An organized, comprehensive, and security-enabled strategic response to the Haiti earthquake: a description of pre-deployment readiness preparation and preliminary experience from an academic anesthesiology department with no preexisting international disaster response program

Existing operational standards for field deployments of rapid response mobile laboratories: a scoping review

Introduction

Rapid response mobile laboratories (RRML) play an important role in responding to emergencies such as outbreaks and humanitarian crises, working in coordination with national authorities. This scoping review aims to provide evidence to support the development of minimum operational standards for the deployment of RRMLs across the five key workstreams: operational support and logistics, biosafety and biosecurity, laboratory information management system, quality management systems and interoperability and coordination.

Methods

We searched PubMed, MEDLINE, EMBASE and the grey literature focusing on RRML deployment missions. Study characteristics such as year, country, objectives, methods, and findings were extracted and summarized to identify common themes, gaps, and patterns. The results were presented in a narrative format. We ensured methodological rigor by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines throughout the review process.

Results

Out of 163 full-text studies assessed for eligibility, 46 met the inclusion criteria and were analyzed. Six studies addressed the five RRML workstreams. Operational support and logistics are most commonly addressed during pre-deployment phases with a focus on personnel, transport and cold chain management. The application of biosafety and biosecurity protocols is most addressed during the mission execution phase, particularly in the use of personal protective equipment and the implementation of decontamination and disinfection procedures. The laboratory information management system procedures most frequently reported include sample identification and result dissemination protocols. The quality management system workstream overlaps significantly with the other four workstreams, with a strong emphasis on internal and external quality assurance measures. Coordination and interoperability aspects involve maintaining multiple collaborations, ranging from coordinating with local authorities to establishing international partnerships. Common field challenges included interrupted data transfer in areas characterized by poor connectivity and difficulties caused by extreme weather conditions.

Discussion

This review highlights RRML deployment procedures and addresses some critical challenges concerning their deployment. It suggests the provision of a pre-deployment logistics checklist, the use of a pre-determined standardized dataset for inputs to reduce data entry errors and the application of standardized internal and external quality assurance measures.

Advancing the scientific study of prehospital mass casualty response through a Translational Science process: the T1 scoping literature review stage

PURPOSE

The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects' objectives, the NIGHTINGALE consortium used a Translational Science (TS) process. The present work is the first TS stage (T1) aimed to extract data relevant for the subsequent modified Delphi study (T2) statements.

METHODS

The authors were divided into three work groups (WGs) MCI Triage, PH Life Support and Damage Control (PHLSDC), and PH Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping reviews. Relevant data were extracted from the included articles and indexed using pre-identified PH MCI response themes and subthemes.

RESULTS

The initial search yielded 925 total references to be considered for title and abstract review (MCI Triage 311, PHLSDC 329, PHP 285), then 483 articles for full reference review (MCI Triage 111, PHLSDC 216, PHP 156), and finally 152 articles for the database extraction process (MCI Triage 27, PHLSDC 37, PHP 88). Most frequent subthemes and novel concepts have been identified as a basis for the elaboration of draft statements for the T2 modified Delphi study.

CONCLUSION

The three simultaneous scoping reviews allowed the extraction of relevant PH MCI subthemes and novel concepts that will enable the NIGHTINGALE consortium to create scientifically anchored statements in the T2 modified Delphi study.

The Multiple Casualty Scenario: Role of the Anesthesiologist

Purpose of Review

Mass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.

Recent Findings

Anesthesiologists should be involved in all aspects of emergency preparedness—mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with managing patients during natural and man-made (unintentional or intentional) disasters, one that takes into account a risk hazard analysis and institutional goals. Unfortunately, most practicing anesthesiologists have not had training and ongoing education for such events, and few academic centers train anesthesiology residents and staff to prepare for mass casualty scenarios.

Summary

The everyday clinical practice of anesthesiologists involves the utilization of some of the skills (vascular access, tracheal intubation) commonly required to successfully manage mass casualty scenarios. Anesthesiologists’ knowledge of anti-cholinesterases makes them subject matter experts on nerve agent poisoning, and their experience managing trauma patients will serve them well, depending on the nature of the mass casualty event. Practicing anesthesiologists however need to continually educate themselves on their role during mass casualty events. and current anesthesiology residency programs should develop a curriculum and incorporate simulation training to better prepare future generations of anesthesiologists.

Understanding readiness metrics for the humanitarian operations through literature review

Purpose

The purpose of this research is to understand whether an organization knows if it is ready to respond to a disaster and whether it has the capabilities to deliver relief. Our initial motivation was to identify unique resources possessed by the United States Navy (USN) and United States Marine Corps (USMC) due to their unique and critical capabilities for humanitarian operations. The recent frequency of disasters around the world suggests these events will continue to create demand for relief capabilities. For this reason we need to understand readiness metrics not just for USN and USMC but for humanitarian organizations (Hos) in general.

Design/methodology/approach

We survey relevant literature for understanding how HOs define and develop readiness metrics and associated factors. We studied documents including peer-reviewed scholarly articles, government documents, white papers, research papers and Department of Defense (DoD) briefings. We study literature that is significantly written for DoD, one, the vast experience of USN and USMC and two, the lessons learned have been documented. The literature offers substantial information on what readiness means and why it is important. This documented information is critical because it is known to the researchers in humanitarian operations that data is hard to come by.

Findings

The framework for readiness proposed at the end of this article is context the emergency responder probably uses in an informal fashion. The validation of readiness framework, we find exists in the supporting literature we review.

Originality/value

The understanding of readiness metrics for humanitarian operations for the organizations we study may offer insight into other HOs. The insights we gain may not be pivotal or counterintuitive to the conclusions based on commonsense. However, they are supported by the literature review. We formalize the concept based on conclusions of a set of diverse set of researchers and practitioners such as academic scholars, DoD personnel and government officials involved in humanitarian missions, USAID representatives that are repeatedly tasked for being ready, military and government officers from host and foreign countries and many more.

Setting Foundations for Developing Disaster Response Metrics

There are few reported efforts to define universal disaster response performance measures. Careful examination of responses to past disasters can inform the development of such measures. As a first step toward this goal, we conducted a literature review to identify key factors in responses to 3 recent events with significant loss of human life and economic impact: the 2003 Bam, Iran, earthquake; the 2004 Indian Ocean tsunami; and the 2010 Haiti earthquake. Using the PubMed (National Library of Medicine, Bethesda, MD) database, we identified 710 articles and retained 124 after applying inclusion and exclusion criteria. Seventy-two articles pertained to the Haiti earthquake, 38 to the Indian Ocean tsunami, and 14 to the Bam earthquake. On the basis of this review, we developed an organizational framework for disaster response performance measurement with 5 key disaster response categories: (1) personnel, (2) supplies and equipment, (3) transportation, (4) timeliness and efficiency, and (5) interagency cooperation. Under each of these, and again informed by the literature, we identified subcategories and specific items that could be developed into standardized performance measures. The validity and comprehensiveness of these measures can be tested by applying them to other recent and future disaster responses, after which standardized performance measures can be developed through a consensus process. (Disaster Med Public Health Preparedness. 2017;11:505–509)

Pre-travel health advice guidelines for humanitarian workers: A systematic review

BACKGROUND

In the last decades, there have been several natural disasters and global catastrophies with a steady increase in humanitarian relief work. This has resulted in increased research in the field of humanitarian aid, however the focus is mostly on the victims of the disasters and not on the individuals and organisations providing aid.

OBJECTIVES

The intent of this research is to review the information available on pre-deployment interventions and recommendations such as vaccinations and other health preserving measures in volunteers and professionals deploying abroad in humanitarian relief missions.

METHODS

We performed a systematic literature review of papers written in English, French, Italian or German. We searched the following databases: Cochrane, PubMed, CINAHL, EMBASE and also hand searched reference lists. The cut-off date for the publication search was November 20th, 2014. In addition to the literature search we also sent a questionnaire to 30 organisations to detail their approach to preparing relief workers.

RESULTS

We identified 163 papers of possible relevance and finally included 35 papers in the systematic review. Six organisations provided information on pre-deployment preparation of aid workers. Identified papers show that pre-deployment physical and mental fitness are paramount for success in humanitarian missions. However, in many settings, pre-travel medical and psychological assessments and/or training/education sessions are not mandatory. We identified high-risk hazards for aid workers (often location specific), these included: travellers׳ diarrhoea, vector-borne infections, accidents, violence, tuberculosis, HIV, hepatitis A, leptospirosis, typhoid fever, seasonal and H1N1 influenza.

CONCLUSIONS

The medical evaluation can identify problems or risk factors, such as psychological frailty, that can be exacerbated by the stressful settings of humanitarian missions. In this pre-travel setting, the status of routine vaccinations can be controlled and completed, medication dispensed and targeted preventive advice provided. A mission specific first-aid kit can be recommended. There is a lack of evidence-based literature on the theme of pre-travel advice guidelines for humanitarian workers. We propose a shared database of literature on this topic as a resource and suggest that some standardization of guidelines would be useful for future planning.

Support Needs for Canadian Health Providers Responding to Disaster: New Insights from a Grounded Theory Approach

Introduction: An earlier descriptive study exploring the various supports available to Canadian health and social service providers who deployed to the 2010 earthquake disaster in Haiti, indicated that when systems are compromised, professionals are at physical, emotional and mental risk during overseas deployment. While these risks are generally well-identified, there is little literature that explores the effectiveness of the supports in place to mitigate this risk. This study provides evidence to inform policy development regarding future disaster relief, and the effectiveness of supports available to responders assisting with international disaster response.

Methods: This study follows Strauss and Corbin’s 1990 structured approach to grounded theory to develop a framework for effective disaster support systems. N=21 interviews with Canadian health and social service providers, who deployed to Haiti in response to the 2010 earthquake, were conducted and analyzed. Resulting data were transcribed, coded and analysed for emergent themes.

Results and Discussion: Three themes were identified in the data and were used to develop the evolving theory. The interview data indicate that the experiences of responders are determined based on an interaction between the individual’s ‘lens’ or personal expectations, as well as the supports that an organization is able to provide. Therefore, organizations should consider the following factors: experience, expectations, and supports, to tailor a successful support initiative that caters to the needs of the volunteer workforce.

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classified into three types: type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open transection nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmacotherapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity declined with increasing duration of being trapped. In the first year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor (0 or 1) after a 1-year period of treatment, further treatment was not effective.

Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training

INTRODUCTION

Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training.

METHOD

This qualitative study was performed in 2013. A questionnaire-based evaluation of experts' opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data.

RESULTS

This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters.

CONCLUSION

The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services. Failures in leadership and in coordination among teams are also a problem. All deficiencies need to be applied to competency-based curricula.

Preparedness of anesthesiologists working in humanitarian disasters

OBJECTIVE

Many skills needed to provide patients with safe, timely, and adequate anesthesia care during humanitarian crisis and disaster relief operations are not part of the daily routine before deployment. An exploratory study was conducted to identify preparedness, knowledge, and skills needed for deployment to complex emergencies.

METHODS

Anesthesiologists who had been deployed during humanitarian crisis and disaster relief operations completed an online questionnaire assessing their preparedness, skills, and knowledge needed during deployment. Qualitative data were sorted by frequencies and similarities and clustered accordingly.

RESULTS

Of 121 invitations sent out, 55 (46%) were completed and returned. Of these respondents, 24% did not feel sufficiently prepared for the deployment, and 69% did not undertake additional education for their missions. Insufficient preparedness involved equipment, drugs, regional anesthesia, and related management.

CONCLUSIONS

As the lack of preparation and relevant training can create precarious situations, anesthesiologists and deploying agencies should improve preparedness for anesthesia personnel. (Disaster Med Public Health Preparedness. 2013;0;1-5).

Supports for health and social service providers from Canada responding to the disaster in haiti

In January 12, 2010, a 7.0 magnitude earthquake shook Port-au-Prince, Haiti. The massive disaster made it difficult for local Haitian community officials to respond immediately, leaving the country reliant on foreign aid and international and non-governmental relief organizations. This study explores the effectiveness of various supports that were made available to health and social service providers in Haiti, by focusing on their lived experiences pre-deployment, on-site and post-deployment. The paper provides a qualitative exploration of participant perceptions with respect to the success of their performance in response, and relevant literature describing the various supports provided to health and social service providers responding to disasters.

METHODS

A single, semi-structured interview was conducted with Canadian health professionals (n=21) who deployed to Haiti during the time of, or after, the 2010 earthquake. The study uses Strauss and Corbin's structured approach to grounded theory to identify main themes and relationships in the interviews.

RESULTS

The interviews indicate that training, and psychological and emotional supports for health and social service providers require improvement to enhance the experience and effectiveness of their work.

CONCLUSIONS

Findings indicate that supports are most effective when they are tailored to the volunteers. The paper highlights future research stemming from the grounded theory findings.

New trends of short-term humanitarian medical volunteerism: professional and ethical considerations

Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.

The academic health center in complex humanitarian emergencies: lessons learned from the 2010 Haiti earthquake

On January 12, 2010, a 7.0-magnitude earthquake struck Haiti. The event disrupted infrastructure and was marked by extreme morbidity and mortality. The global response to the disaster was rapid and immense, comprising multiple actors-including academic health centers (AHCs)-that provided assistance in the field and from home. The authors retrospectively examine the multidisciplinary approach that the University of Chicago Medicine (UCM) applied to postearthquake Haiti, which included the application of institutional structure and strategy, systematic deployment of teams tailored to evolving needs, and the actual response and recovery. The university mobilized significant human and material resources for deployment within 48 hours and sustained the effort for over four months. In partnership with international and local nongovernmental organizations as well as other AHCs, the UCM operated one of the largest and more efficient acute field hospitals in the country. The UCM's efforts in postearthquake Haiti provide insight into the role AHCs can play, including their strengths and limitations, in complex disasters. AHCs can provide necessary intellectual and material resources as well as technical expertise, but the cost and speed required for responding to an emergency, and ongoing domestic responsibilities, may limit the response of a large university and hospital system. The authors describe the strong institutional backing, the detailed predeployment planning and logistical support UCM provided, the engagement of faculty and staff who had previous experience in complex humanitarian emergencies, and the help of volunteers fluent in the local language which, together, made UCM's mission in postearthquake Haiti successful.

Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care

BACKGROUND

Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters.

QUESTIONS/PURPOSES

We therefore (1) identified and compared recurrent interview themes essential to the disaster response following the 2010 Haiti earthquake; (2) determined the difference in reported disaster equipment management task difficulty between disaster-trained and untrained volunteers; and (3) approximated the quantity of various procedures performed.

METHODS

We conducted 14 interviews with selected orthopaedic surgeon volunteers. We also invited the 504 members of the American Academy of Orthopaedic Surgeons (AAOS), who registered as Haiti earthquake volunteers, to complete an online survey; 174 (35%) completed the survey and 131 (26%) were present in Haiti during the 30 days after the earthquake. Recurrent interview themes were identified, quantified, and compared using Poisson regression analysis. The difference in disaster equipment management difficulty scores was determined with a Wilcoxon rank-sum test.

RESULTS

Of 10 recurrent interview themes, group organization (31 occurrences) was mentioned much more often than all but two of the remaining nine themes. Compared with disaster-untrained respondents, equipment management tended to be less challenging for disaster-trained respondents. Transporting to the treatment site and security during storage at the site were less challenging (19.5% and 16.5% decreases, respectively). Revision surgeries, guillotine amputations, fasciotomies, and internal fixations, suggestive of inappropriate disaster care, were frequently reported.

CONCLUSIONS

Organizational and training barriers obstructed orthopaedic care delivery immediately after the Haiti earthquake. Disaster training and outcomes require further study to improve care in future catastrophes.

Global health outreach during anesthesiology residency in the United States: a survey of interest, barriers to participation, and proposed solutions

STUDY OBJECTIVE

To assess the interest in and barriers to pursuing global health outreach (GHO) experiences for anesthesiology residents in the United States.

DESIGN

Survey instrument.

SETTING

Academic department of anesthesiology.

SUBJECTS

Anesthesiology residents who were members of the American Society of Anesthesiologists (ASA).

MEASUREMENTS

An online survey was administered to residents in anesthesiology via the ASA membership database. Descriptive statistics, including means, frequencies, and percentages were calculated.

MAIN RESULTS

91% of participants indicated an interest in GHO, of whom fewer than half (44%) had done a GHO medical mission. Seventy-nine percent reported that GHO affected their current practice or education; 33% commented they were now less wasteful with supplies and resources. Permission from work or obtaining work coverage were the primary barriers for both those with and without previous GHO participation. Of all respondents, 78% agreed that the availability of a GHO residency track would influence their ranking of that program for training, and 71% would pursue a GHO fellowship if available.

CONCLUSIONS

Anesthesiology residents have an interest in residency and fellowship GHO programs. Formalization of GHO programs during training may reduce work-related barriers associated with GHO participation and broaden academic program recruitment.

Surgery in global health delivery

Surgical conditions account for a significant portion of the global burden of disease and have a substantial impact on public health in low- and middle-income countries. This article reviews the significance of surgical conditions within the context of public health in these settings, and describes selected approaches to global surgery delivery in specific contexts. The discussion includes programs in global trauma care, surgical care in conflict and disaster, and anesthesia and perioperative care. Programs to develop surgical training in Botswana and pediatric surgery through international partnership are also described, with a final review of broader approaches to training for global surgical delivery. In each instance, innovative solutions, as well as lessons learned and reasons for program failure, are highlighted.