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Precision Augmentation of Medical Surge Capacity for Disaster Response. Emerg Med Int 2020; 2020:5387043. [PMID: 32257446 PMCID: PMC7102446 DOI: 10.1155/2020/5387043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background In recent years, serious injuries associated with extreme climate, earthquakes, terrorism, and other natural and man-made disasters have occurred frequently throughout the world. A surge in medical demand that extends beyond local medical surge capacity in mass casualty incidents following major disasters is common. Materials and Methods. We reviewed and analyzed emergency medical rescue efforts after major disasters in recent years to elaborate the precision strategy of augmenting medical surge capacity for disaster response. Results Precision augmentation of medical surge capacity for disaster response can be achieved through several measures. These include (1) release of internal capacity through precision launching or through upgrading the levels of response, (2) precision support for medical surge capacity from external efforts, (3) centralized response, and (4) altering standards of care. We should adopt precision augmentation of medical surge capacity according to the specific situation. Conclusions Augmentation of medical surge capacity as a basic strategy can be used to achieve effective disaster response. In disaster response, due to the complexity of disaster medical capacity amplification, it is important to select the appropriate medical capacity strategy accurately according to the actual disaster situation.
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Investigating Lushan Earthquake Victims' Individual Behavior Response and Rescue Organization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121556. [PMID: 29232912 PMCID: PMC5750974 DOI: 10.3390/ijerph14121556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Abstract
Research concerning the impact of earthquake victims’ individual behavior and its association with earthquake-related injuries is lacking. This study examined this relationship along with effectiveness of earthquake rescue measures. The six most severely destroyed townships during the Lushan earthquake were examined; 28 villages and three earthquake victims’ settlement camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers (p < 0.0001, OR (odds ratios) = 3.33) and medical staff (p = 0.001, OR = 4.35) were more vulnerable to the earthquake than were farmers. Individual behavior was directly related to injuries, such as the first reaction after earthquake and fear. There is an obvious connection between earthquake-related injury and individual behavior characteristics. It is strongly suggested that victims receive mental health support from medical practitioners and the government to minimize negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.
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Akl EA, El-Jardali F, Bou Karroum L, El-Eid J, Brax H, Akik C, Osman M, Hassan G, Itani M, Farha A, Pottie K, Oliver S. Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review. PLoS One 2015; 10:e0137159. [PMID: 26332670 PMCID: PMC4558048 DOI: 10.1371/journal.pone.0137159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.
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Affiliation(s)
- Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Fadi El-Jardali
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Research, Advocacy and Public Policy-making Program, Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Jamale El-Eid
- VP of Medical Affairs, American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint Joseph, Beirut, Lebanon
| | - Chaza Akik
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mona Osman
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghayda Hassan
- Department of Psychology, University of Québec, Montreal, Québec, Canada
| | - Mira Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Aida Farha
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Kevin Pottie
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Oliver
- Department of Childhood, Families and Health, Social Science Research Unit, Institute of Education, University of London, London, United Kingdom
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Shen W, Jiang L, Zhang M, Ma Y, Jiang G, He X. Very serious and non-ignorable problem: Crisis in emergency medical response in catastrophic event. Emerg Med Australas 2015; 27:573-579. [PMID: 26289008 DOI: 10.1111/1742-6723.12461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 11/28/2022]
Abstract
The crisis of medical response caused by catastrophic events might significantly affect emergency response, and might even initiate more serious social crisis. Therefore, early identification and timely blocking the formation of crisis in the early phase after a major disaster will improve the efficiency of medical response in a major disaster and avoid serious consequences. In the present paper, we described the emergency strategy to crisis management of medical response after a major disaster. Major catastrophic events often lead to various crises, including excess demand, the crisis of response in barrier and the structural crisis in response. The corresponding emergency response strategies include: (i) shunt of catastrophic medical surge; (ii) scalability of medical surge capacity; (iii) matching of the structural elements of response; (iv) maintaining the functions of support system for medical response and maximising the operation of the integrated response system; and (v) selection of appropriate care 'standard' in extreme situations of overload of disaster medical surge. In conclusion, under the impact of a major catastrophic event, medical response is often complex and the medical surge beyond the conventional response capacity and it is easy to be in crisis. In addition to the current consensus of disaster response, three additional aspects should be considered. First, all relevant society forces led by the government and military should be linkages. Second, a powerful medical response system must be based on a strong support system. Third, countermeasures of medical surge should be applied flexibly to the special and specific disaster environment, to promote the effective medical response force.
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Affiliation(s)
- Weifeng Shen
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
| | - Libing Jiang
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
| | - Yuefeng Ma
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
| | - Guanyu Jiang
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
| | - Xiaojun He
- Department of Emergency Medicine, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou, China
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Shen WF, Jiang LB, Jiang GY, Zhang M, Ma YF, He XJ. Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire. J Zhejiang Univ Sci B 2015; 15:1072-80. [PMID: 25471837 DOI: 10.1631/jzus.b1400225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management. METHODS We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: 'mass casualty incident', 'MCI', 'research method', 'Wenchuan', 'earthquake', 'research paradigm', 'science of surge', 'surge', 'surge capacity', and 'vulnerability'. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. RESULTS The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored-vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. CONCLUSIONS This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research.
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Affiliation(s)
- Wei-feng Shen
- Department of Emergency Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Liu B, Hu H, He YR, Lau WB, Cao Y, Li ZM, Zhang L. An evaluation model of surgery capability of tertiary hospital in disasters: a cross-sectional survey in China. Public Health 2015; 129:1301-3. [PMID: 26149916 DOI: 10.1016/j.puhe.2015.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/23/2015] [Accepted: 05/29/2015] [Indexed: 02/05/2023]
Affiliation(s)
- B Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13th Hangkong Road, Wuhan, 430030, PR China
| | - H Hu
- Emergency Department, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Y R He
- Emergency Department, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - W B Lau
- Department of Emergency Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, 808 College Building, Philadelphia, PA19107, USA
| | - Y Cao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, 610041, PR China
| | - Z M Li
- Office of Health Emergency(Center for Public Health Emergency), National Health and Family Planning Commission of the People's Republic of China, 1st Xizhimenwainan Road, Beijing, 100044, PR China
| | - L Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13th Hangkong Road, Wuhan, 430030, PR China.
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Xu M, Liang Z, Xu Y, Wang J. Chinese vaccine products go global: vaccine development and quality control. Expert Rev Vaccines 2015; 14:763-73. [PMID: 25697690 DOI: 10.1586/14760584.2015.1012503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Through the continuous efforts of several generations, China has become one of the few countries in the world that is capable of independently addressing all the requirements by the Expanded Program on Immunization. Regulatory science is applied to continuously improve the vaccine regulatory system. Passing the prequalification by WHO has allowed Chinese vaccine products to go global. Chinese vaccine products not only secure disease prevention and control domestically but also serve the needs for international public health. This article describes the history of Chinese vaccine development, the current situation of Chinese vaccine industry and its contribution to the prevention and control of infectious diseases. We also share our experience of national quality control and vaccine regulation during the past decades. China's experience in vaccine development and quality control can benefit other countries and regions worldwide, including the developing countries.
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Affiliation(s)
- Miao Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes for Food and Drug Control, No.2, Tiantan Xili, Dongcheng District, Beijing 100050, People's Republic of China
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Du Y, Ding Y, Li Z, Cao G. The role of hazard vulnerability assessments in disaster preparedness and prevention in China. Mil Med Res 2015; 2:27. [PMID: 26605045 PMCID: PMC4657270 DOI: 10.1186/s40779-015-0059-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/22/2015] [Indexed: 11/10/2022] Open
Abstract
China is prone to disasters and escalating disaster losses. Effective disaster mitigation is the foundation for efficient disaster response and rescue and for reducing the degree of hazardous impacts on the population. Vulnerability refers to the population's capacity to anticipate, cope with, and recover from the impact of a hazardous event. A hazard vulnerability assessment (HVA) systematically evaluates the damage that could be caused by a potential disaster, the severity of the impact, and the available medical resources during a disaster to reduce population vulnerability and increase the capacity to cope with disasters. In this article, we summarized HVA team membership, content (disaster identification, probability and consequences), and methods and procedures for an HVA that can be tailored to China's needs. We further discussed the role of epidemiology in an HVA. Disaster epidemiology studies the underlying causes of disasters to achieve effective disaster prevention and reduction. In addition, we made several recommendations that are already in practice in developed countries, such as the U.S., for future implementation in China and other developing countries. An effective HVA plan is crucial for successful disaster preparedness, response, and recovery.
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Affiliation(s)
- Yan Du
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433 People's Republic of China
| | - Yibo Ding
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433 People's Republic of China
| | - Zixiong Li
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433 People's Republic of China
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433 People's Republic of China
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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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