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Post-traumatic psychological changes among survivors of the Lushan earthquake living in the most affected areas. Psychiatry Res 2014; 220:384-90. [PMID: 25128250 DOI: 10.1016/j.psychres.2014.07.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 01/10/2023]
Abstract
The primary objective of our study was to investigate both the negative and positive psychological changes following the Lushan earthquake, and to explore the factors associated with psychological changes. Multi-stage random sampling was used to select respondents from Lushan County, Sichuan Province, China. A simplified Chinese version of the short form of Changes in Outlook Questionnaire (CiOQ-S) was used to assess psychological changes in earthquake survivors. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. A total of 4972 respondents were investigated in the cross-sectional study. The mean scores of the positive and negative psychological changes were 26.61 and 8.12, respectively. The factors associated with positive psychological changes included ethnic minority, high level of education, high household income, not injured in the earthquake, not trapped during the earthquake, and having experienced the Wenchuan earthquake. The factors associated with negative psychological changes included female gender, ethnic minority, low household income, history of diseases, injured during the earthquake, and trapped during the earthquake. The current analysis helps expand our knowledge of the negative and positive psychological changes that may occur following an earthquake experience.
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Simon T, Adini B, El-Hadid M, Goldberg A, Aharonson-Daniel L. The race to save lives: demonstrating the use of social media for search and rescue operations. PLOS CURRENTS 2014; 6:ecurrents.dis.806848c38f18c6b7b0037fae3cd4edc5. [PMID: 25685618 PMCID: PMC4322004 DOI: 10.1371/currents.dis.806848c38f18c6b7b0037fae3cd4edc5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
IMPORTANCE Utilizing social media in an emergency can enhance abilities to locate and evacuate casualties more rapidly and effectively, and can contribute towards saving lives following a disaster, through better coordination and collaboration between search and rescue teams. OBJECTIVE An exercise was conducted in order to test a standard operating procedure (SOP) designed to leverage social media use in response to an earthquake, and study whether social media can improve joint Israeli-Jordanian search and rescue operations following a regional earthquake. DESIGN First responders from both Jordan and Israel were divided into two mixed groups of eight people each, representing joint (Israeli-Jordanian) EMS teams. Simulated patients were dispersed throughout the Ben-Gurion University Campus. The first search and rescue team used conventional methods, while the second team also used social media channels (Facebook and Twitter) to leverage search and rescue operations. PARTICIPANTS Eighteen EMS and medical professionals from Israel and Jordan, which are members of the Emergency Response Development and Strategy Forum working group, participated in the exercise. RESULTS The social media team found significantly more mock casualties, 21 out of 22 (95.45%) while the no-media team found only 19 out of 22 (86.36%). Fourteen patients (63.63%) were found by the social media team earlier than the no-media team. The differences between the two groups were analyzed using the Mann-Whitney U-test, and evacuation proved to be significantly quicker in the group that had access to social media. The differences between the three injury severities groups' extraction times in each group were analyzed using the Kruskal-Wallis test for variance. Injury severity influenced the evacuation times in the social media team but no such difference was noted in the no-media team. CONCLUSIONS Utilizing social media in an emergency situation enables to locate and evacuate casualties more rapidly and effectively. Social media can contribute towards saving lives during a disaster, in national and bi-national circumstances. Due to the small numbers in the groups, this finding requires further verification on a larger study cohort.
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Affiliation(s)
- Tomer Simon
- Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev; Ready.org.il - Emergency readiness and preparedness in Israel; PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Health-related quality of life and the adaptation of residents to harsh post-earthquake conditions in China. Disaster Med Public Health Prep 2014; 8:390-6. [PMID: 25337718 DOI: 10.1017/dmp.2014.94] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study assessed the health-related quality of life (HRQOL) and the adaptation to harsh conditions (APHC) of residents living in post-earthquake zones in Sichuan Province, China, as well as the effect of HRQOL on APHC. METHODS A sample survey was conducted in 5 counties in Sichuan in May and June 2013 (N=2000). The 12-item Short Form Health Survey (SF-12) was used to measure HRQOL. The APHC scale was self-developed and was based on real-life conditions in China. Confirmatory factor analysis and structural equation model were used to analyze how HRQOL affected APHC. RESULTS Cronbach α coefficients indicated that the internal reliability of both scales were good. Results showed that the physical component summary significantly affected APHC, while the effect of the mental component summary was insignificant. APHC had the greatest effect on the adaptation to poor infrastructures (r=0.721) and the least effect on the adaptation to poor social security systems (r=0.608). CONCLUSIONS The HRQOL of residents living in post-earthquake zones positively affected APHC, particularly physical health. These findings suggested the need for governmental improvement of infrastructures in post-disaster areas. (Disaster Med Public Health Preparedness. 2014;0:1-7).
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Zhong S, Clark M, Hou XY, Zang Y, FitzGerald G. Progress and challenges of disaster health management in China: a scoping review. Glob Health Action 2014; 7:24986. [PMID: 25215910 PMCID: PMC4161949 DOI: 10.3402/gha.v7.24986] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/31/2014] [Accepted: 08/13/2014] [Indexed: 11/16/2022] Open
Abstract
Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).
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Affiliation(s)
- Shuang Zhong
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; Center for Health Management and Policy, Shandong University, Jinan, China;
| | - Michele Clark
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Xiang-Yu Hou
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Yuli Zang
- School of Nursing, Shandong University, Jinan, China
| | - Gerard FitzGerald
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia;
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Dan X, Liu W, Ng TB. Chinese bystanders in medical emergencies: apathetic or bewildered? Emerg Med J 2014; 31:698-9. [DOI: 10.1136/emermed-2014-204012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wang Y, Li X, Yuan Y, Patel MS. A multi-method approach to curriculum development for in-service training in China's newly established health emergency response offices. PLoS One 2014; 9:e100892. [PMID: 24971602 PMCID: PMC4074095 DOI: 10.1371/journal.pone.0100892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe an innovative approach for developing and implementing an in-service curriculum in China for staff of the newly established health emergency response offices (HEROs), and that is generalisable to other settings. METHODS The multi-method training needs assessment included reviews of the competency domains needed to implement the International Health Regulations (2005) as well as China's policies and emergency regulations. The review, iterative interviews and workshops with experts in government, academia, the military, and with HERO staff were reviewed critically by an expert technical advisory panel. FINDINGS Over 1600 participants contributed to curriculum development. Of the 18 competency domains identified as essential for HERO staff, nine were developed into priority in-service training modules to be conducted over 2.5 weeks. Experts from academia and experienced practitioners prepared and delivered each module through lectures followed by interactive problem-solving exercises and desktop simulations to help trainees apply, experiment with, and consolidate newly acquired knowledge and skills. CONCLUSION This study adds to the emerging literature on China's enduring efforts to strengthen its emergency response capabilities since the outbreak of SARS in 2003. The multi-method approach to curriculum development in partnership with senior policy-makers, researchers, and experienced practitioners can be applied in other settings to ensure training is responsive and customized to local needs, resources and priorities. Ongoing curriculum development should reflect international standards and be coupled with the development of appropriate performance support systems at the workplace for motivating staff to apply their newly acquired knowledge and skills effectively and creatively.
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Affiliation(s)
- Yadong Wang
- School of Health Management and Education, Capital Medical University, Beijing, China
- * E-mail:
| | | | - Yiwen Yuan
- Peking University Third Hospital, Beijing, China
| | - Mahomed S. Patel
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Zhong S, Clark M, Hou XY, Zang Y, FitzGerald G. Validation of a framework for measuring hospital disaster resilience using factor analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6335-53. [PMID: 24945190 PMCID: PMC4078582 DOI: 10.3390/ijerph110606335] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Abstract
Hospital disaster resilience can be defined as "the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one." This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.
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Affiliation(s)
- Shuang Zhong
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
| | - Michele Clark
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
| | - Xiang-Yu Hou
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
| | - Yuli Zang
- School of Nursing, Shandong University, #44 Wenhua West Road, Jinan, Shandong 250012, China.
| | - Gerard FitzGerald
- Center for Emergency and Disaster Management, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland 4059, Australia.
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Liu C, Robinson P. Better organisation of volunteers in disaster settings is needed: lessons for all from China. Aust N Z J Public Health 2014; 37:595-6. [PMID: 24892166 DOI: 10.1111/1753-6405.12139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zhang L, Zhao M, Fu W, Gao X, Shen J, Zhang Z, Xian M, Jiao Y, Jiang J, Wang J, Gao G, Tang B, Chen L, Li W, Zhou C, Deng S, Gu J, Zhang D, Zheng Y, Chen X. Epidemiological analysis of trauma patients following the Lushan earthquake. PLoS One 2014; 9:e97416. [PMID: 24846207 PMCID: PMC4028270 DOI: 10.1371/journal.pone.0097416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/18/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A 7.0-magnitude earthquake hit Lushan County in China's Sichuan province on April 20, 2013, resulting in 196 deaths and 11,470 injured. This study was designed to analyze the characteristics of the injuries and the treatment of the seismic victims. METHODS After the earthquake, an epidemiological survey of injured patients was conducted by the Health Department of Sichuan Province. Epidemiological survey tools included paper-and-pencil questionnaires and a data management system based on the Access Database. Questionnaires were completed based on the medical records of inpatients with earthquake-related injuries. Outpatients or non-seismic injured inpatients were excluded. A total of 2010 patients from 140 hospitals were included. RESULTS The most common type of injuries involved bone fractures (58.3%). Children younger than 10 years of age suffered fewer fractures and chest injuries, but more skin and soft -tissue injuries. Patients older than 80 years were more likely to suffer hip and thigh fractures, pelvis fractures, and chest injuries, whereas adult patients suffered more ankle and foot fractures. A total of 207 cases of calcaneal fracture were due to high falling injuries related to extreme panic. The most common type of infection in hospitalized patients was pulmonary infections. A total of 70.5% patients had limb dysfunction, and 60.1% of this group received rehabilitation. Most patients received rehabilitation within 1 week, and the median duration of rehabilitation was 3 weeks. The cause of death of all seven hospitalized patients who died was severe traumatic brain injuries; five of this group died within 24 h after the earthquake. CONCLUSIONS Injuries varied as a function of the age of the victim. As more injuries were indirectly caused by the Lushan earthquake, disaster education is urgently needed to avoid secondary injuries.
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Affiliation(s)
- Li Zhang
- State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese PLA General Hospital and Military Medical College, Beijing, China
| | - Minggang Zhao
- National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
| | - Wenhao Fu
- National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
| | - Xinqiang Gao
- National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
| | - Ji Shen
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Zuyun Zhang
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Ming Xian
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Yunzhi Jiao
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Jian Jiang
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Jinqian Wang
- Health and Family Planning Commission of Sichuan Province, Chengdu, China
| | - Guomin Gao
- Department of Health, United Logistic Ministry, Chengdu Military Region, Chengdu, China
| | - Bin Tang
- Department of Health, United Logistic Ministry, Chengdu Military Region, Chengdu, China
| | - Liang Chen
- Department of Health, United Logistic Ministry, Chengdu Military Region, Chengdu, China
| | - Weimin Li
- West China Hospital, Sichuan University, Chengdu, China
| | | | - Shaoping Deng
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Jianwen Gu
- General Hospital of Chengdu Military Command, Chengdu, China
| | - Dong Zhang
- State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese PLA General Hospital and Military Medical College, Beijing, China
| | - Ying Zheng
- State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese PLA General Hospital and Military Medical College, Beijing, China
| | - Xiangmei Chen
- State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese PLA General Hospital and Military Medical College, Beijing, China
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Zhong S, Hou XY, Clark M, Zang YL, Wang L, Xu LZ, FitzGerald G. Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China. BMC Health Serv Res 2014; 14:135. [PMID: 24661641 PMCID: PMC3987831 DOI: 10.1186/1472-6963-14-135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/19/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Hospital disaster resilience can be defined as a hospital's ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. METHODS A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. RESULTS A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a 'portable hospital' function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. CONCLUSIONS This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.
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Affiliation(s)
- Shuang Zhong
- Center for Emergency & Disaster Management, School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia.
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The Operating Room During a Severe Earthquake: Lessons From the 2011 Great East Japan Earthquake. Disaster Med Public Health Prep 2014; 8:123-129. [PMID: 24618082 DOI: 10.1017/dmp.2014.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Great East Japan Earthquake occurred at 14:46 on March 11, 2011, producing serious and widespread damage. To assess damages in hospital operating departments during and after the earthquake, we surveyed hospitals in this region. METHODS Questionnaires were sent to 415 acute care hospitals in Tohoku and east Kanto areas. The questionnaires elicited the number of perioperative patients when the earthquake hit, obstacles to continuing surgery, structural and nonstructural damage to the operating department, and the effect on routine surgery after the earthquake. RESULTS Of the 213 hospitals (51%) that completed questionnaires, 474 patients were undergoing operations during the earthquake, and 222 operations were canceled afterward. Risk factors for continuing operations, as reported by 102 hospitals, were tremors and electrical blackouts (odds ratio [OR]: 79.3 and 110.5; P < .01). In 154 hospitals, difficulties in performing operations after the earthquake were reported. Significant obstacles to the management of operations after the earthquake were characterized by infrastructure disorder scores, seismic intensity, disruption of electrical power and air conditioning, and damage to out-of-hospital telecommunications (OR, 0.46; P = .04). CONCLUSIONS Tremors and electrical blackouts were important risk factors for performing operations. Nonstructural damage, especially to out-of-hospital telecommunications, affected the management of the operating rooms. Hospital logistics are very important to achieve appropriate disaster management. (Disaster Med Public Health Preparedness. 2014;0:1-7).
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Abstract
BACKGROUND Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
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Affiliation(s)
- Douglas G. Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, Hyperbaric Medicine, Shock Trauma Center, Baltimore, Maryland, USA
| | - Brad L. Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Iwata O, Oki T, Ishiki A, Shimanuki M, Fuchimukai T, Chosa T, Chida S, Nakamura Y, Shima H, Kanno M, Matsuishi T, Ishiki M, Urabe D. Infection surveillance after a natural disaster: lessons learnt from the Great East Japan Earthquake of 2011. Bull World Health Organ 2013; 91:784-9. [PMID: 24115802 DOI: 10.2471/blt.13.117945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/20/2013] [Accepted: 06/22/2013] [Indexed: 11/27/2022] Open
Abstract
PROBLEM On 11 March 2011, the Great East Japan Earthquake produced a catastrophic tsunami that devastated the city of Rikuzen-Takata and left it without an effective health infrastructure and at increased risk of outbreaks of disease. APPROACH On 2 May 2011, a disease-surveillance team was formed of volunteers who were clinicians or members of Rikuzen-Takata's municipal government. The team's main goal was to detect the early signs of disease outbreaks. LOCAL SETTING Seven weeks after the tsunami, 16 support teams were providing primary health care in Rikuzen-Takata but the chain of command between them was poor and 70% of the city's surviving citizens remained in evacuation centres. The communication tools that were available were generally inadequate. RELEVANT CHANGES The surveillance team collected data from the city's clinics by using a simple reporting form that could be completed without adding greatly to the workloads of clinicians. The summary findings were reported daily to clinics. The team also collaborated with public health nurses in rebuilding communication networks. Public health nurses alerted evacuation centres to epidemics of communicable disease. LESSONS LEARNT Modern health-care systems are highly vulnerable to the loss of advanced technological tools. The initiation--or re-establishment--of disease surveillance following a natural disaster can therefore prove challenging even in a developed country. Surveillance should be promptly initiated after a disaster by (i) developing a surveillance system that is tailored to the local setting, (ii) establishing a support team network, and (iii) integrating the resources that remain--or soon become--locally available.
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Affiliation(s)
- Osuke Iwata
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
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Delauche MC, Blackwell N, Le Perff H, Khallaf N, Müller J, Callens S, Allafort Duverger T. A Prospective Study of the Outcome of Patients with Limb Trauma following the Haitian Earthquake in 2010 at One- and Two- Year (The SuTra2 Study). PLOS CURRENTS 2013; 5. [PMID: 24818064 PMCID: PMC4011624 DOI: 10.1371/currents.dis.931c4ba8e64a95907f16173603abb52f] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Severe limb trauma is common in earthquake survivors. Overall medium
term outcomes and patient-perceived outcomes are poorly documented. Methods and
Findings The prospective study SuTra2 assessed the functional and socio-economic
status of a cohort of patients undergoing surgery for limb injury resulting in
amputation (A) or limb preservation (LP) one year and two years after the 2010
Haiti earthquake. 305 patients [A: n=199 (65%), LP: n=106 (35%)] were evaluated.
Their characteristics were: 57% female; mean age 31 years; 74% of principal
injuries involved the lower limb; 46% of patients had an additional severe
injury; 60% had fractures, of which two-thirds were compound or associated with
severe soft tissue damage; 15% of amputations were traumatic. At 2 years, 51% of
patients were satisfied with the functional outcome (A: 52%, LP: 49%, ns).
Comparison with the 1-year status indicates a worsening of the perceived
functional status, significantly more pronounced in amputees, and an increase in
pain complaints, mainly in amputees (62% and 80% of pain in overall population
at 1- and 2-year respectively). Twenty eight percent (28%) of LP and 66% of A
considered themselves as “cured”. 100% of LP and 79% of A would have chosen a
conservative approach if an amputation was medically avoidable. Two years after
the earthquake, 23·5 % of patients were still living in a tent, 30% were
working, and 25·5% needed ongoing surgical management. Conclusions Only half the
patients with severe limb injuries, whether managed with amputation or limb
preservation, deemed their functional status satisfactory at 2 years. The
patients’ perspective, clearly favors limb conservative management whenever
possible. Prolonged care and rehabilitation are needed to optimize the outcome
for earthquake survivors with limb injuries. Humanitarian respondents to
catastrophes have professional and ethical obligations to provide optimal
immediate care and ensure scrupulous attention to long-term management. Keywords
Haiti earthquake, limb injury, two-year outcome, patients’ perspective,
amputation, limb salvage
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Affiliation(s)
| | | | - Hervé Le Perff
- The Alliance for International Medical Action ALIMA, Fann Résidence, BP15530The Alliance for International Medical Action (ALIMA)
| | | | - Joël Müller
- Université Lille Nord de France - Université d'Artois
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Zhang X, Reinhardt JD, Gosney JE, Li J. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment. PLoS One 2013; 8:e53995. [PMID: 23308293 PMCID: PMC3538750 DOI: 10.1371/journal.pone.0053995] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background Long-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. ‘NHV’ is a rehabilitation services program comprised of non–governmental organizations (NGOs) (N), local health departments (H), and professional rehabilitation volunteers (V) which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program. Methods/Findings 510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%). The early intervention group (NHV–E) consisted of 298 survivors who received institutional-based rehabilitation (IBR) followed by community-based rehabilitation (CBR); the late intervention group (NHV–L) was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI). Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV–E and NHV–L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0–13.3) and sponaneaous recovery (5.03; 95% CI 1.73–8.34). The effect of NHV-E (11.3, 95% CI 9.0–13.7) was marginally greater than that of NHV-L (10.7, 95% CI 7.9–13.6). It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated. Conclusion Our analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services in China, and international rehabilitation disaster relief planning. Similar IBR/CBR programs should therefore be considered for future large-scale rehabilitation disaster relief efforts.
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Affiliation(s)
- Xia Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
| | - Jan D. Reinhardt
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - James E. Gosney
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
- * E-mail:
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Shen J, Kang J, Shi Y, Li Y, Li Y, Su L, Wu J, Zheng S, Jiang J, Hu W, Yang Y, Tang X, Wen J, Li L, Shen J, Zhong D. Lessons learned from the Wenchuan earthquake. J Evid Based Med 2012; 5:75-88. [PMID: 23557471 DOI: 10.1111/j.1756-5391.2012.01176.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To conclude experience and lessons from emergency medical rescue after Wenchuan Earthquake from national and overall review for consideration on worldwide catastrophe rescue in the future. METHODS To systematically collect huge amount of primary data, and to make analysis, draw conclusions and lessons in terms of five aspects respectively as quake-damage conditions, command system, emergency medical rescue, prevention and control over infectious diseases as well as pairing-assistance for medical system and service reconstruction. RESULTS 1. Numbers as of the death, injured and migrants made Wenchuan Earthquake ranked one of the top 9 catastrophes around the world during the past two decades. 2. Countermeasures such as four-level linkage by nation-province-city-county model, mutual assistance between military force and local forces, frontline commanding did effectively ensure the dispatch and cooperation among rescue forces. 3. Three-leveled medical transfers, "four concentrations" prevention and treatment besides whole-course rehabilitation at early stage managed to lower mortality and disability rate to minimum levels respectively. 4. "Four-keynote infectious disease control" under whole coverage and "five measures and four reinforcement measures" in settlements made rates as for those infectious diseases under the average level as those in the 3 pre-quake years. 5. Pairing-assistance in terms of talents, finance, materials as well as capacity building between other 18 provinces/municipalities and those 18 extremely-stricken/severely-stricken areas in Sichuan Province guaranteed efficient post-quake reconstruction, system reconstruction and long-term mechanism construction. CONCLUSIONS Successful experience from Wenchuan Earthquake could be summarized as: one goal as people-oriented life-rescuing. Two tasks as medical rescue for diseases of those injured and healthcare & anti-epidemic for safe and sound of those lives. Three strategies respectively as medical transfers after on-site triage, treatment for severe diseases in quake-hit areas and rehabilitation in non quake-hit areas for medical rescue, and quick post-quake evaluation, quick promotion for whole coverage and scientific regulation in long term for healthcare & anti-epidemic. Four measures as concentration for patients, experts, resources and treatment respectively for medical rescue, and key regions, key groups, key infectious diseases and key steps for healthcare & anti-epidemic. Five links as overall commanding, medical rescue, healthcare and anti-epidemic, physical/mental rehabilitation and post-quake reconstruction. And whole course surveillance as information guidance, policy guarantee, data collection, evidence producing, effectiveness evaluation, and academic communication.
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Affiliation(s)
- Ji Shen
- Health Department of Sichuan Province, Chengdu, China.
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Hekimoglu Y, Gokhan Dizdar M, Canturk N, Esen Melez I, Canturk G, Erkol Z, Nuri Guler O, Dursun R. Deaths Due to Fires in the Tent City Set Up After the 2011 Earthquake in Van, Turkey. TOHOKU J EXP MED 2012; 228:169-71. [DOI: 10.1620/tjem.228.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yavuz Hekimoglu
- Van Branch Office, The Council of Forensic Medicine, The Ministry of Justice
| | | | - Nergis Canturk
- Department of Criminalistics, Institute of Forensic Sciences, Ankara University
| | | | - Gurol Canturk
- Department of Forensic Medicine, Medical Faculty, Ankara University
| | - Zerrin Erkol
- Department of Forensic Medicine, Medical Faculty, Abant Izzet Baysal University
| | | | - Recep Dursun
- Department of Emergency Medicine, Van Training Research Hospital
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