Disaster Medicine: Current Assessment and Blueprint for the Future

Crisis on the game board - a novel approach to teach medical students about disaster medicine

Introduction: Every year, natural and other disasters cause significant loss of life around the world. This calls for an improved response from, among others, the health professions to strengthen disaster medicine, whether relating to prevention, emergency response or recovery. It includes both knowledge and competencies, such as planning, coordination, and communication. Simulations can be used to acquire these competencies. Project description: In 2016, the German Medical Students' Association founded the project "Disaster Medicine" with the goal of educating and connecting medical students interested in the topic. AFTERSHOCK, a board game simulating early disaster response after an earthquake, was utilized for workshops. It highlights the need for interagency cooperation and the challenges of responding to disasters in dynamic and highly complex settings. Seven workshops were facilitated between October 2016 and December 2017. A survey was conducted to assess participant satisfaction and the design of the workshop. Results: 89 German medical students participated and 74 (83 %) responded with written evaluation. Students generally reported moderate to low levels of previous knowledge. The event produced very positive feedback, with participants overwhelmingly finding the simulation to be a useful or very useful way to learn about the challenges of humanitarian assistance and disaster relief. Qualitative feedback included requests for more theoretical background information and highlighted the need for small group sizes. Discussion and Conclusion: Board games such as AFTERSHOCK are well-suited for medical education and enjoy high rates of acceptance among students. To ensure deeper and longer-term learning, they should be accompanied by theoretical coursework.

Emergency department surge capacity: recommendations of the Australasian Surge Strategy Working Group

For more than a decade, emergency medicine (EM) organizations have produced guidelines, training, and leadership for disaster management. However, to date there have been limited guidelines for emergency physicians (EPs) needing to provide a rapid response to a surge in demand. The aim of this project was to identify strategies that may guide surge management in the emergency department (ED). A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations and identified underlying assumptions from disaster epidemiology and clinical practice. The group then characterized surge strategies from their corpus of experience; examined them through available relevant published literature; and collated these within domains of space, staff, supplies, and system operations. These recommendations detail 22 potential actions available to an EP working in the context of surge, along with detailed guidance on surge recognition, triage, patient flow through the ED, and clinical goals and practices. The article also identifies areas that merit future research, including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies, and measurement of strategy impacts on throughput, cost, and quality of care.

The Surge Capacity for People in Emergencies (SCOPE) study in Australasian hospitals

OBJECTIVES

To measure physical assets in Australasian hospitals required for the management of mass casualties as a result of terrorism or natural disasters.

DESIGN AND SETTING

A cross-sectional survey of Australian and New Zealand hospitals.

PARTICIPANTS

All emergency department directors of Australasian College for Emergency Medicine (ACEM)-accredited hospitals, as well as private and non-ACEM accredited emergency departments staffed by ACEM Fellows in metropolitan Sydney.

MAIN OUTCOME MEASURES

Numbers of operating theatres, intensive care unit (ICU) beds and x-ray machines; state of preparedness using benchmarks defined by the Centers for Disease Control and Prevention in the United States.

RESULTS

We found that 61%-82% of critically injured patients would not have immediate access to operative care, 34%-70% would have delayed access to an ICU bed, and 42% of the less critically injured would have delayed access to x-ray facilities.

CONCLUSIONS

Our study demonstrates that physical assets in Australasian public hospitals do not meet US hospital preparedness benchmarks for mass casualty incidents. We recommend national agreement on disaster preparedness benchmarks and periodic publication of hospital performance indicators to enhance disaster preparedness.

A strategic plan for disaster medicine in Australasia

Disaster epidemiology reveals epidemic increases in incidence of disasters. Rare disasters with catastrophic consequences also threaten modern populations. This paper profiles natural disasters, transportation incidents, emerging infectious diseases, complex disasters and terrorism for their historical and future potential impact on Australasia. Emergency physicians are in a position to assume leadership roles within the disaster management community in Australasia. The Australasian College for Emergency Medicine is in a position to lead medical specialty advances in disaster medicine in Australasia. To optimize its impact in disaster medicine, the specialty and its College have opportunities for advances in key areas of College administration, intra and interinstitutional representation, disaster preparedness and planning, disaster relief operations, education and training programs, applied clinical research, and faculty development.

Emergency health and risk management in sub-saharan Africa: a lesson from the embassy bombings in Tanzania and Kenya

In 1998, terrorists simultaneously bombed United States Embassies in Dar es Salaam, Tanzania and Nairobi, Kenya. The local response to these bombings was unorganized and ad hoc, indicating the need for basic disaster preparedness and improvement of emergency management capabilities in both countries. In this context, risk and risk management are defined and are related to the health hazards affecting Tanzanians and Kenyans. In addition, the growing number of injuries in Tanzania is addressed and the relationship between risk management and injury is explored. Also, an emergency medicine-based strategy for injury control and prevention is proposed. Implications of implementing such a protocol in developing nations also are discussed.