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Showing papers in "Prehospital and Disaster Medicine in 2014"


Journal ArticleDOI
TL;DR: It is suggested that teams often are not competent during the response phase because of education and training deficiencies and foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services.
Abstract: Introduction: Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training. Method: This qualitative study was performed in 2013. A questionnaire-based evaluation of experts’ opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data. Results: This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters. Conclusion: The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always

77 citations


Journal ArticleDOI
TL;DR: It is shown 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.
Abstract: 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. Language: en

57 citations


Journal ArticleDOI
TL;DR: The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti, and demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone.
Abstract: Introduction During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting. Problem There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Medecins Sans Frontieres-Orthopedic Centre Paris orthopedic program. Methods Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010. Results Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%). Conclusion The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings. Teicher CL , Alberti K , Porten K , Elder G , Baron E , Herard P . Medecins Sans Frontieres Experience in Orthopedic Surgery in Postearthquake Haiti in 2010. Prehosp Disaster Med. 2014;29(1):1-6 .

54 citations


Journal ArticleDOI
TL;DR: The need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce is identified.
Abstract: Introduction: Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highlystructured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. Methods: An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. Results: The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. Conclusion: Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to

53 citations


Journal ArticleDOI
TL;DR: The designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.
Abstract: In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of "Disaster Health" according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants' knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools. Table 1 List of Modules and Topics Module Topics 1. Introduction to disaster medicine and public health during emergencies - Modern taxonomy of disaster and common disaster medicine definitions - Differences between disaster and emergency medicine - Principles of public health during disasters - Different phases of disaster management 2. Prehospital disaster management - Mass-casualty disposition, treatment area, and transport issues - Disaster plans and command-and-control chain structure - Functional response roles 3. Specific disaster medicine and triage procedures in the - Mass-casualty triage definitions and principles management of disasters - Different methodologies and protocols - Patient assessment, triage levels and tags 4. Hospital disaster preparedness and response - Hospital disaster laws - Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach - Medical management for a massive influx of casualties 5. Health consequences of different disasters - Characteristics of different types of disasters - Health impact of natural and man-made disasters - Disaster-related injury after exposure to a different disasters with an all-hazard approach 6. Psychosocial care - Techniques to deal with psychic reactions caused by exposure to disaster scenarios - Treatment approaches to acute and delayed critical incident stress reactions 7. Presentation of past disasters and public health emergencies, and Case study: review of assistance experiences - Haiti earthquake - Cholera outbreaks in Haiti - National and international disaster response mechanism Ingrassia PL , Ragazzoni L , Tengattini M , Carenzo L , Della Corte F. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014;29(5):1-8. Language: en

50 citations


Journal ArticleDOI
TL;DR: It is argued that people who experience a natural disaster are likely to suffer from solastalgia for a number of reasons, which may include the loss of housing, livestock and farmland, and the ongoing danger of living in a disaster-prone area.
Abstract: Forced separation from one's home may trigger emotional distress. People who remain in their homes may experience emotional distress due to living in a severely damaged environment. These people experience a type of 'homesickness' similar to nostalgia because the land around them no longer resembles the home they knew and loved. What they lack is solace or comfort from their home; they long for the home environment to be the way it was before. "Solastalgia" is a term created to describe feelings which arise in people when an environment changes so much that it negatively affects an individual's quality of life. Such changed environments may include drought-stricken areas and open-cut mines. The aim of this article is to describe how solastalgia, originally conceptualized as the result of man-made environmental change, can be similarly applied to the survivors of natural disasters. Using volcanic eruptions as a case example, the authors argue that people who experience a natural disaster are likely to suffer from solastalgia for a number of reasons, which may include the loss of housing, livestock and farmland, and the ongoing danger of living in a disaster-prone area. These losses and fears challenge people's established sense of place and identity and can lead to feelings of helplessness and depression.

49 citations


Journal ArticleDOI
TL;DR: The aims of this systematic review were to explore the factors associated with the intention of health care personnel to respond to uncommon events, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response.
Abstract: OBJECTIVE: Emergency response relies on the assumption that essential health care services will continue to operate and be available to provide quality patient care during and after a patient surge. The observed successes and failures of health care systems during recent mass-casualty events and the concern that these assumptions are not evidence based prompted this review. METHOD: The aims of this systematic review were to explore the factors associated with the intention of health care personnel (HCP) to respond to uncommon events, such as a natural disaster or pandemic, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response. RESULTS: Authors of the 70 studies (five mixed-methods, 49 quantitative, 16 qualitative) that met inclusion criteria reported a variety of variables that influenced the intent of HCP to respond. Current evidence suggests that four primary factors emerged as either facilitating or hindering the willingness of HCP to respond to an event: (1) the nature of the event; (2) competing obligations; (3) the work environment and climate; and (4) the relationship between knowledge and perceptions of efficacy. CONCLUSIONS: Findings of this study could influence and strengthen policy making by emergency response planners, staffing coordinators, health educators, and health system administrators. Connor SB. When and why health care personnel respond to a disaster: the state of the science. Prehosp Disaster Med. 2014;29(3):1-5. Language: en

44 citations


Journal ArticleDOI
TL;DR: Recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community are highlighted.
Abstract: India is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.

42 citations


Journal ArticleDOI
Alison Hutton1, Jamie Ranse1, Naomi Verdonk1, Shahid Ullah1, Paul Arbon1 
TL;DR: The characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia are understood, and the relative proportion and type of injury and illness presentations at these events are analyzed.
Abstract: Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the "typical" patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations. Hutton A , Ranse J , Verdonk N , Ullah S , Arbon P . Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehosp Disaster Med. 2014;29(2):1-7 . Language: en

42 citations


Journal ArticleDOI
TL;DR: Several opportunities to improve the current state of all hospitals’ pediatric disaster preparedness are identified, through increased training on pediatric disaster triage methods and additional training on the safety and security of children.
Abstract: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Language: en

38 citations


Journal ArticleDOI
TL;DR: This pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures.
Abstract: IntroductionThe assessment of hospital disaster preparedness and response performance is a way to find and remove possible gaps and weaknesses in hospital disaster management effectiveness. The aim of this pilot study was to test the association between the level of preparedness and the level of response performance during a full-scale hospital exercise.MethodThis pilot study was conducted in a hospital during a full-scale exercise in the Piedmont region of Italy. The preparedness evaluation was conducted by a group of three experts, three days before the exercise, and the response evaluation was conducted during the exercise. The functional capacity module was used for preparedness evaluation, and the response performance of the “command and control” function of the hospital was evaluated by nine semiquantitative performance indicators.ResultsThe preparedness of the chosen hospital was 59%, while the response performance was evaluated as 70%. The hospital staff conducted Simple Triage and Rapid Transport (START) triage while they received 61 casualties, which was 90% correct for the yellow group and 100% correct for the green group.ConclusionThis pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures. An experimental study including a group of hospitals, also using more comprehensive evaluation tools, should be done to evaluate the correlation between the level of preparedness and the response performance of a hospital, and the impact of hospital disaster planning, on the outcome of disasters victims.DjalaliA, CarenzoL, RagazzoniL, AzzarettoM, PetrinoR, Della CorteF, IngrassiaPL. Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study. Prehosp Disaster Med. 2014;29(4):1-7.

Journal ArticleDOI
TL;DR: In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation.
Abstract: Introduction Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant. Hypothesis Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied. Methods This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS). Results Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS. Conclusion In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted. Karamanos E , Talving P , Skiada D , Osby M , Inaba K , Lam L , Albuz O , Demetriades D . Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis. Prehosp Disaster Med. 2013;28(6):1-5 .

Journal ArticleDOI
TL;DR: Because of the victims’ hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.
Abstract: On March 11, 2011, a 9.1 magnitude earthquake occurred in the eastern Pacific Ocean off the coast of northern Japan. A resulting tsunami struck the Japan Pacific coast, causing >20,000 deaths, injuries and missing persons. Survivors' post-tsunami health and nutritional status were surveyed one month after the disaster in a school shelter in Ishinomaki City. Hyogo College of Medicine's disaster relief team observations and survivors' questionnaires were used to assess the disaster's effects on survivors' lifestyles and gastrointestinal symptoms while residing in temporary shelters. Of 236 disaster evacuees 9-88 years of age (mean age 52 years), 23% lost weight and 28% reported decreased food intake one month after the earthquake. Up to 25% of the participants presented with gastrointestinal symptoms, including constipation (10%), appetite loss (6.4%), vomiting (6.4%), and nausea (2.1%). Although the victims preferred more vegetables (44%) or fruit (33%), most food aid received, such as rice balls or bread, was carbohydrate-based, possibly because of easy provision and abundance in emergency food pantries. The authors asked the volunteers and the Japan Self-Defense Forces to provide a more balanced diet, including vegetables and fruit. Consumption of imbalanced diets may have caused more gastrointestinal symptoms for the survivors. Because of the victims' hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.

Journal ArticleDOI
TL;DR: Attitudes and perceptions regarding EMS active shooter incident response appear to change among providers after participation in a focused active shooter response training program, and further studies are needed to determine if these changes are significant and whether early EMS response to active shooter incidents improves patient outcomes.
Abstract: Introduction Emergency Medical Services (EMS) routinely stage in a secure area in response to active shooter incidents until the scene is declared safe by law enforcement. Due to the time-sensitive nature of injuries at these incidents, some EMS systems have adopted response tactics utilizing law enforcement protection to expedite life-saving medical care. Objective Describe EMS provider perceptions of preparedness, adequacy of training, and general attitudes toward active shooter incident response after completing a tactical awareness training program. Methods An unmatched, anonymous, closed-format survey utilizing a five-point Likert scale was distributed to participating EMS providers before and after a focused training session on joint EMS/police active shooter rescue team response. Descriptive statistics were used to compare survey results. Secondary analysis of responses based on prior military or tactical medicine training was performed using a chi-squared analysis. Results Two hundred fifty-six providers participated with 88% (225/256) pretraining and 88% (224/256) post-training surveys completed. Post-training, provider agreement that they felt adequately prepared to respond to an active shooter incident changed from 41% (92/225) to 89% (199/224), while agreement they felt adequately trained to provide medical care during an active shooter incident changed from 36% (82/225) to 87% (194/224). Post-training provider agreement that they should never enter a building with an active shooter changed from 73% (165/225) to 61% (137/224). Among the pretraining surveys, significantly more providers without prior military or tactical experience agreed they should never enter a building with an active shooter until the scene was declared safe (78% vs 50%, P = .002), while significantly more providers with prior experience felt both adequately trained to provide medical care in an active shooter environment (56% vs 31%, P = .007) and comfortable working jointly with law enforcement within a building if a shooter were still inside (76% vs 56%, P = .014). There was no difference in response to these questions in the post-training survey. Conclusions Attitudes and perceptions regarding EMS active shooter incident response appear to change among providers after participation in a focused active shooter response training program. Further studies are needed to determine if these changes are significant and whether early EMS response during an active shooter incident improves patient outcomes. Jones J , Kue R , Mitchell P , Eblan G , Dyer KS . Emergency Medical Services Response to Active Shooter Incidents: Provider Comfort Level and Attitudes Before and After Participation in a Focused Response Training Program. Prehosp Disaster Med. 2014;29(4):1-7 .

Journal ArticleDOI
TL;DR: Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.
Abstract: BACKGROUND: Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature. Aim The aim of this research was to determine the international research priorities for disaster nursing. METHOD: This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed. RESULTS: Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking. CONCLUSIONS: Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities. Ranse J , Hutton A , Jeeawody B , Wilson R. What are the research needs for the field of disaster nursing? An international Delphi study. Prehosp Disaster Med. 2014;29(5):1-7. Language: en

Journal ArticleDOI
TL;DR: Consistent definitions of MG populations will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling, and support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs.
Abstract: BACKGROUND: The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events. Process A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings. FINDINGS and Interpretation Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations. CONCLUSIONS: Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects. Lund A , Turris SA , Bowles R , Steenkamp M , Hutton A , Ranse J , Arbon P. Mass-gathering health research foundational theory: part 1 - population models for mass gatherings. Prehosp Disaster Med. 2014;29(6):1-7. Language: en

Journal ArticleDOI
TL;DR: This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes.
Abstract: Introduction In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required. METHODS: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2013. Data were analyzed and categorized using the existing 2012 MDS as a framework. RESULTS: In total, 19 manuscripts were identified that met the inclusion criteria. Variation in the patient presentation types was described in the literature from the mass-gathering papers reviewed. Patient presentation types identified in the literature review were compared to the 2012 MDS. As a result, 16 high-level patient presentation types were identified that were not included in the 2012 MDS. CONCLUSION: Adding patient presentation types to the 2012 MDS ensures that the collection of biomedical data for mass-gathering health research and evaluation remains contemporary and comprehensive. This review proposes the addition of 16 high-level patient presentation categories to the 2012 MDS in the following broad areas: gastrointestinal, obstetrics and gynecology, minor illness, mental health, and patient outcomes. Additionally, a section for self-treatment has been added, which was previously not included in the 2012 MDS, but was widely reported in the literature. Ranse J , Hutton A , Turris SA , Lund A. Enhancing the minimum data set for mass-gathering research and evaluation: an integrative literature review. Prehosp Disaster Med. 2014;29(3):1-10. Language: en

Journal ArticleDOI
TL;DR: This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.
Abstract: This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.

Journal ArticleDOI
TL;DR: The development of a series of event lenses that serve as a beginning “ MG event model,” complimenting the “MG population model” reported elsewhere are described, addressing a gap in the current body of knowledge.
Abstract: BACKGROUND: Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning "MG event model," complimenting the "MG population model" reported elsewhere. METHODS: Existing descriptions of "MGs" were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion. FINDINGS Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events. Interpretation The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs. Turris SA , Lund A , Hutton A , Bowles R , Ellerson E , Steenkamp M , Ranse J , Arbon P. Mass-gathering health research foundational theory: part 2 - event modeling for mass gatherings. Prehosp Disaster Med. 2014;29(6):1-9. Language: en

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TL;DR: The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management.
Abstract: Introduction The March 11, 2011 disaster was unparalleled in the disaster history of Japan. There is still enormous effort required in order for Japan to recover from the damage, not only financially, but psychosocially. This paper is a review of the studies that have been undertaken since this disaster, from after the March 11th disaster in 2011 to the end of 2012, and will provide an overview of the disaster-health research literature published during this period. Methods The Japanese database Ichushi Ver. 5 was used to review the literature. This database is the most frequently used database in Japanese health-sciences research. The keywords used in the search were “Higashi Nihon Dai-shinsai” (The Great East Japan Earthquake). Results A total of 5,889 articles were found. Within this selection, 163 articles were categorized as original research (gencho ronbun). The articles were then sorted and the top four key categories were as follows: medicine (n = 98), mental health (n = 18), nursing (n = 13), and disaster management (n = 10). Additional categories were: nutrition (n = 4), public health (n = 3), radiology, preparedness, and pharmacology (n = 2 for each category). Nine articles appeared with only one category label and were grouped as “others.” Conclusion This review provides the current status of disaster-health research following the Great East Japan Earthquake. The research focus over the selected period was greatly directed towards medical considerations, especially vascular conditions and renal dialysis. Considering the compounding factors of the cold temperatures at the time of the disaster, the geography, the extensive dislocation of the population, and the demographics of an aging community, it is noteworthy that the immediate and acute impact of the March 11th disaster was substantial compared with other events and their studies on the impact of disaster on chronic and long-term illness. The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management. Kako M , Arbon P , Mitani S . Disaster Health After The 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-6 .

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TL;DR: It is suggested that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events.
Abstract: BACKGROUND: Despite federal and local efforts to educate the public to prepare for major emergencies, many US households remain unprepared for such occurrences. United States Armed Forces veterans are at particular risk during public health emergencies as they are more likely than the general population to have multiple health conditions. METHODS: This study compares general levels of household emergency preparedness between veterans and nonveterans by focusing on seven surrogate measures of household emergency preparedness (a 3-day supply of food, water, and prescription medications, a battery-operated radio and flashlight, a written evacuation plan, and an expressed willingness to leave the community during a mandatory evacuation). This study used data from the 2006 through 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state representative, random sample of adults aged 18 and older living in 14 states. RESULTS: The majority of veteran and nonveteran households had a 3-day supply of food (88% vs 82%, respectively) and prescription medications (95% vs 89%, respectively), access to a working, battery-operated radio (82% vs 77%, respectively) and flashlight (97% vs 95%, respectively), and were willing to leave the community during a mandatory evacuation (91% vs 96%, respectively). These populations were far less likely to have a 3-day supply of water (61% vs 52%, respectively) and a written evacuation plan (24% vs 21%, respectively). After adjusting for various sociodemographic covariates, general health status, and disability status, households with veterans were significantly more likely than households without veterans to have 3-day supplies of food, water, and prescription medications, and a written evacuation plan; less likely to indicate that they would leave their community during a mandatory evacuation; and equally likely to have a working, battery-operated radio and flashlight. CONCLUSION: These findings suggest that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events. Further research should examine household preparedness among other vulnerable groups including subgroups of veteran populations and the reasons why their preparedness may differ from the general population. Der-Martirosian C , Strine T , Atia M , Chu K , Mitchell MN , Dobalian A. General household emergency preparedness: a comparison between veterans and nonveterans. Prehosp Disaster Med. 2014;29(2):1-7. Language: en

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TL;DR: Emergency/disaster health and medical research is at risk of failing because of a global breakdown in the manner in which modern research is conducted, and the need to publish for career advancement of some researchers is problematic.
Abstract: In October 2013, the British weekly The Economist published a series of articles that questioned the validity of much of modern scientific research. In essence, The Economist reported that much of current published ‘‘scientific’’ research is rubbish that squanders money, stymies progress and may put the lives of people at risk. The observations of The Economist are enlightening and compelling, and support the claim that much of modern published science is flawed. As a relative newcomer to the area of accepted research, emergency and disaster health research is at risk of following the flawed publishing path described by The Economist. If this occurs, there will be a failing to validly advance the science that affects the lives of millions across the globe. At present, common errors in disaster planning and response are repeated more than they are corrected. For example, failures that occurred in the US Hurricane Katrina event were repeated later in Japan and the Philippines despite the opportunity to scientifically study and improve the field of emergency medical management and response. Further, in organized emergency medical services, there continues to be heavy use of resources to develop advanced life support activities (such as adult endotracheal intubation and use of vasopressors to manage ventricular fibrillation cardiac arrest) without scientific exploration of the value of these activities. As a new field of scientific inquiry, emergency/disaster health and medical research is at risk of failing because of a global breakdown in the manner in which modern research is conducted. As pointed out in The Economist, important published research results often cannot be replicated when retested by reputable concerns such as the Amgen and Bayer pharmaceutical companies. The validity of a scientific finding is established by the ability to repeat the original study and obtain the same results. Without verification through repeating a study and obtaining the same results, the findings of a single reported research study are unconvincing. This is true no matter how compellingly the original paper is written or how well the original research was conducted. An example is the use of thrombolytic therapy in the management of acute myocardial infarction. While original studies two decades ago were compelling for the use of thrombolytic therapy for treatment of acute ST elevation myocardial infarction, only after repeated studies provided results that confirmed the original findings was there acceptance clinically and scientifically of the validity of benefit for the intervention. The same verification is needed for many of the assumed scientific principles accepted in prehospital and disaster medicine. To replicate an original study, one must have the recipe used for conducting the first study. This recipe is provided by presenting a Methods Section that will allow any researcher to repeat the study and determine if the reported results are the same. The Methods Section of a published scientific study is often scrutinized by readers and other researchers to determine if the validity of the research presented can be accepted. In fact, the methodology may be more important than the statistical analysis techniques chosen by the researcher. In review of submitted papers that have been returned to authors and not published this past year in Prehospital and Disaster Medicine, none were without significant criticism of the methods that were described for the study. In addition to study methods that tended to allow bias, the lack of a sufficient description of methods used for the presented research such that another researcher could repeat the study was common among manuscripts that were not published. The need to publish for career advancement of some researchers is problematic. Publication of research is expected of many academics and professionals, and this stress leads to publication as a goal as opposed to conducting valid scientific research. The drive to publish can lead to exaggeration of study results and efforts to over-interpret the significance of findings. Medical journals add another obstacle to valid science by having a bias toward publishing papers that have positive outcomes. For journals there is a tendency to avoid publication of papers that replicate previous studies or that fail to prove a hypothesis (negative results papers). Also, many journals are interested in journalistic impact similar to that of newspapers as opposed to solid scientific work. This tendency stems from competition to sell the journals to university libraries at inflated subscription rates and to be indexed in various indexing services along with having a high impact factor (a measure of how often papers published in a journal are cited). In essence, current medical ‘‘scientific’’ publishing is a sophisticated form of journalism that is designed to sell subscriptions and draw authors of sensational and not necessarily valid studies. Science is a higher goal than publication. Valid science should be published no matter how mundane the study. At this stage in development of the science for emergency/disaster health and medicine, publication of research should prioritize methodologically valid studies regardless of potential negative results or appeal outside the discipline. Citation indexes, subscription revenues, and media headlines are dangerous distractions for those with a goal of conducting and publishing valid scientific work. Beginning its 29 year of publication, Prehospital and Disaster Medicine will continue to focus on publication of valid science with the goal of advancing global knowledge of emergency/disaster health and medicine.

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TL;DR: Findings provide potential improvement options for receiving hospitals dialysis units to prepare for future events after Hurricane Sandy and explore difficulties encountered by hospitals in Brooklyn, New York (USA).
Abstract: Objective Hurricane Sandy forced closures of many free-standing dialysis centers in New York City in 2012. Hemodialysis (HD) patients therefore sought dialysis treatments from nearby hospitals. The surge capacity of hospital dialysis services was the rate-limiting step for streamlining the emergency department flow of HD patients. The aim of this study was to determine the extent of the HD patients surge and to explore difficulties encountered by hospitals in Brooklyn, New York (USA) due to Hurricane Sandy. Methods A retrospective survey on hospital dialysis services was conducted by interviewing dialysis unit managers, focusing on the influx of HD patients from closed dialysis centers to hospitals, coping strategies these hospitals used, and difficulties encountered. Results In total, 347 HD patients presented to 15 Brooklyn hospitals for dialysis. The number of transient HD patients peaked two days after landfall and gradually decreased over a week. Hospital dialysis services reported issues with lack of dialysis documentation from transient dialysis patients (92.3%), staff shortage (50%), staff transportation (71.4%), and communication with other agencies (53.3%). Linear regression showed that factors significantly associated with enhanced surge capacity were the size of inpatient dialysis unit (P = .040), having affiliated outpatient dialysis centers (P = .032), using extra dialysis machines (P = .014), and having extra workforce (P = .007). Early emergency plan activation (P = .289) and shortening treatment time (P = .118) did not impact the surge capacity significantly in this study. Conclusion These findings provide potential improvement options for receiving hospitals dialysis units to prepare for future events. Lin C , Pierce LC , Roblin PM , Arquilla B . Impact of Hurricane Sandy on Hospital Emergency and Dialysis Services: A Retrospective Survey. Prehosp Disaster Med. 2014;29(4):1-6 .

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TL;DR: Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints, and construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs.
Abstract: Introduction The goal of an Emergency Medical Services (EMS) system is to prevent needless death or disability from time-sensitive disease processes. Despite growing evidence that these processes contribute significantly to mortality in low- and middle- income countries (LMICs), there has been little focus on the development of EMS systems in poor countries. Problem The objective of this study was to understand the utilization pattern of a newly-implemented EMS system in Ruhiira, Uganda. Methods An EMS system based on community priorities was implemented in rural Uganda in 2009. Six months of ambulance logs were reviewed. Patient, transfer, and clinical data were extracted and analyzed. Results In total, 207 cases were reviewed. Out of all transfers, 66% were for chief complaints that were obstetric related, while 12% were related to malaria. Out of all activations, 77.8% were for female patients. Among men, 34% and 28% were related to malaria and trauma, respectively. The majority of emergency transfers were from district to regional hospitals, including 52% of all obstetric transfers, 65% of malaria transfers, and 62% of all trauma transfers. There was no significant difference in the call to arrival on scene time, the time to scene or the scene to treatment time during the day and night (P > .05). Cost-benefit analysis revealed a cost of $0.09/capita/year to maintain the system. Conclusion Contrary to current belief, EMS systems in rural Africa can be affordable and highly utilized, particularly for life-threatening, nontrauma complaints. Construction of a simple but effective EMS system is feasible, acceptable, and an essential component to the primary health care system of LMICs. Stewart De Ramirez S , Doll J , Carle S , Anest T , Arii M , Hsieh YH , Okongo M , Moresky R , Sachs SE , Millin M . Emergency Response in Resource-poor Settings: A Review of a Newly-implemented EMS System in Rural Uganda. Prehosp Disaster Med. 2014;29(3):1-6 .

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TL;DR: Findings from this study suggest that only full-scale exercises were significant in improving response and recovery outcomes, and establishment of empirical data provides communities with reinforcement to continue resilience-building activities at the local level.
Abstract: Introduction The aim of this study was to determine if a relationship exists between the development of adaptive capacity and disaster response and recovery outcomes. Hospitals and health care systems are a critical element in community planning for all phases of the disaster cycle. There is a lack of research, however, to validate the relationship between the development of these capabilities and improved response and recovery outcomes. Hypothesis/Problem Two hypotheses were formulated to address the research question. The first hypothesis argued that counties or parishes that developed adaptive capacity through pre-event planning, community engagement, training, and the use of national response frameworks would have improved response and recovery performance outcomes. The second hypothesis argued that adaptive capacity, along with response and recovery performance outcomes, predicts the trajectory of recovery progression. Methods This study employed a quantitative cross-sectional survey methodology and existing community demographic data to explore the development of adaptive capacity and its ability to predict disaster response and recovery outcomes in communities affected by major disaster in 2011. A total of 333 counties and parishes were included in the final sample, providing a 95% confidence interval with a 5% margin of error. Data were analyzed using both descriptive and inferential statistics. Multiple, hierarchical, and robust regression were used to find the best fitting model. Multi-level modeling with random intercepts was used to control for the nesting effects associated with county, state, and the Federal Emergency Management Agency (FEMA) region sampling. Results Descriptive results provide a baseline assessment of adaptive capacity development at the community level. While controlling for other variables, hypothesis testing revealed that pre-event planning, community engagement, full-scale exercises, and use of national frameworks predicated overall response and recovery performance outcomes (R 2 = .43; F 13,303 = 13.34; P < .001). In terms of recovery progression, pre-event planning, overall response and recovery performance outcome, total time of disruption, and percent of people below poverty were significant (R 2 = .15; F14,302 = 4.53; P < .001). Conclusions Establishment of empirical data provides communities with reinforcement to continue resilience-building activities at the local level. However, findings from this study suggest that only full-scale exercises were significant in improving response and recovery outcomes. Implications for re-evaluation of disaster training warrant further exploration. Zukowski RS . The Impact of Adaptive Capacity on Disaster Response and Recovery: Evidence Supporting Core Community Capabilities. Prehosp Disaster Med. 2014;29(4):1-8 .

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TL;DR: There is little evidence regarding the relationship between prehospital spinal immobilization and patient neurological outcomes, however, early patient transfer to spinal care units and effective resuscitation have been demonstrated to lead to better neurological outcomes.
Abstract: Introduction Spinal cord injury (SCI) is a serious condition that may lead to long-term disabilities placing financial and social burden on patients and their families, as well as their communities. Spinal immobilization has been considered the standard prehospital care for suspected SCI patients. However, there is a lack of consensus on its beneficial impact on patients’ outcome. Objective This paper reviews the current literature on the epidemiology of traumatic SCI and the practice of prehospital spinal immobilization. Design A search of literature was undertaken utilizing the online databases Ovid Medline, PubMed, CINAHL, and the Cochrane Library. The search included English language publications from January 2000 through November 2012. Results The reported annual incidence of SCI ranges from 12.7 to 52.2 per 1 million and occurs more commonly among males than females. Motor vehicle collisions (MVCs) are the major reported causes of traumatic SCI among young and middle-aged patients, and falls are the major reported causes among patients older than 55. There is little evidence regarding the relationship between prehospital spinal immobilization and patient neurological outcomes. However, early patient transfer (8-24 hours) to spinal care units and effective resuscitation have been demonstrated to lead to better neurological outcomes. Conclusion This review reaffirms the need for further research to validate the advantages, disadvantages, and the effects of spinal immobilization on patients’ neurological outcomes. Oteir AO , Smith K , Jennings PA , Stoelwinder JU . The Prehospital Management of Suspected Spinal Cord Injury: An Update. Prehosp Disaster Med. 2014;29(4):1-4 .

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TL;DR: Real-time portable ultrasound video transmission via commercially available video mobile phones from a simulated disaster triage location is feasible and emergency physicians were able to accurately interpret video of FAST ultrasound examinations.
Abstract: Objective Disaster management is a complex and difficult undertaking that may involve limited health care resources and evaluation of multiple victims. The objectives of this study were to evaluate the feasibility of real-time ultrasound video transmission from a simulated disaster triage location via commercially available video mobile phones and assess the ability of emergency physicians to accurately interpret the transmitted video of Focused Assessment with Sonography for Trauma (FAST) ultrasound examinations. Methods This was a prospective, observational study that took place at a simulated disaster scene put on for an Advanced Disaster Life Support (ADLS) course. The second component occurred at a Level I academic urban emergency department (ED) with an annual census of 78,000. Nineteen subjects at a simulated disaster scene were scanned using a SonoSite Titan ultrasound system (Bothell, Washington USA). An off-the-shelf, basic, video-capable mobile phone was used to record each ultrasound examination; and then immediately transmit the videos to another mobile phone approximately 170 miles away. The transmitted video was received by three emergency physicians with hospital credentialing in emergency ultrasound. Each FAST examination video was assessed for pathology, such as free fluid. The reviewers graded the image quality and documented the overall confidence level regarding whether or not a complete and adequate examination was visualized. Spearman's rank correlation coefficient was used to examine the agreement between the reviewers and the sonologist who performed the ultrasound examinations. Results A total of 19 videos were transmitted. The median time for transmission of a video was 82.5 seconds (95% CI, 67.7 seconds-97.3 seconds). No video failed to transmit correctly on the first attempt. The image quality ratings for the three reviewers were 7.7, 7.5, and 7.4 on a 10-point Likert scale. There was a moderate agreement between the reviewers and sonologist in image quality rating and overall confidence level scores (rho = 0.6). Conclusions Real-time portable ultrasound video transmission via commercially available video mobile phones from a simulated disaster triage location is feasible and emergency physicians were able to accurately interpret video of FAST ultrasound examinations. Adhikari S , Blaivas M , Lyon M , Shiver S . Transfer of Real-time Ultrasound Video of FAST Examinations from a Simulated Disaster Scene Via a Mobile Phone. Prehosp Disaster Med. 2014;29(3):1-4 .

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TL;DR: The specialized nurse role was identified, along with the need for preparedness education to support the nurse's role in a disaster, and a need to further explore the roles of specialized nurses in disasters.
Abstract: Background An earthquake and tsunami hit the east coast of Japan on March 11, 2011. Nurses were actively involved in the health response to this disaster and, subsequently, many authors have reported on the role nurses played in these efforts in Japanese nursing professional journals. Aim To describe the role of nurses who assisted in the 2011 Great East Earthquake of Japan by reviewing Japanese literature and reporting the findings in English. Method This research used an integrative literature review methodology. Manuscripts were obtained from the Japanese database Ichushi Ver. 5 (Japan Medical Abstracts Society, Tokyo, Japan). A total of 44 manuscripts were identified and included in a thematic analysis. Results Three main themes were identified: (1) nursing roles, (2) specialized nursing roles, and (3) preparedness education. Nurses fulfilled different roles in the period after the disaster (ie, as a clinician, a communicator, a leader, and a provider of psychosocial support). Additionally, the specialized nurse role was identified, along with the need for preparedness education to support the nurse's role in a disaster. Conclusion The understanding of the role of nurses in disasters is expanding. There is a need to further explore the roles of specialized nurses in disasters. Further disaster education opportunities should be available as a part of continuing education for all nurses. Radiation aspects of disaster assistance should be included in disaster education programs where there are radio-nuclear hazards present in the environment. Kako M , Ranse J , Yamamoto A , Arbon P . What Was the Role of Nurses During the 2011 Great East Earthquake of Japan? An Integrative Review of the Japanese Literature. Prehosp Disaster Med. 2014;29(3):1-5.

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TL;DR: It is concluded that future research should clearly define the constituent components included in available interventions, which will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements.
Abstract: Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.

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TL;DR: Through a 2011 field-based exercise that simulated a humanitarian crisis, a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers.
Abstract: The need to provide a professionalization process for the humanitarian workforce is well established. Current competency-based curricula provided by existing academically affiliated training centers in North America, the United Kingdom, and the European Union provide a route toward certification. Simulation exercises followed by timely evaluation is one way to mimic the field deployment process, test knowledge of core competences, and ensure that a competent workforce can manage the inevitable emergencies and crises they will face. Through a 2011 field-based exercise that simulated a humanitarian crisis, delivered under the auspices of the World Health Organization (WHO), a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers.