Worldwide disaster medical response: An historical perspective

Scientists' perspectives on ethical issues in research with emerging portable neuroimaging technology: The need for guidance on ethical, legal, and societal implications (ELSI)

Deployment of new, more portable, and less costly neuroimaging technologies such as portable magnetoencephalography, electroencephalography, positron emission tomography, functional near-infrared spectroscopy, high-density diffuse optical tomography, and magnetic resonance imaging is advancing rapidly. Given this trajectory toward increasing use of neuroimaging outside the hospital, we sought to identify ethical, legal, and societal implications (ELSI) of these new technologies by understanding the perspectives of those scientists and engineers developing and implementing portable neuroimaging technologies in the United States, Europe, and Asia. Based on a literature review, we identified and contacted 19 potential interviewees and then conducted 11 semi-structured interviews in English by Zoom. Analysis of the interviews revealed key themes and ELSI issues. Developers reported that without proper ELSI guidance, portable and accessible neuroimaging technology could be misused, fail to comply with applicable regulation and policy, and ultimately fall short in its mission to provide neuroimaging for the world. Our interviews suggested that ELSI guidance should address differences between imaging modalities because they vary in capability, limitations, and likelihood of generating incidental findings.

The relationship between ambulance team's professional commitment, occupational anxiety, and resilience levels

BACKGROUND

Individuals who have the ability to bounce back from stressful events, to recover from their troubles and adverse environmental conditions by getting stronger each time are known as resilient people. Some professions may cause more occupational anxiety than others due to their characteristics and working conditions. In this research, we aimed to develop a professional commitment scale for the ambulance team. Another aim was to analyze the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit variables.

METHODS

In the study, data were collected from a total of 1142 emergency ambulance workers working in Emergency Ambulance and Emergency Call Centers in 34 different cities in Turkey. Data were collected using the "Professional Commitment of Ambulance Team Scale (PCATS), Occupational Anxiety Scale for Emergency Medical Service Professionals (OASEMSP), and Resilience Scale for Adults (RSA). Scale development analyses were carried out using Classical Test Theory (CTT) and Item Response Theory (IRT). Regression analysis were used to examine the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit.

RESULTS

As a result of the exploratory factor analysis (EFA), it was determined that 8 items remaining in the professional commitment scale formed a single-factor structure, explaining 46% of the variance of professional commitment of the team. The Cronbach's Alpha reliability value was 0.867. Confirmatory factor analysis (CFA) confirmed the results of exploratory factor analysis. The Cronbach's Alpha reliability coefficient obtained through CTT was 0.868, and the marginal reliability coefficient within the scope of IRT was 0.877. The test-retest reliability coefficient was calculated as 0.832, which indicates that the scale is valid and reliable.

CONCLUSIONS

The study revealed that resilience has a positive effect for professional commitment while occupational anxiety has a negative effect for professional commitment. In addition, having a moderate seniority has a negative (reducing) effect for professional commitment. Other variables (gender, job, and working unit) was found to have no significant impact on professional commitment.

Challenges Faced by Medical Rescue Teams During Disaster Response: A Systematic Review Study

This study was conducted to identify the challenges faced by medical rescue teams during the response phase of sudden-onset disasters and provide a comprehensive understanding of these challenges. Peer-reviewed, English-language articles published until January 2023 that described the challenges faced by medical rescue teams during disaster response were searched in the Web of Science, Scopus, Cochrane, PubMed, and Science Direct databases. The articles were assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018, a quality evaluation tool, and a qualitative thematic synthesis approach was adopted. A total of 353 publications were identified, and 18 of these met the inclusion criteria. Of the 18 included studies, 8 were review articles, 4 were special reports, 3 were cross-sectional studies, 1 was a mixed methods study, 1 was a qualitative study, and 1 was a short communication. Through qualitative analysis, the challenges faced by medical rescue teams during disaster response were categorized into 6 factors: organizational, individual, environmental and health, logistical, communication and information, and other factors. These factors are significant in terms of issues such as delayed access to disaster victims, disruptions in response processes, and an increase in morbidity and mortality rates. Therefore, the findings in our study shed light on future research in the field of disasters and offer opportunities to develop a roadmap for improving the conditions of medical rescue teams.

Surgical Science and the Evolution of Critical Care Medicine

Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.

The needs of cancer patients during the COVID-19 pandemic-psychosocial, ethical and spiritual aspects-systematic review

The COVID-19 pandemic resulted in unprecedented changes in the functioning of the health care system, which were connected with the occurrence of new challenges for both the health care system's employees and for the patients. The purpose of the present article is to analyze the needs of persons with oncological diseases. Taking into account the multiple aspects of the term health, psychological, social, and existential needs of the patients were analyzed. This article is directed mainly at persons who remain in a direct therapeutic relation with a patient. It is to facilitate recognizing the needs of ill people and to increase sensitivity to the issue of maintaining or improving the well-being of patients which requires paying special attention to their psychological, social, and existential needs during the period of hindered access to the health care system. This systematic review takes advantage of quantitative and qualitative methods of text analysis with phenomenological analysis factored in. The COVID-19 pandemic resulted in the appearance of new problems in the population of oncological patients or it made the existing problems more severe. As a consequence, it made it significantly more difficult to meet their needs on various levels and sometimes it even made it impossible. It seems necessary to determine and introduce strategies to ensure that patients with oncological diseases have access to psychological and spiritual support in the period of the pandemic.

Germs, Guns, and Fear in Disaster Response: A Rapid Qualitative Assessment to Understand Fear-Based Responses in the Population at Large: Lessons From Sierra Leone 2014-2015

We set out to assess the feasibility of community-focused randomized qualitative assessment at the start of an emergency to identify the root causes of fear-based responses driving the pandemic. We used key informant interviews, focus group discussions, reviewing of government and non-government organization documents, combined with direct field observation. Data were recorded and analyzed for key-themes: (1) lack of evidence-based information about Ebola; (2) lack of support to quarantined families; (3) culturally imbedded practices of caring for ill family members; (4) strong feeling that the government would not help them, and the communities needed to help themselves: (5) distrust of nongovernmental organizations and Ebola treatment centers that the communities viewed as opportunistic. On-the-ground real-time engagement with stakeholders provided deep insight into fear-based-responses during the Ebola epidemic, formed a coherent understanding of how they drove the epidemic, presenting an alternative to the standard disaster-response United Nations-strategy, producing community-driven solutions with local ownership.

Lessons on Outbreak Preparedness From the Cleveland Clinic

Disasters, including infectious disease outbreaks, are inevitable. Hospitals need to plan in advance to ensure that their systems can adapt to a rapidly changing environment if necessary. This review provides an overview of 10 general principles that hospitals and health-care systems should consider when developing disaster plans. The principles are consistent with an "all-hazards" approach to disaster mitigation. This approach is adapted to planning for a multiplicity of threats but emphasizes highly relevant scenarios, such as the coronavirus disease 2019 pandemic. We also describe specific ways these principles helped prepare our hospital for this pandemic. Key points include acting quickly, identifying and engaging key stakeholders early, providing accurate information, prioritizing employee safety and mental health, promoting a fully integrated clinical response, developing surge plans, preparing for ethical dilemmas, and having a cogent exit strategy for post-disaster recovery.

Can a 'second disaster' during and after the COVID-19 pandemic be mitigated?

In most disasters that have been studied, the underlying dangerous cause does not persist for very long. However, during the COVID-19 pandemic a progressively emerging life threat remains, exposing everyone to varying levels of risk of contracting the illness, dying, or infecting others. Distancing and avoiding company have a great impact on social life. Moreover, the COVID-19 pandemic has an enormous economic impact for many losing work and income, which is even affecting basic needs such as access to food and housing. In addition, loss of loved ones may compound the effects of fear and loss of resources. The aim of this paper is to distil, from a range of published literature, lessons from past disasters to assist in mitigating adverse psychosocial reactions to the COVID-19 pandemic. European, American, and Asian studies of disasters show that long-term social and psychological consequences of disasters may compromise initial solidarity. Psychosocial disruptions, practical and financial problems, and complex community and political issues may then result in a 'second disaster'. Lessons from past disasters suggest that communities and their leaders, as well as mental healthcare providers, need to pay attention to fear regarding the ongoing threat, as well as sadness and grief, and to provide hope to mitigate social disruption.

Pilot study of a longitudinal integrated disaster and military medicine education program for undergraduate medical students

Disaster medicine education in medical curricula is scarce and frequently nonexistent. It is reasonable to initiate educational approaches for physicians in this field at the medical school level. An understanding of disaster medicine and the health care system during massive casualty incidents has been recommended as an integral part of the medical curriculum in the United States and Germany.The goal of the reformed curriculum was to develop a longitudinal integrated disaster and military medicine education program extending from the first year to the sixth year based on previously separated clinical and military medicine topics. Emergency medicine physicians, military emergency medical technicians, and Tactical Combat Casualty Care instructors formed an interprofessional faculty group and designed a learning curriculum.A total of 230 medical students participated in the revised disaster preparedness curriculum. Satisfaction survey response rates were high (201/230, 87.4%). Most of the free-text comments on the program were highly appreciative. The students considered the number of teaching hours for the whole program to be adequate. The students showed significant improvements in knowledge and judgment regarding disaster medicine after the program.We found that medical students were highly interested, were appreciative of, and actively participated in this longitudinal integrated disaster and military medicine education program, but gaps existed between the students' scores and the educators' expectations. The educators believed that the students needed more disaster preparedness knowledge and skills.

Portable Health Care Facilities in Disaster and Rescue Zones: Characteristics and Future Suggestions

Introduction

Natural and man-made disasters are becoming global concerns. Natural disasters appear to be growing in number and intensity due to global warming, population explosion, increased travel, and overcrowding of cities. In addition, man-made disasters do not seem to be diminishing.

At disaster sites, an immediate response is needed. National and international organizations; nongovernmental, military, and commercial organizations; and even private donors enlist to provide humanitarian and medical support and to send supplies, shelters, and temporary health care facilities to disaster zones.

Problem

The literature is sparse regarding the design of portable health care facilities intended for disaster zones and their adaptability to the tasks required and site areas.

Methods

Data were collected from peer-reviewed literature, scientific reports, magazines, and websites regarding health care facilities at rescue and salvage situations. Information was grouped according to categories of structure and properties, and relative strengths and weaknesses. Next, suggestions were made for future directions.

Results

Permanent structures and temporary constructed facilities were the two primary categories of health care facilities functioning at disaster zones. Permanent hospitals were independent functioning medical units that were moved or transported to and from disaster zones as complete units, as needed. These facilities included floating hospitals, flying (airborne) hospitals, or terrestrial mobile facilities. Thus, these hospitals self-powered and contained mobility aids within their structure using water, air, or land as transporting media.

Temporary health care facilities were transported to disaster zones as separate, nonfunctioning elements that were constructed or assembled on site and were subsequently taken apart. These facilities included the classical soft-type tents and solid containers that were organized later as hospitals in camp configurations. The strengths and weaknesses of the diverse hospital options are discussed.

Conclusions

Future directions include the use of innovative materials, advanced working methods, and integrated transportation systems. In addition, a holistic approach should be developed to improve the performance, accessibility, time required to function, sustainability, flexibility, and modularity of portable health care facilities.

Bitterman N, Zimmer Y. Portable health care facilities in disaster and rescue zones: characteristics and future suggestions. Prehosp Disaster Med. 2018;33(4):411–417

Field Organization and Disaster Medical Assistance Teams

Disasters cause an acute deterioration in all stages of life. An area affected by the disaster in which the normal activities of life are disrupted is described as a "Field" in disaster terminology. Although it is not easy to define the borders of this zone, the area where there is normally functioning society is accepted as the boundary. Disaster management is the responsibility of the local government. However, in many large disaster responses many non-governmental and international organizations play a role. A Disaster Medical Team is a trained, mobile, self-contained, self-sufficient, multidisciplinary medical team that can act in the acute phase of a sudden-onset disaster (48 to 72 hours after its occurrence) to provide medical treatment in the affected area. The medical team can include physicians, nurses, paramedics and EMTS, technicians, personnel to manage logistics, security and others. Various models of Disaster Medical Teams can be observed around the world. There is paucity of evidence based literature regarding DMTs. There is a need for epidemiological studies with rigorous designs and sampling. In this section of the special edition of the journal, field organizations in health management during disasters will be summarized, with emphasis on preparedness and response phases, and disaster medical teams will be discussed.

History of Disaster Medicine

Erik Noji, mentioned, tongue in cheek, Noah as the first disaster manager during a lecture in 2005. The canonical description of “The Genesis Flood” does describe Noah as a master planner and executer of an evacuation of biblical proportions. After gaining knowledge of a potential catastrophic disaster he planned and executed an evacuation to mitigate the effects of the “Genesis Flood” by building the Ark and organizing a mass exodus. He had to plan for food, water, shelter, medical care, waste disposal and other needs of all the evacuees. Throughout history, management of large disasters was conducted by the military. Indeed, the military still plays a large role in disaster response in many countries, particularly if the response is overseas and prolonged. The histories of emergency preparedness, disaster management and disaster medicine have coevolved and are inextricably intertwined. While disaster management in one form or another existed as long as people started living together in communities, the development of disaster medicine took off with the emergence of modern medicine. Similar to disaster management, disaster medicine also has roots in military organizations.

Are Belgian military students in medical sciences better educated in disaster medicine than their civilian colleagues?

Introduction

Historically, medical students have been deployed to care for disaster victims but may not have been properly educated to do so. A previous evaluation of senior civilian medical students in Belgium revealed that they are woefully unprepared. Based on the nature of their military training, we hypothesised that military medical students were better educated and prepared than their civilian counterparts for disasters. We evaluated the impact of military training on disaster education in medical science students.

Methods

Students completed an online survey on disaster medicine, training, and knowledge, tested using a mixed set of 10 theoretical and practical questions. The results were compared with those of a similar evaluation of senior civilian medical students.

Results

The response rate was 77.5%, mean age 23 years and 59% were males. Overall, 95% of military medical students received some chemical, biological, radiological and nuclear training and 22% took part in other disaster management training; 44% perceived it is absolutely necessary that disaster management should be incorporated into the regular curriculum. Self-estimated knowledge ranged from 3.75 on biological incidents to 4.55 on influenza pandemics, based on a 10-point scale. Intention to respond in case of an incident ranged from 7 in biological incidents to 7.25 in chemical incidents. The mean test score was 5.52; scores improved with educational level attained. A comparison of survey data from civilian senior medical master students revealed that, except for influenza pandemic, military students scored higher on knowledge and capability, even though only 27% of them were senior master students. Data on willingness to work are comparable between the two groups. Results of the question/case set were significantly better for the military students.

Conclusions

The military background and training of these students makes them better prepared for disaster situations than their civilian counterparts.

Progress and challenges of disaster health management in China: a scoping review

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).

Nonclinical core competencies and effects of interprofessional teamwork in disaster and emergency response training and practice: a pilot study

OBJECTIVE

To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration.

METHODS

In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis.

RESULTS

Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration.

CONCLUSIONS

The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1-8).

A consensus based template for reporting of pre-hospital major incident medical management

BACKGROUND

Structured reporting of major incidents has been advocated to improve the care provided at future incidents. A systematic review identified ten existing templates for reporting major incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital major incident medical management that will be tested for feasibility.

METHODS

An expert group of thirteen European major incident practitioners, planners or academics participated in a four stage modified nominal group technique consensus process to design a novel reporting template. Initially, each expert proposed 30 variables. Secondly, these proposals were combined and each expert prioritized 45 variables from the total of 270. Thirdly, the expert group met in Norway to develop the template. Lastly, revisions to the final template were agreed via e-mail.

RESULTS

The consensus process resulted in a template consisting of 48 variables divided into six categories; pre-incident data, Emergency Medical Service (EMS) background, incident characteristics, EMS response, patient characteristics and key lessons.

CONCLUSIONS

The expert group reached consensus on a set of key variables to report the medical management of pre-hospital major incidents and developed a novel reporting template. The template will be freely available for downloading and reporting on http://www.majorincidentreporting.org. This is the first global open access database for pre-hospital major incident reporting. The use of a uniform dataset will allow comparative analysis and has potential to identify areas of improvement for future responses.

Systematic literature review of templates for reporting prehospital major incident medical management

OBJECTIVE

To identify and describe the content of templates for reporting prehospital major incident medical management.

DESIGN

Systematic literature review according to PRISMA guidelines.

DATA SOURCES

PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded.

RESULTS

The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing major incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template.

CONCLUSIONS

More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life incidents.

TRIAL REGISTRATION

The review is registered in PROSPERO (registration number: CRD42012002051).

Disaster management in flash floods in leh (ladakh): a case study

Background:

On August 6, 2010, in the dark of the midnight, there were flash floods due to cloud burst in Leh in Ladakh region of North India. It rained 14 inches in 2 hours, causing loss of human life and destruction. The civil hospital of Leh was badly damaged and rendered dysfunctional. Search and rescue operations were launched by the Indian Army immediately after the disaster. The injured and the dead were shifted to Army Hospital, Leh, and mass casualty management was started by the army doctors while relief work was mounted by the army and civil administration.

Objective:

The present study was done to document disaster management strategies and approaches and to assesses the impact of flash floods on human lives, health hazards, and future implications of a natural disaster.

Materials and Methods:

The approach used was both quantitative as well as qualitative. It included data collection from the primary sources of the district collectorate, interviews with the district civil administration, health officials, and army officials who organized rescue operations, restoration of communication and transport, mass casualty management, and informal discussions with local residents.

Results:

234 persons died and over 800 were reported missing. Almost half of the people who died were local residents (49.6%) and foreigners (10.2%). Age-wise analysis of the deaths shows that the majority of deaths were reported in the age group of 25–50 years, accounting for 44.4% of deaths, followed by the 11–25-year age group with 22.2% deaths. The gender analysis showed that 61.5% were males and 38.5% were females. A further analysis showed that more females died in the age groups <10 years and ≥50 years.

Conclusions:

Disaster preparedness is critical, particularly in natural disasters. The Army's immediate search, rescue, and relief operations and mass casualty management effectively and efficiently mitigated the impact of flash floods, and restored normal life.

Human resources issues and Australian Disaster Medical Assistance Teams: results of a national survey of team members

BACKGROUND

Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, this study was designed to evaluate Australian DMAT experience in relation to the human resources issues associated with deployment.

METHODS

Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster.

RESULTS

The response rate for this survey was 50% (59/118). Most personnel had deployed to the Asian Tsunami affected areas with DMAT members having significant clinical and international experience. While all except one respondent stated they received a full orientation prior to deployment, only 34% of respondents (20/59) felt their role was clearly defined pre deployment. Approximately 56% (33/59) felt their actual role matched their intended role and that their clinical background was well suited to their tasks. Most respondents were prepared to be available for deployment for 1 month (34%, 20/59). The most common period of notice needed to deploy was 6-12 hours for 29% (17/59) followed by 12-24 hours for 24% (14/59). The preferred period of overseas deployment was 14-21 days (46%, 27/59) followed by 1 month (25%, 15/59) and the optimum shift period was felt to be 12 hours by 66% (39/59). The majority felt that there was both adequate pay (71%, 42/59) and adequate indemnity (66%, 39/59). Almost half (49%, 29/59) stated it was better to work with people from the same hospital and, while most felt their deployment could be easily covered by staff from their workplace (56%, 33/59) and caused an inconvenience to their colleagues (51%, 30/59), it was less likely to interrupt service delivery in their workplace (10%, 6/59) or cause an inconvenience to patients (9%, 5/59). Deployment was felt to benefit the affected community by nearly all (95%, 56/59) while less (42%, 25/59) felt that there was a benefit for their own local community. Nearly all felt their role was recognised on return (93%, 55/59) and an identical number (93%, 55/59) enjoyed the experience. All stated they would volunteer again, with 88% strongly agreeing with this statement.

CONCLUSIONS

This study of Australian DMAT members provides significant insights into a number of human resources issues and should help guide future deployments. The preferred 'on call' arrangements, notice to deploy, period of overseas deployment and shift length are all identified. This extended period of operations needs to be supported by planning and provision of rest cycles, food, temporary accommodation and rest areas for staff. The study also suggests that more emphasis should be placed on team selection and clarification of roles. While the majority felt that there was both adequate pay and adequate indemnity, further work clarifying this, based on national conditions of service should be, and are, being explored currently by the state based teams in Australia. Importantly, the deployment was viewed positively by team members who all stated they would volunteer again, which allows the development of an experienced cohort of team members.

Leadership and Use of Standards by Australian Disaster Medical Assistance Teams: Results of a National Survey of Team Members

Introduction

It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters.

Objective

As part of a national survey, the present study was designed to evaluate leadership issues and use of standards in Australian DMATs.

Methods

Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.

Results

The response rate for this survey was estimated to be approximately 50% (59/118). Most of the personnel had deployed to the Asian Tsunami affected areas. The DMAT members were quite experienced, with 53% (31/59) of personnel in the 45-55 years of age group. Seventy-five percent (44/59) of the respondents were male. Fifty-eight percent (34/59) of the survey participants had significant experience in international disasters, although few felt they had previous experience in disaster management (5%, 3/59). There was unanimous support for a clear command structure (100%, 59/59), with strong support for leadership training for DMAT commanders (85%, 50/59). However only 34% (20/59) felt that their roles were clearly defined pre-deployment, and 59% (35/59) felt that team members could be identified easily. Leadership was identified by two team members as one of the biggest personal hardships faced during their deployment. While no respondents disagreed with the need for meaningful, evidence-based standards to be developed, only 51% (30/59) stated that indicators of effectiveness were used for the deployment.

Conclusions

In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.

Aitken P, Leggat PA, Robertson AG, Harley H, Speare R, Leclercq MG. Leadership and use of standards by Australian disaster medical assistance teams: results of a national survey of team members.Prehosp Disaster Med.2012;27(2):1-6.

Logistic support provided to Australian disaster medical assistance teams: results of a national survey of team members

BACKGROUND

It is likely that calls for disaster medical assistance teams (DMATs) continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the Australian DMAT experience and the need for logistic support.

METHODS

Data were collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.

RESULTS

The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the South East Asian Tsunami affected areas. The DMAT members had significant clinical and international experience. There was unanimous support for dedicated logistic support with 80% (47/59) strongly agreeing. Only one respondent (2%) disagreed with teams being self sufficient for a minimum of 72 hours. Most felt that transport around the site was not a problem (59%; 35/59), however, 34% (20/59) felt that transport to the site itself was problematic. Only 37% (22/59) felt that pre-deployment information was accurate. Communication with local health providers and other agencies was felt to be adequate by 53% (31/59) and 47% (28/59) respectively, while only 28% (17/59) felt that documentation methods were easy to use and reliable. Less than half (47%; 28/59) felt that equipment could be moved easily between areas by team members and 37% (22/59) that packaging enabled materials to be found easily. The maximum safe container weight was felt to be between 20 and 40 kg by 58% (34/59).

CONCLUSIONS

This study emphasises the importance of dedicated logistic support for DMAT and the need for teams to be self sufficient for a minimum period of 72 hours. There is a need for accurate pre deployment information to guide resource prioritisation with clearly labelled pre packaging to assist access on site. Container weights should be restricted to between 20 and 40 kg, which would assist transport around the site, while transport to the site was seen as problematic. There was also support for training of all team members in use of basic equipment such as communications equipment, tents and shelters and water purification systems.

Education and training of Australian disaster medical assistance team members: results of a national survey

INTRODUCTION

Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters.

OBJECTIVE

As part of a national survey, the present study was designed to evaluate the education and training of Australian DMATs.

METHODS

Data were collected via an anonymous, mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Southeast Asia tsunami disaster.

RESULTS

The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami-affected areas. The DMAT members were quite experienced, with 53% of personnel in the 45-55-year age group (31/59). Seventy-six percent of the respondents were male (44/58). While most respondents had not participated in any specific training or educationalprogram, any kind of relevant training was regarded as important in preparing personnel for deployment. The majority of respondents had experience in disasters, ranging from hypothetical exercises (58%, 34/59) to actual military (41%, 24/49) and non-governmental organization (32%, 19/59) deployments. Only 27% of respondents felt that existing training programs had adequately prepared them for deployment. Thirty-four percent of respondents (20/59) indicated that they had not received cultural awareness training prior to deployment, and 42% (25/59) received no communication equipment training. Most respondents felt that DMAT members needed to be able to handle practical aspects of deployments, such as training as a team (68%, 40/59), use of communications equipment (93%, 55/59), ability to erect tents/shelters (90%, 53/59), and use of water purification equipment (86%, 51/59). Most respondents (85%, 50/59) felt leadership training was essential for DMAT commanders. Most (88%, 52/59) agreed that teams need to be adequately trained prior to deployment, and that a specific DMAT training program should be developed (86%, 51/59).

CONCLUSIONS

This study of Australian DMAT members suggests that more emphasis should be placed on the education and training. Prior planning is required to ensure the success of DMAT deployments and training should include practical aspects of deployment. Leadership training was seen as essential for DMAT commanders, as was team-based training. While any kind of relevant training was regarded as important for preparing personnel for deployment, Australian DMAT members, who generally are a highly experienced group of health professionals, have identified the need for specific DMAT training.

Disaster preparedness of families with young children in Hong Kong

AIMS

The aims of this study were to explore the perception of disaster among the head of household mainly responsible for family matters of Hong Kong families with young children, and the extent of their preparedness for disasters.

BACKGROUND

Being prepared for disasters can minimize damage to our health, lives, and property. Families with young children are particularly vulnerable during disasters.

METHODS

A questionnaire was distributed to a convenience sample of families with young children in March and September in 2008.

RESULTS

A total of 198 out of 220 questionnaires distributed to heads of households were collected and analyzed for this study. Most of the householders (94.4%) considered the SARS outbreak in Hong Kong in 2003 to have been a disaster. They considered that the disastrous events most likely to occur in Hong Kong were infectious disease outbreaks (96.5%) and major transport accidents (94.4%). In preparing for unexpected events, these families reported having stocked up on ''young children's necessities'' (82.8%, 73.7%) and ''medications'' (82.8%, 60.1%) sufficient for three and seven days respectively. These families also kept a flashlight with adequate batteries (74.7%), extra blankets (69.2%), and a first aid kit (60.6%) at home for safety. They reported ''panic buying'' for necessities during previous typhoon strikes (68.2%) and infectious disease outbreaks (46.0%). Only 9.1% considered themselves adequately prepared for disasters (9.1%).

CONCLUSIONS

Although the families with young children in this study are prepared for disaster to some extent, their preparedness is still considered grossly inadequate and in need of public attention.

Health care emergency management: establishing the science of managing mass casualty and mass effect incidents

Particularly since 2001, the health care industry has witnessed many independent and often competing efforts to address mitigation and preparedness for emergencies. Clinicians, health care administrators, engineers, safety and security personnel, and others have each developed relatively independent efforts to improve emergency response. A broader conceptual approach through the development of a health care emergency management profession should be considered to integrate these various critical initiatives. When based on long-standing emergency management principles and practices, health care emergency management provides standardized, widely accepted management principles, application concepts, and terminology. This approach could also promote health care integration into the larger community emergency response system. The case for a formally defined health care emergency management profession is presented with discussion points outlining the advantages of this approach.

Preparedness lessons from modern disasters and wars

Disasters come in all shapes and forms, and in varying magnitudes and intensities. Nevertheless, they offer many of the same lessons for critical care practitioners and responders. Among these, the most important is that well thought out risk assessment and focused planning are vital. Such assessment and planning require proper training for providers to recognize and treat injury from disaster, while maintaining safety for themselves and others. This article discusses risk assessment and planning in the context of disasters. The article also elaborates on the progress toward the creation of portable, credible, sustainable, and sophisticated critical care outside the walls of an intensive care unit. Finally, the article summarizes yields from military-civilian collaboration in disaster planning and response.

Pre- and post-deployment health support provided to Australian disaster medical assistance team members: results of a national survey

BACKGROUND

Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to pre- and post-deployment health care.

METHODS

Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster.

RESULTS

The response rate for this survey was estimated to be around 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59). Seventy-six percent of the respondents were male (44/58). Only 42% (25/59) received a medical check prior to departure and only 15% (9/59) received a psychological assessment prior to deployment. Most respondents indicated that both medical and psychological screening of personnel would be desirable. Most DMAT personnel received some vaccinations (83%, 49/59) before departure and most felt that they were adequately immunised. While nearly all DMAT members participated in formal debriefing post-deployment (93%, 55/59), far less received psychological debriefing (44%, 26/59), or a medical examination upon return (10%, 6/59). Three respondents reported experiencing physical ill health resulting in time off work following their return. While only one reportedly experienced any adjustment problems post-deployment that needed time off work, 32% (19/59) found it somewhat difficult to return to work. There were multiple agencies involved in the post-deployment debriefing (formal and psychological) and medical examination process including Emergency Management Australia (EMA), Australian Government, State/Territory Health Departments, District Health services and others.

CONCLUSIONS

This study of Australian DMAT members suggests that more emphasis should be placed on health of personnel prior to deployment with pre-deployment medical examinations and psychological assessment. Following the return home, and in addition to mission and psychological debriefing, there should be a post-deployment medical examination and ongoing support and follow-up of DMAT members. More research is needed to examine deployment health support issues.

Making difficult ethical decisions in patient care during natural disasters and other mass casualty events

OBJECTIVE

Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief.

STUDY DESIGN

A survey of pertinent literature was performed to assess experience and opinions on the condition of medical care in terrorist attacks and natural disasters, the ethical challenges of disaster medical care, and the professional responsibilities and responsiveness in disasters.

CONCLUSIONS

It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims.

Organizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems

Critical care in the U.S. military has significantly evolved in the last decade. More recently, the U.S. military has implemented organizational changes, including the use of multidisciplinary teams in austere environments to improve outcomes in severely injured polytrauma combat patients. Specifically, organizational changes in combat support hospitals located in combat zones during Operation Iraqi Freedom have led to decreased intensive care unit mortality and length of stay as well as resource use. These changes were implemented without increases in logistic support or the addition of highly technologic equipment. The mechanism for improvement in mortality is likely attributable to the adherence of basic critical care medicine fundamentals. This intensivist-directed team model provides sophisticated critical care even in the most austere environments. To optimize critically injured patients' outcomes, intensive care organizational models similar to the U.S. military, described in this article, can possibly be adapted to those of civilian care during disaster management to meet the challenges of emergency mass critical care.

Definitive care for the critically ill during a disaster: current capabilities and limitations: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL

In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.

Preliminary investigation into the role of physiotherapists in disaster response

INTRODUCTION

Increasingly, disasters and disaster response have become prominent issues in recent years. Despite their involvement, there have been almost no investigations into the roles of physiotherapists in emergency disaster responses. Additionally, physiotherapists are not employed in emergency disaster response by many of the principal non-governmental organizations supplying such care, although they are included in military responses in the United States and United Kingdom, and in Disaster Medical Assistance Teams in the US. This paper, based on a small qualitative study, focuses on the potential role and nature of input of physiotherapists in disaster response.

METHODS

A qualitative approach was chosen due to the emergent nature of the phenomenon. Four physiotherapists, all of whom had been involved in some type of disaster response, agreed to participate. Semi-structured telephone interviews were used to explore participants' experiences following disaster response, and to gain ideas about future roles for physiotherapists. Interviews were recorded, transcribed, and later analyzed using coding and categorization of data.

RESULTS

Four main themes emerged: (1) descriptions of disasters; (2) current roles of the physiotherapist; (3) future roles of physiotherapists; and (4) overcoming barriers. Although all four physiotherapists had been ill-prepared for disaster response, they took on multiple roles, primarily in organization and treatment. However, participants identified several barriers to future involvement, including organizational and professional barriers, and gave suggestions for overcoming these.

CONCLUSIONS

The participants had participated in disaster response, but in ill-defined roles, indicating a need for a greater understanding of disaster response among the physiotherapy community and by organizations supplying such care. The findings of this study have implications for such organizations in terms of employing skilled physiotherapists in order to improve disaster response. In future disasters, physiotherapy will be of benefit in treating and preventing rescue worker injury and treating musculoskeletal, critical, respiratory, and burn patients.

Psychosocial care for adult and child survivors of the tsunami disaster in India

OBJECTIVES

The tsunami disaster in South Asia affected the mental health and livelihoods of thousands of child and adult survivors, but psychological aspects of rehabilitation efforts are frequently neglected in public health initiatives.

METHODS

Professional teams from the National Institute of Mental Health and Neurosciences in Bangalore, India, traveled to the worst-affected areas in South India and implemented a mental health program of psychosocial care for child and adult survivors. This descriptive report is based on observations of child and adult survivors in Tamil Nadu State of India during January-March 2005.

OBSERVATIONS

Symptoms of emotional distress were observed in child and adult survivors. A train-the-trainer community-based model was implemented for teachers and community-level workers to respond to the emotional needs of children and adults.

CONCLUSION

In resource-poor settings with few trained mental health professionals, community workers were taught basic mental health interventions by teams of psychiatrists, nurses, and social workers. This train-the-trainer, community-based approach has implications for natural and man-made disasters in developed and developing countries.

Responding to disasters: academic medical centers' responsibilities and opportunities

Disaster preparedness and disaster response should be a capability of all academic health centers. The authors explore the potential role and impact of academic medical centers (AMC)s in disaster response. The National Disaster Medical System and the evolution of disaster medical assistance teams (DMAT) are described, and the experience at one AMC with DMAT is reviewed. The recent deployment of a DMAT sponsored by an AMC to the Hurricane Katrina disaster is described, and the experience is used to illustrate the opportunities and challenges of future disaster medical training, research, and practice at AMCs. AMCs are encouraged to identify an appropriate academic unit to house and nurture disaster-preparedness activities, participate in education programs for health professionals and the public, and perform research on disaster epidemiology and response. Networks of AMCs offer the potential of acting as a critical resource for those AMCs stricken by a disaster and for communities needing the infusion of highly trained and motivated health care providers. The Association of American Medical Colleges can play a critical role in assisting and coordinating AMC networks through its relationship with all AMCs and the federal government and by increasing the awareness of medical educators and researchers about this important, emerging area of medical knowledge.

CCATT: a military model for civilian disaster management

When major disasters incapacitate hospitals and definitive care facilities-as Hurricane Katrina did in 2005-a crisis point is rapidly reached. Critical care services are often the first to be overwhelmed. Personal experiences and regional disaster plans were examined in the wake of Hurricane Katrina to uncover shortfalls in delivery of care and resources. A search was undertaken for a viable model for delivering critical care services in the immediate post-disaster period. Such a model already exists in the US Air Force's (USAF) Critical Care Air Transport Teams (CCATT). These teams have functioned well during recent military conflicts by providing both ground critical care and transport of high-risk, severely injured patients. The need for augmented critical care and transport resources in the face of overwhelming casualties in the civilian environment does not require a de novo construct. The USAF's CCATT model should be easily adaptable to the civilian disaster scenario.

Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care

BACKGROUND

Federal planners have suggested that one strategy to accommodate disaster surges of 500 inpatients per million population would involve altering standards of care. No data are available indicating the extent of alterations necessary to meet disaster surge targets.

OBJECTIVE

Our goal was to, in a Monte Carlo simulation study, determine the probability that specified numbers of children could be accommodated for PICU and non-ICU hospital care in a disaster by a set of strategies involving altered standards of care.

METHODS

Simulated daily vacancies at each hospital in New York City were generated as the difference between peak capacity and daily occupancy (generated randomly from a normal distribution on the basis of empirical data for each hospital). Simulations were repeated 1000 times. Capacity for new patients was explored for normal standards of care, for expansion of capacity by a discretionary 20% increase in vacancies by altering admission and discharge criteria, and for more strictly reduced standards of care to double or quadruple admissions for each vacancy. Resources were considered to reliably serve specified numbers of patients if that number could be accommodated with a probability of 90%.

RESULTS

Providing normal standards of care, hospitals in New York City would reliably accommodate 250 children per million age-specific population. Hypothetical strict reductions in standards of care would reliably permit hospital care of 500 children per million, even if the disaster reduced hospital resources by 40%. On the basis of historical experience that as many as 30% of disaster casualties may be critically ill or injured, existing pediatric intensive care beds will typically be insufficient, even with modified standards of care.

CONCLUSIONS

Extending resources by hypothetical alterations of standards of care would usually satisfy targets for hospital surge capacity, but ICU capacity would remain inadequate for large disasters.

Hospital emergency surge capacity: an empiric New York statewide study

STUDY OBJECTIVE

National policy for emergency preparedness calls for hospitals to accommodate surges of 500 new patients per million population in a disaster, but published studies have not evaluated the ability of existing resources to meet these goals. We describe typical statewide and regional hospital occupancy and patterns of variation in occupancy and estimate the ability of hospitals to accommodate new inpatients.

METHODS

Daily hospital occupancy for each hospital was calculated according to admission date and length of stay for each patient during the study period. Occupancy was expressed as the count of occupied beds. Peak hospital capacity was defined as the 95th percentile highest occupancy at each facility. Data obtained from the New York Statewide Planning and Research Cooperative System were analyzed for 1996 to 2002. Patients were classified as children (0 to 14 years, excluding newborns) or adults. Vacant hospital beds per million age-specific population were determined as the difference between peak capacity and average occupancy.

RESULTS

In New York State, 242 hospitals cared for a peak capacity of 2,707 children and 46,613 adults. Occupancy averaged 60% of the peak for children and 82% for adults, allowing an average statewide capacity for a surge of 268 new pediatric and 555 adult patients for each million age-specific population. After the September 11, 2001, attacks, in the New York City region, a discretionary modification of admissions and discharges resulted in an 11% reduction from the expected occupancy for children and adults.

CONCLUSION

Typically, there are not enough vacant hospital beds available to serve 500 children per million population. Modified standards of hospital care to expand capacity may be necessary to serve children in a mass-casualty event.

Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters

The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command.

Floods and tsunamis

Floods and tsunamis cause few severe injuries, but those injuries can overwhelm local areas, depending on the magnitude of the disaster. Most injuries are extremity fractures, lacerations, and sprains. Because of the mechanism of soft tissue and bone injuries, infection is a significant risk. Aspiration pneumonias are also associated with tsunamis. Appropriate precautionary interventions prevent communicable dis-ease outbreaks. Psychosocial health issues must be considered.

Disaster management teams

PURPOSE OF REVIEW

All disasters, regardless of cause, have similar medical and public health consequences. A consistent approach to disasters, based on an understanding of their common features and the response expertise they require, is becoming the accepted practice throughout the world. This strategy is called the mass casualty incident response. The complexity of today's disasters, particularly the threat of terrorism and weapons of mass destruction, has increased the need for multidisciplinary medical specialists as critical assets in disaster response. A review of the current literature emphasizes the expanding role of disaster management teams as an integral part of the mass casualty incident response.

RECENT FINDINGS

The incident command system has become the accepted standard for all disaster response. Functional requirements, not titles, determine the organizational hierarchy of the Incident Command System structure. All disaster management teams must adhere to this structure to integrate successfully into the rescue effort. Increasingly, medical specialists are determining how best to incorporate their medical expertise into disaster management teams that meet the functional requirements of the incident command system.

SUMMARY

Disaster management teams are critical to the mass casualty incident response given the complexity of today's disaster threats. Current disaster planning and response emphasizes the need for an all-hazards approach. Flexibility and mobility are the key assets required of all disaster management teams. Medical providers must respond to both these challenges if they are to be successful disaster team members.