Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Prehosp Disaster Med [journal]
- Improving Olympic Health Services: What are the Common Health Care Planning Issues? [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 29.:1-6.
Introduction Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. Hypothesis Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts.A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report.The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities.Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts. Kononovas K , Black G , Taylor J , Raine R . Improving Olympic health services: what are the common health care planning issues? Prehosp Disaster Med. 2014;29(6):1-6 .
- Streamlining of Medical Relief to Areas Affected by the Great East Japan Earthquake with the "Area-based/Line-linking Support System" [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 22.:1-9.
Introduction When disasters that affect a wide area occur, external medical relief teams play a critical role in the affected areas by helping to alleviate the burden caused by surging numbers of individuals requiring health care. Despite this, no system has been established for managing deployed medical relief teams during the subacute phase following a disaster. After the Great East Japan Earthquake and tsunami, the Ishinomaki Medical Zone was the most severely-affected area. Approximately 6,000 people died or were missing, and the immediate evacuation of approximately 120,000 people to roughly 320 shelters was required. As many as 59 medical teams came to participate in relief activities. Daily coordination of activities and deployment locations became a significant burden to headquarters. The Area-based/Line-linking Support System (Area-Line System) was thus devised to resolve these issues for medical relief and coordinating activities.A retrospective analysis was performed to examine the effectiveness of the medical relief provided to evacuees using the Area-Line System with regards to the activities of the medical relief teams and the coordinating headquarters. The following were compared before and after establishment of the Area-Line System: (1) time required at the coordinating headquarters to collect and tabulate medical records from shelters visited; (2) time required at headquarters to determine deployment locations and activities of all medical relief teams; and (3) inter-area variation in number of patients per team.The time required to collect and tabulate medical records was reduced from approximately 300 to 70 minutes/day. The number of teams at headquarters required to sort through data was reduced from 60 to 14. The time required to determine deployment locations and activities of the medical relief teams was reduced from approximately 150 hours/month to approximately 40 hours/month. Immediately prior to establishment of the Area-Line System, the variation of the number of patients per team was highest. Variation among regions did not increase after establishment of the system.This descriptive analysis indicated that implementation of the Area-Line System, a systematic approach for long-term disaster medical relief across a wide area, can increase the efficiency of relief provision to disaster-stricken areas. Yamanouchi S , Ishii T , Morino K , Furukawa H , Hozawa A , Ochi S , Kushimoto S . Streamlining of medical relief to areas affected by the Great East Japan Earthquake with the "Area-based/Line-linking Support System." Prehosp Disaster Med. 2014;29(6):1-9 .
- Using Mixed Methods to Assess Pediatric Disaster Preparedness in the Hospital Setting. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 21.:1-7.
Introduction Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims. Problem The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims.A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training.According to quantitative participant feedback, the disaster exercise enhanced respondents' perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises.Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has identified several opportunities to improve the current state of all hospitals' pediatric disaster preparedness, through increased training on pediatric disaster triage methods and additional training on the safety and security of children. Regular assessment and evaluation of supplies, equipment, leadership assignments, and inter-hospital communication is also suggested to optimize the effectiveness and efficiency of response to pediatric victims in a disaster. Burke RV , Kim TY , Bachman SL , Iverson EI , Berg BM . Using mixed methods to assess pediatric disaster preparedness in the hospital setting. Prehosp Disaster Med. 2014;29(6): 1-7 .
- Does Disaster Education of Teenagers Translate into Better Survival Knowledge, Knowledge of Skills, and Adaptive Behavioral Change? A Systematic Literature Review. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 20.:1-14.
An increasing number of people are affected worldwide by the effects of disasters, and the United Nations International Strategy for Disaster Reduction (UNISDR) has recognized the need for a radical paradigm shift in the preparedness and combat of the effects of disasters through the implementation of specific actions. At the governmental level, these actions translate into disaster and risk reduction education and activities at school. Fifteen years after the UNISDR declaration, there is a need to know if the current methods of disaster education of the teenage population enhance their knowledge, knowledge of skills in disasters, and whether there is a behavioral change which would improve their chances for survival post disaster. This multidisciplinary systematic literature review showed that the published evidence regarding enhancing the disaster-related knowledge of teenagers and the related problem solving skills and behavior is piecemeal in design, approach, and execution in spite of consensus on the detrimental effects on injury rates and survival. There is some evidence that isolated school-based intervention enhances the theoretical disaster knowledge which may also extend to practical skills; however, disaster behavioral change is not forthcoming. It seems that the best results are obtained by combining theoretical and practical activities in school, family, community, and self-education programs. There is a still a pressing need for a concerted educational drive to achieve disaster preparedness behavioral change. School leavers' lack of knowledge, knowledge of skills, and adaptive behavioral change are detrimental to their chances of survival. Codreanu TA , Celenza A , Jacobs I . Does disaster education of teenagers translate into better survival knowledge, knowledge of skills, and adaptive behavioral change? A systematic literature review. Prehosp Disaster Med. 2014;29(6):1-14 .
- Research in prehospital and disaster health and medicine: the introduction section of a study manuscript. [Journal Article]
- Prehosp Disaster Med 2014 Oct; 29(5):439-40.
- Securing the Second Front: Achieving First Receiver Safety and Security through Competency-based Tools. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 14.:1-5.
Introduction Limited research has focused on the safety and security of First Responders and Receivers, including clinicians, hospital workers, public safety officials, community volunteers, and other lay personnel, during public health emergencies. These providers are, in some cases, at greater peril during large-scale disasters due to their lack of training and inadequate resources to handle major influxes of patients. Exemplified in the 1995 Tokyo sarin gas attacks and the 2008 Wenchuan earthquakes, lack of training results in poor outcomes for both patients and First Receivers.The improvement of knowledge and comfort level of First Receivers preparing for a medical disaster via an affordable, repeatable emergency preparedness training (EPT) curriculum.A 5-hour EPT curriculum was developed including nine learning objectives, 18 competencies, and 34 performance objectives. Following brief didactic and small group sessions, interprofessional teams of four to six trainees were observed in a large patient simulator designed to recreate environmentally challenging (ie, flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors. Trained observers assessed successful completion of 16 individual and 18 team performance objectives. Prior to training, team members completed a 24-question knowledge assessment, a demographic survey, and a comfort level self-assessment. Following training, trainees repeated the 24 questions, self-assessment, and course assessment.One hundred ninety-five participants completed the course between November 2012 and August 2013. One hundred ninety-one (98.5%), 150 (76.9%), and 66 (33.8%) participants completed the pretest, post-test, and course assessment, respectively. The mean (SD) percentage of correct answers between the pretest and post-test increased from 46.3 (13.4) to 75.3 (12.2), P < .0001. Thirty-eight participants (19.5%) reported more than three hours of disaster EPT each year while 157 participants (80.5%) reported three hours or less of yearly EPT. Sixty-six (100%) reported the course relevant to care providers and 61 (92.4%) highly recommended the course. Comfort level increased from 37.0/100 (n = 192) before training to 76.3/100 (n = 145) after training.The Center for Health Professional Training and Emergency Response's (CHPTER's) 5-hour EPT curriculum for patient care providers recreates simultaneous multi-actor disasters, measures EPT performance, and improves trainee knowledge and comfort level to save patient and provider lives during a disaster, via an affordable, repeatable EPT curriculum. A larger-scale study, or preferably a multi-center trial, is needed to further study the impact of this curriculum and its potential to enhance the safety and security of the "Second Front." Jones J , Staub J , Seymore A , Scott LA . Securing the second front: achieving first receiver safety and security through competency-based tools. Prehosp Disaster Med. 2014;29(6):1-5 .
- Swedish Ambulance Managers' Descriptions of Crisis Support for Ambulance Staff After Potentially Traumatic Events. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Oct 10.:1-4.
Introduction Ambulance staff face complex and sometimes stressful or potentially traumatic situations, not only in disasters but also in their routine daily work. The aim of this study was to survey ambulance managers' descriptions of crisis support interventions for ambulance staff after potential traumatic events (PTEs).Semistructured interviews with a qualitative descriptive design were conducted with six ambulance managers in a health care region in central Sweden. The data was analyzed using content analysis. Result Five categories were found in the result: (1) description of a PTE; (2) description and performance of crisis support interventions; (3) impact of working in potentially traumatic situations; (4) the ambulance managers' role in crisis support interventions; and (5) the ambulance managers' suggestions for improvement. Ambulance managers described crisis support interventions after a PTE as a single, mandatory group meeting with a structure reminiscent of debriefing. The ambulance managers also expressed doubts about the present structures for crisis support and mentioned an alternative approach which is more in line with present evidence-based recommendations.The results indicated a need for increased understanding of the importance of the managers' attitudes for ambulance staff; a need for further implementation of evidence-based recommendations for crisis support interventions was also highlighted. Hugelius K , Berg S , Westerberg E , Gifford M , Adolfsson A . Swedish ambulance managers' descriptions of crisis support for ambulance staff after potentially traumatic events. Prehosp Disaster Med. 2014;29(6):1-4 .
- Hospital Disaster Response Using Business Impact Analysis. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Sep 30.:1-8.
Introduction The catastrophic Great East Japan Earthquake in 2011 created a crisis in a university-affiliated hospital by disrupting the water supply for 10 days. In response, this study was conducted to analyze water use and prioritize water consumption in each department of the hospital by applying a business impact analysis (BIA). Identifying the minimum amount of water necessary for continuing operations during a disaster was an additional goal. Problem Water is essential for many hospital operations and disaster-ready policies must be in place for the safety and continued care of patients.A team of doctors, nurses, and office workers in the hospital devised a BIA questionnaire to examine all operations using water. The questionnaire included department name, operation name, suggested substitutes for water, and the estimated daily amount of water consumption. Operations were placed in one of three ranks (S, A, or B) depending on the impact on patients and the need for operational continuity. Recovery time objective (RTO), which is equivalent to the maximum tolerable period of disruption, was determined. Furthermore, the actual use of water and the efficiency of substitute methods, practiced during the water-disrupted periods, were verified in each operation.There were 24 activities using water in eight departments, and the estimated water consumption in the hospital was 326 (SD = 17) m3 per day: 64 (SD = 3) m3 for S (20%), 167 (SD = 8) m3 for A (51%), and 95 (SD = 5) m3 for B operations (29%). During the disruption, the hospital had about 520 m3 of available water. When the RTO was set to four days, the amount of water available would have been 130 m3 per day. During the crisis, 81% of the substitute methods were used for the S and A operations.This is the first study to identify and prioritize hospital operations necessary for the efficient continuation of medical treatment during suspension of the water supply by applying a BIA. Understanding the priority of operations and the minimum daily water requirement for each operation is important for a hospital in the event of an unexpected adverse situation, such as a major disaster. Suginaka H , Okamoto K , Hirano Y , Fukumoto Y , Morikawa M , Oode Y , Sumi Y , Inoue Y , Matsuda S , Tanaka H . Hospital disaster response using business impact analysis. Prehosp Disaster Med. 2014;29(5):1-8 .
- Comparison of Prediction Models for Use of Medical Resources at Urban Auto-racing Events. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Sep 26.:1-6.
Introduction Predicting the number of patient encounters and transports during mass gatherings can be challenging. The nature of these events necessitates that proper resources are available to meet the needs that arise. Several prediction models to assist event planners in forecasting medical utilization have been proposed in the literature. Hypothesis/Problem The objective of this study was to determine the accuracy of the Arbon and Hartman models in predicting the number of patient encounters and transportations from the Baltimore Grand Prix (BGP), held in 2011 and 2012. It was hypothesized that the Arbon method, which utilizes regression model-derived equations to estimate, would be more accurate than the Hartman model, which categorizes events into only three discreet severity types.This retrospective analysis of the BGP utilized data collected from an electronic patient tracker system. The actual number of patients evaluated and transported at the BGP was tabulated and compared to the numbers predicted by the two studied models. Several environmental features including weather, crowd attendance, and presence of alcohol were used in the Arbon and Hartman models.Approximately 130,000 spectators attended the first event, and approximately 131,000 attended the second. The number of patient encounters per day ranged from 19 to 57 in 2011, and the number of transports from the scene ranged from two to nine. In 2012, the number of patients ranged from 19 to 44 per day, and the number of transports to emergency departments ranged from four to nine. With the exception of one day in 2011, the Arbon model overpredicted the number of encounters. For both events, the Hartman model overpredicted the number of patient encounters. In regard to hospital transports, the Arbon model underpredicted the actual numbers whereas the Hartman model both overpredicted and underpredicted the number of transports from both events, varying by day.These findings call attention to the need for the development of a versatile and accurate model that can more accurately predict the number of patient encounters and transports associated with mass-gathering events so that medical needs can be anticipated and sufficient resources can be provided. Nable JV , Margolis AM , Lawner BJ , Hirshon JM , Perricone AJ , Galvagno SM , Lee D , Millin MG , Bissell RA , Alcorta RL . Comparison of prediction models for use of medical resources at urban auto-racing events. Prehosp Disaster Med. 2014;29(6):1-6 .
- Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment. [JOURNAL ARTICLE]
- Prehosp Disaster Med 2014 Sep 23.:1-5.
Introduction Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed. Problem Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target.This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts.From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration.While there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission. Redwood-Campbell LJ , Sekhar SN , Persaud CR . Health care workers in danger zones: a special report on safety and security in a changing environment. Prehosp Disaster Med. 2014;29(5):1-5 .