6 results
Chapter 11 - Auxiliary Medical Services in a Field Hospital
- from Section 3 - Operational Considerations
- Edited by Elhanan Bar-On, Kobi Peleg, Yitshak Kreiss
-
- Book:
- Field Hospitals
- Published online:
- 09 January 2020
- Print publication:
- 09 January 2020, pp 88-100
-
- Chapter
- Export citation
-
Summary
Field hospitals are a vital element in providing as many medical services as possible to a stricken population in times of disaster. Setting up a field hospital with advanced auxiliary medical services is possible as long as there is comprehensive and careful planning, training, and preparation done ahead of time. The main objective of the AMS department is to organize and assist in establishing the field hospital, ensure its smooth and efficient operation throughout the stay, and, at the close of a mission to disassemble the equipment for its return journey and then ensure it is in optimum working order for the next call up. The department is responsible for maintaining all medical devices in perfect working order with the focus being on safety compliance and patient welfare. The four core services provided by the department cover medical engineering, medical equipment and pharmacy, diagnostic imaging, and the clinical laboratory. All these services operate according to a predetermined workflow and clear working guidelines. In keeping with the goals of the humanitarian mission, the medical engineering service will handle the acquisition and maintenance of equipment capable of functioning in an electricity free environment. They will verify that all devices are robust and capable of operating under extreme weather conditions and comply with any specifications mandated by the different countries. The pharmacy service plays a vital role in ensuring medicine and its accompanying information is handled efficiently and safely. Data is accrued over the span of a mission to assist with ever more accurate future planning. The diagnostic imaging service must be able to provide both investigative and diagnostic examinations. This service is agile and can be provided in an imaging department tent, a dedicated container unit or bedside for patients who are not to be moved. The clinical laboratory service performs a full array of tests that facilitate in diagnosis and treatment of the patient. The services provided by the laboratory include biochemistry, hematology, and microbiology. The laboratory diagnoses the pathogens in infectious diseases and identifies the type of bacteria and its susceptibility to various antibiotics.
PP121 How To Involve Patients In Decisions About Antibiotic Prophylaxis After Tick Bite
- Sylvie Bouchard, Gaelle Gernigon, Fatiha Karam, Jean-Marc Daigle, Genevieve Morrow, Adriana Freitas, Mélanie Tardif
-
- Journal:
- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 59
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Antibiotic prophylaxis with a single dose of doxycycline after a tick bite is one of the tools for preventing Lyme disease, which is becoming increasingly prevalent in Quebec. The aim of this work was to revisit this practice in adults and children younger than 8 years of age.
MethodsTo assess the safety and absolute risk reduction (ARR) of doxycycline for preventing Lyme disease in contraindicated populations, two systematic reviews were conducted with a re-analysis of the original efficacy data. A knowledge mobilization framework was used to consider the scientific, contextual, and experiential evidence, taking into account information on patients’ and clinicians’ experiences.
ResultsA single dose of doxycycline prescribed within 72 hours of being bitten by a tick (Ixodes scapularis) could prevent cutaneous manifestation of Lyme disease (ARR -2.8%, 95% confidence interval: -11.7–6.1; p = 0.06), without serious side effects, provided that the bite occurred in a geographical region where at least 25 percent of nymph and 50 percent of adult ticks are infected with the disease. However, the level of evidence was low and its generalizability to other contexts was doubtful. The decision to prescribe antibiotic prophylaxis may be based more on the fear of Lyme disease, rather than on effectiveness data and the real risk of contracting Lyme disease.
ConclusionsIt may be challenging for clinicians to discuss Lyme disease prophylaxis with patients and their families in contexts where people are fearful of the disease, and the risk of contracting it from a tick bite is uncertain. Decision aids that provide scientific evidence on the real risk of developing Lyme disease after a tick bite, particularly in Quebec, can promote informed decisions based on patient preferences and values by supporting discussion between clinicians and patients.
Disaster Preparedness Technician = Striking Cost Savings
- Jasmine Dexter, Melanie Morrow, Kelly Fogarty, Abigail Trewin
-
- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, pp. s122-s123
- Print publication:
- May 2019
-
- Article
-
- You have access Access
- Export citation
-
Introduction:
The workplace holds a rapidly deployable, self-sufficient field hospital including a medicine cache valued at $80,000. The cache is rotated through the affiliated hospital pharmacy when they have less than 12 months to their expiry. Rotations are done regularly due to the short expiry dates of stock coming from suppliers. A senior pharmacy technician is employed two days per week at a cost of $13,024.80 per annum to manage this cache.
Aim:To demonstrate the associated cost savings of employing a pharmacy technician to manage a medication cache.
Methods:Every month, the technician extracts items with less than a year expiry from the stock control system and compares these dates with that of the stock held in the pharmacy. All items with a better expiry date are rotated as long as there is sufficient turnover to ensure use before its expiry. Automatic recording occurs of items rotated, items discarded, and their costs are used as key performance indicators (KPI).
Results:Over a 12 month period, $52,803 worth of stock was rotated. On average, 48 lines and 7,619 individual items were rotated monthly with a value of $4,061.83 (range $0-$8,820 per month). During this period, there were 2 months where no rotations occurred due to staff changeover and annual leave. 10 lines of medicines at a value of $4,041 were discarded over this time period. The two main reasons for discarding were that the medicine was not a pharmacy item or was not used in a large enough quantity to allow rotation.
Discussion:The equivalent of four times the technician’s wage was saved over 12 months. This illustrates striking cost savings gained by efficient, timely rotations and the cost benefits of employing a technician.
Preparing for Disaster: Behind the Scenes of Maintaining and Deploying an Emergency Medical Team…Equipped. Prepared. Ready.
- Matthew Schobben, Inda Acharya, Dinorah Caeiro Alves, Juno Eadie, Melanie Morrow, Abigail Trewin, Hollie Sekulich
-
- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, pp. s159-s160
- Print publication:
- May 2019
-
- Article
-
- You have access Access
- Export citation
-
Introduction:
Deploying an EMT to respond to a sudden onset disaster entails significant operational activities and support back home to deploy and support a responding team. These activities also include peacetime operations, exercising, innovation, engagement, training, and development of both team members and operational staff to further knowledge and experience.
Aim:To exhibit the operational activities and complexities of maintaining a deployable cache of equipment and consumables for deploying a self-sustaining Emergency Medical Team (EMT). This includes the elements of managing a high-performance team, human resource management ensuring the readiness of personnel to rapidly respond, maintaining World Health Organization (WHO) international standards for EMTs, and the operational aspects and support behind the scenes to deploy a team.
Methods:Analysis of operational activities and support for pre-deployment, deployment, and post-deployment phases including preparedness through innovation, collaboration, development, and maintenance of a high-performance team and cache.
Results:The analysis of operational activities behind the scenes of deploying EMT maps the unique complexities of maintaining and deploying a high-performance team at all stages of deployment, demonstrating the success of a team in the field is attributed to the support and activities of the team back home to deploy them.
Discussion:There is substantial preparation and behind the scenes operational activities that are undertaken to deploy and support a deployed EMT. Lessons learned from each deployment build on the operational capacity of staff deploying a team and on the future directions, innovations, and practices of a deployed team in the field.
Immunization Readiness of a Deploying Emergency Medical Team
- Melanie Morrow, Hollie Sekulich, Abigail Trewin, Peter Archer
-
- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, pp. s137-s138
- Print publication:
- May 2019
-
- Article
-
- You have access Access
- Export citation
-
Introduction:
It is a requirement for a World Health Organization verified Emergency Medical Team (EMT) that all members be immunized against common diseases in the deploying region. Most jurisdictions use private suppliers such as travel doctors for immunization services. When a deployment is announced, members are nominated by their jurisdiction under the condition they are fully immunized. It is up to the individual to monitor their immunization status.
Aim:To determine how many members nominated for deployment were fully immunized.
Methods:Nominated members sent their completed vaccination record to a central location for assessment of their immunization status. The following data were recorded: vaccination status, last-minute booster doses required, and the number of emails sent by the assessor in processing the records. The number of phone calls made and received were not recorded.
Results:To complete the skills matrix for a field hospital containing an emergency department and operating theater (an EMT type 2), 61 members were nominated. At the time of assessment, 32 (52%) were fully immunized, requiring no further booster doses (vaccinations or serology tests). Three members were removed from the deployment as they were not fully immunized. Last-minute booster doses were required by 27 (44%) members, with a total of 74 booster doses administered (range 0-5). 19 of the booster doses administered were immunizations required to work in any health facility in Australia. The most common vaccines requiring booster doses were rabies (n=21) and typhoid (n=15). 58 emails were sent over a period of 5 days to 24 members to clarify vaccination status.
Discussion:This deployment highlighted a gap in members’ perception of their immunization status, leading to delays in deployment readiness for the team. A new electronic system where vaccine status tracking occurs in real time should address this issue.
Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner
- Jiwon Oh, Marie-Sarah Gagné-Brosseau, Melanie Guenette, Catherine Larochelle, François Lemieux, Suresh Menon, Sarah A. Morrow, Laurence Poliquin-Lasnier, Chantal Roy-Hewitson, Carolina Rush, Anne-Marie Trudelle, Paul S. Giacomini
-
- Journal:
- Canadian Journal of Neurological Sciences / Volume 45 / Issue 3 / May 2018
- Published online by Cambridge University Press:
- 14 May 2018, pp. 304-312
-
- Article
-
- You have access Access
- HTML
- Export citation
-
The objective of this study was to develop a shared-care model to enable primary-care physicians to participate more fully in meeting the complex, multidisciplinary healthcare needs of patients with multiple sclerosis (MS). Design: The design consisted of development of consensus recommendations and a shared-care algorithm. Participants: A working group of 11 Canadian neurologists involved in the management of patients with MS were included in this study. Main message: The clinical management of patients with multiple sclerosis is increasing in complexity as new disease-modifying therapies (DMTs) become available, and ongoing safety monitoring is required. A shared-care model that includes primary care physicians is needed. Primary care physicians can assist in the early detection of MS of individuals presenting with neurological symptoms. Additional key roles for family physicians are health promotion, symptom management, and safety and relapse monitoring of DMT-treated patients. General principles of health promotion include counseling MS patients on maintaining a healthy lifestyle; performing standard screening measures; and identifying and treating comorbidities. Of particular importance are depression and anxiety, which occur in >20% of MS patients. Standard work-ups and treatments are needed for common MS-related symptoms, such as fatigue, pain, bladder dysfunction, sexual dysfunction, spasticity, and sleep disorders. Ongoing safety monitoring is required for patients receiving specific DMTs. Multiple sclerosis medications are generally contraindicated during pregnancy, and patients should be counseled to practice effective contraception. Conclusions: Multiple sclerosis is a complex, disabling illness, which, similar to other chronic diseases, requires ongoing multidisciplinary care to meet the evolving needs of patients throughout the clinical course. Family physicians can play an invaluable role in maintaining general health, managing MS-related symptoms and comorbidities, monitoring for treatment-related adverse effects and MS relapses, and coordinating allied health services to ensure continuity of care to meet the complex and evolving needs of MS patients through the disease course. RÉSUMÉ:Élaborer un modèle de soins partagés dans les cas de sclérose en plaques récurrente-rémittente.Objectif: Élaborer un modèle de soins partagés afin de permettre aux médecins de première ligne de mieux répondre aux besoins complexes et multidisciplinaires de patients atteints de la sclérose en plaques (SP). Conception : Recommandations résultant d’un consensus et élaboration d’un algorithme en matière de soins partagés. Participants : Un groupe de travail formé de onze neurologues canadiens impliqués dans la prise en charge de patients atteints de la SP. Message-clé : La prise en charge clinique de patients atteints de la SP est de plus en plus complexe dans la mesure où des médicaments modificateurs de l’évolution de la maladie (MMSP) deviennent accessibles et où un suivi permanent en matière de sécurité est nécessaire. Soulignons aussi qu’un modèle de soins partagés incluant les médecins de première ligne est nécessaire. Ces professionnels peuvent permettre un dépistage plus rapide de la SP chez des individus présentant des symptômes neurologiques. Ils peuvent aussi jouer un rôle de premier plan en matière de promotion de la santé, de soulagement des symptômes et de suivi de patients traités avec des MMSP en ce qui a trait à leur sécurité et à de possibles rechutes. Parmi les principes généraux de promotion de la santé, on peut inclure les suivants : offrir aux patients atteints de la SP des conseils leur permettant de maintenir de saines habitudes de vie ; adopter des mesures de dépistage standards ; identifier et traiter les comorbidités. À cet égard, l’anxiété et la dépression sont d’une importance particulière et sont fréquemment signalées (> 20 %) chez les patients atteints de SP. Des démarches d’investigation et des traitements standards sont nécessaires dans le cas des symptômes courants reliés à la SP, par exemple de la fatigue, des douleurs, une dysfonction vésicale, des dysfonctions sexuelles, de la spasticité et des troubles du sommeil. On l’a dit, un suivi permanent s’impose dans le cas de patients bénéficiant d’un traitement spécifique avec des MMSP. Les médicaments associés à la SP sont généralement contre-indiqués durant la grossesse de sorte qu’on devrait conseiller aux patients d’adopter des méthodes de contraception efficaces. Conclusions : La SP est une maladie complexe et invalidante qui, à l’instar d’autres maladies chroniques, exige des soins multidisciplinaires continus afin de répondre, en lien avec un tableau clinique précis, aux besoins en constante évolution des patients. Les médecins de première ligne peuvent jouer un rôle irremplaçable à plusieurs égards : dans le maintien d’une bonne santé ; le suivi et le soulagement des symptômes et des comorbidités reliés à la SP ; le suivi des rechutes et des effets indésirables associés aux traitements. N’oublions pas non plus la coordination des services paramédicaux afin d’assurer, durant l’évolution de la SP, une continuité des soins répondant aux besoins complexes et en constante évolution des patients atteints de cette maladie.