness outcomes.
. ,Savoia E ,Preston J .Biddinger PD A Consensus Process on the Use of Exercises and After Action Reports to Assess and Improve Public Health Emergency Preparedness and Response . Prehosp Disaster Med.2013 ;28 (3 ):1 -4