- A hospital mass casualty exercise using city buses and a tent as a hybrid system for patient decontamination. [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):189-196
- CONCLUSIONS: The use of city buses as triage and waiting zones prior to decontamination appears feasible for centers without a garage and facing unpredictable weather conditions. Further simulations are required for fine-tuning and testing real-time unfolding of tasks, ideally during an unannounced exercise.
- The pulmonary consequences of sandstorms in Saudi Arabia: A comprehensive review and update. [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):179-188
- Sandstorms represent a major natural hazard in the Arabian Peninsula. Their pulmonary consequences can be life-threatening, especially to those with a history of allergies, asthma, and chronic obstru...
Sandstorms represent a major natural hazard in the Arabian Peninsula. Their pulmonary consequences can be life-threatening, especially to those with a history of allergies, asthma, and chronic obstructive pulmonary diseases. Novel presentations of respiratory diseases caused by sandstorms can now be traced to specific chemical and organic components of sandstorms. We present an update of the pathophysiology of pulmonary conditions based on the results of clinical and epidemiologic research as well as from greater knowledge of the complex chemical composition of sandstorms. This has led to more precise therapeutic approaches to severe respiratory illnesses and a greater understanding of risk factors for morbidity and mortality due to Arabian sandstorms.
- Verification of the airway securing capacity of a life jacket in a flood disaster. [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):173-178
- CONCLUSIONS: The biggest drawback is that the parameters of this study are not based on real-world experience. Therefore, if an evacuee with a life jacket is submerged in a flood disaster, we cannot easily decide whether the buoyancy is appropriate because in some situations, buoyancy adversely affected airway security. If we could decide buoyancy based on specific disaster conditions, the airway-securing capacity of a life jacket would improve.
- Invoking the "expectant" triage category: Can we make the paradigm shift? [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):167-172
- Medical triage is the process of determining the priority of patients' treatments based on the severity of their condition. Triage provides the healthcare provider the ability to identify the most ur...
Medical triage is the process of determining the priority of patients' treatments based on the severity of their condition. Triage provides the healthcare provider the ability to identify the most urgent cases first, with the goal of maximizing each individual patient's outcome. When resources are challenged, such as in a disaster, the healthcare provider's goal becomes to maximize overall population survival. In this context, the triage process must identify patients who require resources urgently, as well as those who have the best chance of survival. The revised triage process must include an "expectant management" category, to identify patients for whom further resuscitation is delayed, as they have a poor chance of survival and require significant resources. The paradigm shift that is required in these circumstances can be challenging for pediatric healthcare providers. Many may find themselves unable to change the decision-making process that would favor overall survival and best outcome for the most members of a population, while potentially not addressing the most sick or injured because they have low chances of survival. We hypothesized that participating in a multiprofessional ethics-based educational session regarding making difficult triage decisions may improve participants' perceived ability to use the "expectant" triage category in a disaster setting. Participants took part in an ethics-based educational session and completed a pre- and postsurvey. Results demonstrated a significant change in the participants' self-perceived comfort level using the disaster triage tools and improved their confidence to use the expectant triage category in a disaster setting.
- Planning for a medical surge incident: Is rehabilitation the missing link? [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):157-165
- This mixed methods study explored surge planning for patients who will need rehabilitative care after a mass casualty incident. Planning for a patient surge incident typically considers only prehospi...
This mixed methods study explored surge planning for patients who will need rehabilitative care after a mass casualty incident. Planning for a patient surge incident typically considers only prehospital and hospital care. However, in many cases, disaster patients need rehabilitation for which planning is often overlooked. The purpose of this study was to explore this hidden dimension of patient rehabilitation for surge planning and preparedness and ask: 1. To what extent can an analysis of standard patient acuity assessment tools [Simple Triage and Rapid Treatment and Injury Severity Score] be used to project future demand for admission to rehabilitative care? 2. What improvements to medical disaster planning are needed to address patient surge related to rehabilitation? This study found that standard patient benchmarks can be used to project demand for rehabilitation following a mass casualty incident, and argues that a reconceptualization of surge planning to include rehabilitation would improve medical disaster planning.
- Presence of undertriage and overtriage in simple triage and rapid treatment. [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):147-154
- CONCLUSIONS: EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.
- A study of the blood flow restriction pressure of a tourniquet system to facilitate development of a system that can prevent musculoskeletal complications. [Journal Article]
- AJAm J Disaster Med 2017 Summer; 12(3):139-145
- CONCLUSIONS: A relationship between blood flow restriction pressure and tissue oxygen saturation was noted. rSO2measurement can be used to assess the restriction of blood flow during surgery. On the basis of the decrease in rSO2, blood flow was effectively restricted at a pressure of 30 kPa or more. When, however, blood flow was restricted at a pressure of 40 kPa, weight loss and decreased movement were noted and CK levels increased after the behavioral experiment. Thus, complications had presumably developed due to damage to muscle tissue. These findings indicate that blood flow was effectively restricted in this experiment and they also indicate the existence of an optimal blood flow restriction pressure that does not cause musculoskeletal complications. The pressure in question was around 30 kPa. The tourniquet system that was developed here is actuated with an EHD pump that is still in the trial stages. That said, its pressure can readily be controlled and this pump could be used in a tourniquet system since it is quiet, vibration-free, and small. The pressure of this pump can be finely adjusted to prevent musculoskeletal complications.
- Are you ready? Crisis leadership in a hyper-VUCA environment. [Journal Article]
- AJAm J Disaster Med 2017 Spring; 12(2):107-134
- The current hyper-volatile, -uncertain, -complex, and -ambiguous (VUCA) threat environment demands a more cohesive support structure for crisis leaders who may be faced with crises of increasing magn...
The current hyper-volatile, -uncertain, -complex, and -ambiguous (VUCA) threat environment demands a more cohesive support structure for crisis leaders who may be faced with crises of increasing magnitude and frequency and, in some instances, multiple crisis events simultaneously. The project team investigates the perceptions of crisis leaders regarding establishing a crisis leader advisor position for crisis leaders to benefit from their experience while prosecuting crisis response activities. The team linked hyper-VUCA crises, crisis response frameworks, meta-leadership, crisis leader attributes, and advisor attributes. The overall goal of the project is to increase the ability of the crisis leaders to more effectively and efficiently navigate crisis events resulting in more efficient and effective response and recovery. Three research questions were developed to assess the following: thoughts of integrating a crisis leader advisor position; development of a crisis leader advisor certification program; and attributes of crisis leader advisors. A qualitative research methodology using a phenomenological approach was employed. Forty-one participants were purposefully selected and administered a short, online survey consisting of 11 questions. Data were analyzed using percentage analysis, weighted sums, and inductive thematic analysis. The project team found an overwhelming support for the crisis leader advisor position and the crisis leader advisor certification program. Additionally, experience and trustworthiness ranked among the top sought after attributes of a crisis leader advisor. The team recommendations included (1) implement a crisis leaders advisor guide/framework; (2) create a formal crisis leader advisor position in national incident management system; (3) implement a crisis leader advisor certification framework; (4) benchmark established advisor programs; and (5) implement a framework to match leaders and advisors.
- Emergency preparedness training preferences and perceived barriers to training among various healthcare providers and public health practitioners in Massachusetts. [Journal Article]
- AJAm J Disaster Med 2017 Spring; 12(2):85-106
- CONCLUSIONS: This study demonstrates important areas of agreement with respect to desired training topics and points out areas where providers in different disciplines and from different geographic areas may have differing educational preferences. Even within the limitation of this investigation, we expect that this study will be a valuable tool for those attempting to effectively target emergency preparedness training and structure course offerings in ways that minimize the impact of barriers to training.
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- 60 seconds to survival: A pilot study of a disaster triage video game for prehospital providers. [Journal Article]
- AJAm J Disaster Med 2017 Spring; 12(2):75-83
- CONCLUSIONS: The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game's effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.