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American Journal of Disaster Medicine [journal]
- Pediatric Surge Pocket Guide: Review of an easily accessible tool for managing an influx of pediatric patients. [Journal Article]
- Am J Disaster Med 2013; 8(1):75-82.
As seen in recent disasters, large-scale crisis events have the potential to cause significant pediatric death and injury. During such disaster situations, both distance and decreased mobility will likely limit access to pediatric hospitals. Thus, all hospitals, regardless if they regularly treat children or not, should anticipate an influx of pediatric patients in the event of a disaster. The Pediatric Surge Pocket Guide was developed for and distributed at a Pediatric Medical Surge Workshop held by the Los Angeles County Department of Public Health in June 2009. Designed both as a supplement to the workshop training and as an effective stand-alone resource, the Guide provides comprehensive pediatric-specific recommendations for hospitals experiencing a surge in pediatric capacity. Because of its unique pocket-size format, the Guide has the potential to be a readily accessible tool with application to a wide range of disaster or nondisaster situations, for use in hospital or nonhospital settings, and by pediatric specialists, nonspecialists, and nonclinicians alike.
- Assessing hospital disaster preparedness in Shiraz, Iran 2011: Teaching versus private hospitals. [Journal Article]
- Am J Disaster Med 2013; 8(1):65-73.
Background:In disasters, hospitals play a crucial role in supplying essential medical care to the society but there is no standardized checklist for assessing hospital disaster preparedness.
Objectives:The objective of this study was to recognize and compare almost all the components of disaster preparedness between teaching and private hospitals in Shiraz, Iran, focusing on incident command systems (ICS), communications, surge capacity, human resources, supply management, logistic service, case management, surveillance, laboratory and operating room management.
Methods:From May to August 2011, we assessed the preparedness of teaching and private hospitals in Shiraz, using the 10-key component World Health Organization checklist.
Results:Twenty four out of 31 hospitals responded. The scores for preparedness of ICS, communication, surge capacity and human resources was 73.9 percent, 67.3 percent, 49 percent, and 52.6 percent respectively. The preparedness scores for supply management and logistic services were 68.5 percent and 61.8 percent. While the levels of preparedness of laboratory and operating room management were low, preparedness of the surveillance system and case management were 66.7 percent and 70.8 percent, respectively. The average total preparedness of all hospitals was 59.5 percent, with scores of 62.2 percent in teaching hospitals and 55 percent in private hospitals.
Conclusion:At the time of our study, the total preparedness among hospitals was at the intermediate level, but in some key components such as operating room management, surge capacity, and human resources, the total preparedness was very limited and at an early stage of development, therefore, requiring urgent attention and improvement.
- La Gloria, Mexico: The possible origins and response of a worldwide H1N1 flu pandemic in 2009. [Journal Article]
- Am J Disaster Med 2013; 8(1):57-64.
This article traces the spread and route of the H1N1 pandemic in 2009 from its possible origin in La Gloria to Mexico City. A lack of health control measures or nonpharmaceutical interventions (NPIs) in La Gloria accounts for the unprecedented high basic reproductive number (R0) in that town and a higher incidence of H1N1 flu in Mexico City. We analyzed data collected from Mexican news articles, the Healthmaps dataset, the Google search engine, and telephone interviews with Mexican community physicians and residents. Our article uses a simple Susceptible Infected and Recovered model based on the data collected, to show the relationship between the disease curve and the implementation of NPI use. As a result of this study, we conclude that, with strict government measures to control the disease over an extended period of time, it is possible that many hundreds or even thousands of lives might be saved in the future.
- Public health preparedness and response competency model methodology. [Journal Article]
- Am J Disaster Med 2013; 8(1):49-56.
Objective:The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards.
Design:A systematic review of existing competency models generated a competency model of proposed domains and competencies.
Participants:National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process.
Results:The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers.
Conclusions:Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.
- Emergency preparedness in a sample of persons with disabilities. [Journal Article]
- Am J Disaster Med 2013; 8(1):35-47.
Objective:The objective of this study was to characterize emergency preparedness in this vulnerable population, and to ascertain the role of the personal assistant (PA) and the potential impact of prior emergency experience on preparedness efforts.
Design:Cross-sectional Internet-based survey conducted in 2011.
Participants:Two-hundred fifty-three community residents with cognitive and /or physical disabilities, all receiving personal assistance services. Main outcome variables: Emergency preparedness, operationalized as responses to a seven-item scale.
Results:The mean score for the emergency preparedness scale was 2.32 (SD = 2.74), range 0-7. Even though 62.8 percent (n = 159) of the participants had previously experienced one or more large-scale emergencies, only 47.4 percent (n = 120) of the entire sample and 55.3 percent (n = 88) of those with actual emergency experience reported preparing an emergency plan. Sixty-three percent (n = 76) of those reporting a plan had involved their PA in its development. Participants who reported such involvement were significantly more likely to have higher scores on the emergency preparedness scale (p < 0.001). Participants who had experienced a prior emergency were also more likely to score higher on the emergency preparedness scale (p < 0.001). In general, participants reported limited attention to other basic preparedness recommendations: only 28 percent (n = 70) had prepared a "go-bag" with necessary supplies, 29 percent (n = 74) had developed a strategy for communicating with their PA during emergencies, and 32 percent (n = 81) had stockpiled emergency supplies. Of particular importance, only 26 percent (n = 66) had made alternative back-up plans for personal assistance.
Conclusions:Involving the PA in the planning process and experiencing an emergency were both significantly associated with higher emergency preparedness scores in this sample of people living with disabilities. However, critical deficiencies in preparedness were noted, such as lack of back-up plans for replacing their PA. Despite a concerted national effort to improve preparedness in the population of people living with disabilities, important preparedness gaps remain. These findings highlight the need for additional study on emergency preparedness barriers in people living with disabilities so that effective strategies to reduce vulnerabilities can be identified.
- A decision process for determining whether to conduct responder health research following large disasters. [Journal Article]
- Am J Disaster Med 2013; 8(1):25-33.
Disasters often set the stage for scientific inquiry within the field of occupational safety and health. This is especially true when the long-term consequences of exposures associated with a particular disaster are unclear. However, a responder research study can be costly and difficult to design, and researchers must consider whether the proposed study will produce useful, reliable results and is a prudent public health investment. The decision process can be segregated into various components, including scientific rationale that should be formally recognized as critical to efficiently and effectively determine whether a research study is warranted. The scientific rationale includes certain controlling or "gatekeeper" factors that should be present to proceed with research.
- A pan-European study of capabilities to manage mass casualties from the release of chemical agents: The MASH project. [Journal Article]
- Am J Disaster Med 2013; 8(1):13-23.
The European Union (EU) Mass Casualties and Health (MASH) project that ran between 2008 and 2010 was designed to study the management of mass casualties from chemical and radiological releases and associated health implications. One area of study for this project concerned arrangements within EU Member States for the management of mass casualties following a chemical release. This was undertaken via a confidential online questionnaire that was sent to selected points of contact throughout the EU. Responses were obtained from 18 states from respondents holding senior positions in chemical planning and incident response. Information gathered shows a lack of uniformity within the EU about the organization of responses to chemical releases and the provision of medical care. This article presents the overall findings of the study demonstrating differences between countries on planning and organization, decontamination, prehospital emergency medical responses, clinical diagnoses, and therapy and aftercare. Although there may be an understandable reluctance from national respondents to share information on security and other grounds, the findings, nevertheless, revealed substantial differences between current planning and operational responses within the EU states for the manage-ment of mass chemical casualties. The existing international networks for response to radiation incidents are not yet matched by equivalent networks for chemical responses yet sufficient information was available from the study to identify potential deficiencies, identify common casualty management pathways, and to make recommendations for future operations within the EU. Improvements in awareness and training and the application of modern information and communications will help to remedy this situation. Specialized advanced life support and other medical care for chemical casualties appear lacking in some countries. A program of specialized training and action are required to apply the findings revealed by the MASH study into a unified cross-border emergency medical response.
- Results of in-hospital triage in 17 mass casualty trainings: Underestimation of life-threatening injuries and need for re-triage. [Journal Article]
- Am J Disaster Med 2013; 8(1):5-11.
Background:In-hospital triage is the key factor for successful management of an overwhelming number of patients in lack of treatment capacity. The main goal of in-hospital triage is to identify casualties with life-threatening injuries and to allocate immediate medical aid. For the first time, we evaluate the quality of in-hospital triage in the German capital Berlin.
Methods:In this prospective observational study of 17 unheralded external mass casualty trainings for Berlin disaster hospitals in 2010/2011, we analyzed the in-hospital triage of 601 rouged casualty actors. Evaluation was performed by structured external survey and interview of the casualty actors after the disaster training. In 93 percent (n = 558), complete data were available and suitable for statistical analysis.
Results:The primary triage category was allocated correctly to 61 percent (n = 338) of the simulated injury severity. The following measurements were performed: anamnesis in 77 percent, physical examination 71 percent, blood pressure in 68 percent, heart rate in 61 percent, and oxygen saturation in 25 percent. Additive radiological diagnostics were used: 38 percent X-ray, 16 percent computer tomography, and 7 percent ultrasound. On an average, 1.6 ± 1.2 diagnostic tools were used to allocate injury severity to rouged casualties. Of all the rouged casualties, 24 percent overtriage and 16 percent undertriage were observed. Overtriage was significantly infrequent in level I trauma centers (p = 0.03). Of the patients with life-threatening injuries, 18 percent was undertriaged. Of the 62 percent with secondary right allocation to triage category, re-triage was only used in 4 percent.
Conclusion:The accuracy of in-hospital triage is low (61 percent). Predominately, the problem of overtriage (24 percent) due to insufficient triage training in contrast to undertriage (16 percent) occurs. The diagnostic triage adjuncts, ultrasound and re-triage, should be routinely used to lower the rate of undetected life threat in mass casualty incidents. Furthermore, a standardized training program and triage algorithm for in-hospital triage should be established.
- Business continuity after catastrophic medical events: the Joplin medical business continuity report. [Journal Article]
- Am J Disaster Med 2012; 7(4):321-31.
On May 22, 2011, The St Johns Mercy Medical Center in Joplin, MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.
- A comparison of different types of hazardous material respirators available to anesthesiologists. [Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't]
- Am J Disaster Med 2012; 7(4):313-9.
Despite anesthesiology personnel involvement in initial treatment of patients exposed to potentially lethal agents, less than 40 percent of US anesthesiology training programs conduct training to manage these patients.(1) No previous studies have evaluated performance of anesthesiologists wearing protective gear. The authors compared the performance of anesthesiologists intubating a high-fidelity mannequin while wearing either a powered air-purifying respirator (PAPR) or a negative pressure respirator (NPR).Twenty participants practiced intubations on a high-fidelity simulator until comfortable. Each subject performed 10 repetitions, initially without any gear, then while wearing a protective suit, gloves, and respirator. The order of gear use was randomized and all subjects used both devices. Time for task completion were recorded, and at the end of the trial, subjects were asked to rate their comfort with the equipment.After controlling for other variables, overall statistically slower total performance times were observed with use of the PAPR when compared to the control arm and use of the NPR (p 5 0.01 and p < 0.007, respectively). Of the total 90 intubations, only one proved to be esophageal and initially undetected.The use of an NPR or PAPR does not preclude an anesthesiologist from successfully intubating, but practice is necessary. The slightly better performance with the NPR is weighed against the improved comfort of the PAPR and the fact that PAPR users could wear eyeglasses. Neither type of gear allowed the users to auscultate the lung fields to confirm correct endotracheal tube placement.