American journal of disaster medicine最新文献

Importance: This article surveys the literature for in-hospital active shooter training models. While most hospital systems utilize computer-based Code Silver training modules, evidence suggests that employees are not adequately prepared for an actual event.

Objective: Although several government agencies and case reports advocate for in situ active shooter training, no gold standard simulation training method has yet been implemented across health systems. This literature review seeks to reveal and evaluate the existing training methodologies to progress toward a gold standard active training model.

Evidence review: A literature survey across two platforms was conducted with predetermined inclusion and exclusion criteria. The search yielded three articles that conducted and evaluated in situ Code Silver training exercises with analysis of before and after participant performance alongside review of weak points in existing hospital policy.

Findings: Across the three identified articles, data from interviews, surveys, and video recordings suggest that participants readiness for an active shooter event increases with simulated training exercises. Furthermore, training exercises allow improvement of hospital policy based on identified weakness.

Conclusion and relevance: While the existing body of literature on training for an active shooter event in a healthcare setting is sparse, the data reviewed in this article underscores the importance of real-world training to inform review of current policies. Furthermore, active training models prove superior to computer-based modules for preparation for an in-hospital active shooter event. Development of a gold standard proactive training approach holds the potential to substantially fortify staff readiness and response capabilities across the American healthcare system in anticipation of the growing threat of active shooter incidences.

We aim to evaluate the health impacts of the Fundão tailings dam disaster by analyzing secondary data collected from various databases of the Brazilian Ministry of Health and conducting a study to assess the burden of disease using years of life lost due to disability and the disability-adjusted life year (DALY) indicator as a summary measure. An ecologic study design was used to compare municipalities affected by the disaster with a group of controls. Based on the incidence of diseases registered in public databases, an assessment of the impact on mental and physical health associated with the disaster was carried out using a burden of diseases approach. DALYs were calculated for all the diseases identified based on the evaluation of the epidemiological parameters: (i) attributable risk (AR) ratio, (ii) ratio of cumulative incidences (CIs) before and after the disaster, and (iii) a plausibility coefficient, idealized in order to express the relevance of the health conditions identified to a set of health conditions plausibly associated with the disaster. Key findings include the estimation of an average loss of 2.39 years of life due to disability for the affected municipalities, considering 75 groups of diseases that had higher CIs and ARs after the disaster, compared with a set of control municipalities, indicating a worsening of health of these populations. We also identified respiratory diseases, various types of cancer, mental disorders, and violence as responsible for a very significant portion of the damage identified. We included a series of public health recommendations that can be implemented to facilitate the resilience of those living in affected municipalities.

The increasing frequency and intensity of wildfires, driven by rising global temperatures, pose significant health risks, particularly in low socioeconomic status (SES) communities. This study explores the correlation between wildfire air pollution and atopic dermatitis (AD), highlighting the compounded impact on low SES populations. Through a novel study analyzing data from the 2018 Camp Fire in Northern California, an association was identified between increased wildfire pollution and a rise in AD-related healthcare utilization. Given the exacerbation of AD in low SES communities, further research and targeted interventions are essential to mitigate the disproportionate burden on these vulnerable populations.

Objective: Evidence-based evaluation of working dog decontamination is needed following several contemporary events involving threats for contamination with hazardous materials. The purpose of this study was to describe the behavior of ex vivo neat chemical warfare agent exposure on military working dog breed-specific canine cadaver tissue and measure the potential effectiveness of standard and potential alternative decontamination methods.

Methods: Previously frozen German Shepherd, Belgian Malinois, and Labrador Retriever full-thickness skin tissue with attached hair coat was used to test the efficacy of decontamination procedures in the removal of sulfur mustard blister agent (HD) and organophosphate nerve agent (VX) chemical warfare contaminants. Four different decontamination treatments were evaluated: none, microfiber towel only (MFTO), low-water method (LWM), and high-water method (HWM). The lesser/nonhaired inner ear, paw pads, and underbelly were evaluated using a Reactive Skin Decontamination Lotion treatment.

Results: The MFTO condition showed a significant removal amount of HD and VX agent from hair coats. An average of 83.1 percent HD and 80.9 percent VX reduction in the initially applied agent was observed with microfiber towel wipes in all tested breeds. As tested, the MFTO method resulted in less recovered agent than the 4 percent chlorhexidine scrub LWM. The HWM resulted in an average of 80.3 percent HD and 98.7 percent VX reduction in the initially applied agent.

Conclusion: The data suggest that the MFTO method alone may be an effective field expedient decontamination method for VX and HD in situations with limited water resources.

Emergency medical services (EMS) throughout the world utilize volunteers. Magen David Adom (MDA), Israel's EMS organization and an official member of the International Federation of Red Cross and Red Crescent Societies, has incorporated these volunteer roles on a national level and significantly expanded upon them for pandemic and disaster response. In addition to traditional ambulance-based volunteers, MDA utilizes automobile-based on-call volunteers, motorcycle on-call volunteers, international volunteers, youth volunteers, and volunteers during the coronavirus disease 2019 pandemic. They are also integrated into the national disaster response team. As a national organization, MDA is responsible for coordinating EMS members throughout Israel, which allows for the successful integration of the various types of volunteers into its emergency response. This model can be integrated into EMS systems throughout the world during routine times as well as for multicausality incidents, pandemics, and disasters.

This case study highlights the critical need for radiographic imaging in the military medical field, especially for diagnosing orthopedic injuries. The absence of on-site X-ray equipment can lead to patient transport, resource expenditure, and misdiagnosis. This study presents a practical solution through the use of lightweight and portable X-ray systems, as employed by explosive ordnance disposal teams, which not only reduce transport time and resources but also offer high-quality imaging with low radiation risk. Alternative diagnostic tools like ultrasound are also discussed, emphasizing their limitations in terms of user-dependency and precision. In conclusion, the adoption of portable X-ray systems can significantly enhance patient safety, diagnostic capabilities, and overall force readiness in forward-deployed medical teams.

Introduction: Tourniquets have been demonstrated to reduce preventable deaths due to exsanguination. However, studies have suggested that the Combat Action Tourniquet (CAT®), a popular prehospital device, may have a 19-30 percent failure rate, thus prompting the creation of a new, lever-operated device for exsanguinating extremity hemorrhage. However, the efficacy of this device compared to the CAT has not been reported.

Objective: To determine efficacy and ease of use of the Hemorrhage Arresting Lever Operated (HALO®) tourniquet compared to the CAT.

Methods: This was a prospective crossover observational study where an arterial hemorrhage was created on the right anterior, medial calf of a softly embalmed middle-aged female cadaver. A Kamoer UIP-CK15 continuous high-precision peristaltic pump was sutured to the femoral artery that measured the efflux of simulated bleeding. Participants were given manufacturer instructions for each tourniquet, randomized regarding which device to apply first, and queried about perceived ease of use and preference. All tourniquet applications were timed. Chi-square, McNemar test, t-test, and analysis of variance were used to compare groups. Factors significant in the univariate analysis were used to construct multivariate models of tourniquet success for each device type.

Results: Altogether, 135 participants were enrolled in the study, including 75 (55.5 percent) females, 13 (9.6 percent) ethnic minorities, 51 (37.7 percent) paramedics, 19 (14.1 percent) nurses, and 24 (17.7 percent) with prior military service. A total of 43 (31.8 percent) participants were able to achieve hemorrhage cessation with the HALO but not the CAT, compared with 6 (4.4 percent) of the participants who were able to achieve hemorrhage cessation with the CAT but not the HALO (p < .001). For participants who found the lever of the HALO easy to use, successful application of the HALO was 12.3 times more likely (odds ratio [OR] = 12.3; 95 percent confidence interval [CI]: 1.47-103.05). For those clinicians who applied the HALO properly compared with those who did not, hemorrhage cessation was 34.89 times more likely (OR = 34.89; 95 percent CI: 2.12-575.60). In contrast, there were no statistically significant predictors found for successful CAT -application.

Conclusions: With minimal practice, results suggest that the HALO tourniquet may be as effective and easier to use than the CAT tourniquet in the presence of exsanguinating lower extremity hemorrhage. Additional research is required for alternate locations and patient types.

Objective: This study aimed to understand pediatricians' experiences with disasters, their perceptions of potential threats, and their preferences for disaster education.

Design: This is a survey study.

Background: The increasing frequency of disasters highlights the need for specialized care for vulnerable populations, particularly children. Pediatricians play a crucial role in disaster preparedness, but they are underprepared due to insufficient disaster-specific education.

Methods: A survey was conducted among pediatricians in Washington, DC, Maryland, and Virginia. We collected data on personal disaster experiences, perceived threats, and preferences for educational resources. Descriptive statistics and odds ratios (OR) were used to analyze the data.

Results: One hundred and four pediatricians responded. The majority were attending physicians (88 percent) in healthcare or academic settings (73 percent), predominantly Millennials or Generation X (91 percent). Most respondents (82 percent) worked over 20 clinical hours per week. Commonly experienced disasters included winter storms, hurricanes, floods, power outages, and infectious disease outbreaks. However, cyberattacks (OR 25.9, p < 0.0001) and mass shootings (OR 2.71, p < 0.01) were perceived as major threats despite limited direct experiences. Preferred educational resources differed between routine practice and disaster settings, with a notable preference for digital sources like social media during disasters (OR 3.11, p = 0.0005).

Conclusion: There is a need for targeted disaster education for pediatricians. Specific areas of concern include cyberattacks and mass shootings. Digital platforms to provide timely and relevant information were more preferred during disasters. Future efforts should focus on developing and disseminating educational content through preferred formats and outlets to better meet pediatricians' needs.

Objective: To assess the impacts of flooding on access to dialysis care and compare current and future risk from flood inundation and isolation.

Design: A cross-sectional study. Maps were generated in ArcGIS using the 100-year flood plain, transportation networks, and dialysis center locations, showing spatial flood risks for dialysis center locations in the State of Delaware.

Main outcome measure: Number of roads, intersections, and dialysis centers closed due to flood inundation or isolation and population expected to be impacted.

Results: Six dialysis facilities would be flooded in a flooding event, and three additional facilities would be isolated. The spatial distribution of dialysis care access is inequitable across the state and among socially vulnerable groups.

Conclusions: Mapping the impact of flooding on access to dialysis center care in Delaware is important for identifying geographic areas and socially vulnerable populations at high risk for dialysis service disruptions in flooding events.

Background: More needs to be known on how the South African health system contained the coronavirus disease 2019 (COVID-19) pandemic and maintained the core business of health service delivery. We describe the practices that have shown to affect the health systems' resilience in ensuring maintenance of polio surveillance and immunization systems in South Africa (SA) during the COVID-19 pandemic.

Methodology: This is a descriptive, reflective desk review study using the South African polio surveillance systems and immunization coverage as a case study. We applied a health systems' resilience framework to highlight how the South African health system contained the pandemic and maintained its core business. Routine immunization and polio surveillance data were obtained and analyzed.

Results: The effect of SA's immunization campaigns, which contributed positively to maintaining the polio immunization coverage during the COVID-19 pandemic, is highlighted, with varied performances among provinces. We established delayed integration of pandemic services and missing public health emergency response structures, which led to redeployment of service providers compromising on the health systems' core business.

Conclusion: Immunization campaigns are key in maintaining coverage, with individualized approaches in supporting the provinces. The existing health systems' structures of countries are a critical determinant of response to pandemics regardless of the available resources. Therefore, to ensure that the health systems maintain a balance between containing pandemics like COVID-19 and maintaining its core business, we recommend the establishment of a public health structure from the national to the community level to respond to public health emergencies and the early integration of pandemic services into the day-to-day health systems' business.