American journal of disaster medicine最新文献

Background: Shooting events in hospitals are increasing in frequency, with the emergency department (ED) being the most common site of such events. EDs must be prepared for shooting events, but current practices surrounding active shooter preparation are unknown.

Objective: To determine what active shooter training emergency medicine physicians are receiving.

Methods: A survey was developed to assess current practices around active shooter preparation in EDs. The survey was distributed to members of the American College of Emergency Physicians' Emergency Medicine Practice Research Network. All members of the Emergency Medicine Practice Research Network are currently practicing emergency medicine physicians.

Results: There were 194 respondents. The most common form of training received was online (76/194), followed by lecture (50/194). Only 39 respondents had participated in an active shooter drill. Sixty-five respondents (33 percent) reported having never received any formal active shooter training.

Conclusion: There is a wide array of active shooter training that emergency medicine physicians are receiving, with nearly one-third receiving no training at all.

Background: Highly communicable infectious diseases (HCIDs) such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Ebola are a containment challenge for the emergency department (ED). Donning and doffing personal protective equipment is necessary to protect healthcare workers but is time consuming and rife with errors. Furthermore, children present an additional containment challenge since they are often unable to follow directions or be separated from family members. To address these challenges, a novel child-friendly medical apparatus was developed for the rapid containment and evaluation of a HCID patient in the ED.

Objectives: The primary objective was to determine if routine emergency triage procedures (vital signs and basic physical examination) can be performed using this medical apparatus. The secondary objective was to determine if invasive procedures (bag-valve-mask ventilation and endotracheal intubation) can be performed.

Design: This was a prospective pilot study. A clear acrylic apparatus was built containing arm ports with gloves, simulating a specialized HCID barrier. Emergency physicians attempted routine triage procedures on a healthy volunteer and invasive procedures using a simulation mannequin through this apparatus.

Results: Twenty-four physicians were enrolled. All physicians (100 percent) successfully obtained vital signs, auscultated heart/lung sounds, completed bag-valve-mask ventilation, and performed intubation through the apparatus.

Conclusions: This novel apparatus is a feasible tool in the rapid evaluation of a HCID patient in the ED. A future study is needed to assess protection and training using this apparatus.

Background and objective: Numerous disasters have occurred over the recent years. Moreover, there has been a considerable rise in the number of victims, injured people, and damages caused by disasters worldwide. Governments cannot meet needs alone due to the complicated nature of crises and accidents. Therefore, nongovernmental organizations (NGOs) and communities must assist the states during disasters. The present study aimed to derive the factors affecting the participation of NGOs in disaster management using a systematic review in 2022.

Design: This systematic review was done using ISI, Science Direct, Scopus, PubMed/MEDLINE, ProQuest, and Cochran Library based on the preferred reporting items for systematic reviews (PRISMA) standard from January 1, 2000 to December 31, 2021. The articles were selected based on the search keywords (population, intervention, comparison, outcome (PICO)). After studying the titles, abstracts, and full texts of the articles, the factors affecting the participation of NGOs in disaster management were derived.

Results: The final assessment was done on 13 articles. Cooperation and coordination with other organizations, education, communication between NGOs, social empowerment, access to adequate references, and flexibility were the criteria with the highest frequency.

Conclusion: As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a -measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Major disasters often displace populations, requiring coordinated response efforts from governmental and voluntary organizations to support and assist an influx of evacuees. Despite the frequency and significance of this occurrence, this aspect of disaster management has received limited scholarly attention, with research predominantly focusing on response and recovery at the impacted disaster sites. This study investigates disaster management and support offered to Puerto Rican evacuees arriving in Central Florida after Hurricane Maria. A multiagency resource center (MARC) was established at the Orlando Airport to support evacuees, facilitating a network of agencies to coordinate response efforts. The analysis uses data obtained through in-depth, semistructured interviews from members of the Orlando metropolitan area disaster response community who worked at the MARC center, and content analysis of state and local government documents. The results identify challenges and successes and common themes in disaster support for displaced evacuees after disasters. Results confirm some conventional wisdom about disaster response, such as persistent significant challenges related to shelter and housing, and offer new insights about how to successfully support displaced evacuees, particularly using MARCs. This study provides foundational knowledge to inform future research and contributes to the development of successful support for those who are displaced after disaster.

Objective: To review the current standards being followed for diagnostic radiology at low-resource settings.

Design: A systematic review was conducted.

Setting: Low-resource field hospitals were reviewed.

Patients and participants: All patients who were diagnosed using imaging in field hospitals were included in this review.

Interventions: Only standard care diagnostic imaging was reviewed.

Results: Scanty evidence on the standard quality control for mobile health unit (MHU) in low-resource settings is observed. The lack of evidence makes it inconclusive to decide if suboptimal quality of care is being provided to patients at the MHUs or if the quality is optimal. Multiple international societies such as the Radiological Society of North America and European Society of Radiology do provide extensive guidelines and algorithms for radiologists under normal conditions in the hospital. However, no such guidelines were found for MHUs. The most significant contributions that have been done in the guidance and quality control of the MHUs have been done by the World Health Organization with their emergency medical team guidelines and publications.

Conclusions: MHUs are critical interventions introduced to mitigate crises and manage health campaigns. Diagnostic imaging also plays a pivotal role in ensuring successful patient management in the MHUs. No international or local diagnostic imaging standard for quality control was found in the evidence. Investigations to access the feasibility of different quality control standards in the MHUs are warranted.

Background: The use and storage of chemical weapons in war was banned. However, chemical weapons continue to be used in wars. Therefore, in this study, we tried to identify the chemical agents used by defining the characteristics of chemical attacks.

Method: We designed our study using the international dataset that can be accessed from www.start.umd.edu/gtd/. Chemical attacks between 1970 and 2020 were recorded in terms of decade, type of attack, success, suicidal purpose, property damage, number of deaths and injuries, and agents used.

Results: A total of 347 attacks were reported. The highest number of attacks was 162 (46.7 percent), which occurred between 2010 and 2020. Among the chemical agents used, acidic substances (39, 11.2 percent), chlorine gas (32, 9.2 percent), and tearing agents (24, 6.9 percent) were found to be the most common. When the distribution of the five most common chemical agents by years was examined, it was found that the use of chlorine gas gradually increased in the last three decades. In the last decade, it was found that the use of mustard gas increased, whereas cyanide was not used.

Conclusion: In the last decade, we found that chemical attacks have increased more, especially chlorine and mustard gas were predominantly used.

Objectives: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies.

Study design: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed.

Methods: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals.

Results: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psycho-logical well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines.

Conclusions: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Objectives: This information paper will describe the current research and recommendations for improving healthcare worker's (HCW) mental health. Individual and organizational goals will be outlined with items broken up into the time frames of predisaster, during a disaster, and post-disaster.

Methods: A team of subject matter experts reviewed the current literature utilizing a search of PubMed, Google Scholar, relevant article reference lists, and subject matter interviews.

Results: Thirty-six distinct recommendations were identified and distributed into the time frames of predisaster, during a disaster, and post-disaster. Twenty-one of these are pertaining to organizational goals and factors. Fifteen recommendations are identified for individual HCWs.

Conclusions: Additional institutional and government policies supporting the protection of HCW's mental health are required to reduce the stigma and fear, preventing frontline workers from seeking help with the psychological effects of disasters, mass casualty incidents, and pandemics. Further research dealing with ways to ameliorate the negative effects of the stress related to the duties and responsibilities of HCWs, which are exacerbated by disasters, is needed.

The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to adapt, innovate, and collaborate to protect public health through treatment, testing, and vaccination initiatives related to the virus. As the pandemic evolved, lessons learned early on through testing and treatment were applied to vaccination efforts. Hartford HealthCare (HHC) is one of the largest healthcare systems in New England and took an integral role in vaccinating patients throughout the region, thus providing one of the largest vaccination campaigns in Connecticut. Early planning for equipment and personnel, in addition to effective communication between providers and patients, was critical in accomplishing HHC's goal of rapidly providing access to COVID-19 vaccines. The efficient and effective response to the pandemic at HHC was led by the Office of Emergency Management, which worked to ensure continuity of patient care and physician excellence in the face of disaster. Initially, resources were directed to testing and treatment of the disease; as vaccine clinical trials announced successful outcomes, these efforts shifted to preparing for the storage and distribution of a mass number of vaccines. This manuscript details the factors that enabled success in HHC's vaccination campaign and serves to provide a useful template for similar healthcare systems for future pandemic response.

Purpose: The purpose of the research discussed in this paper is to better understand the negative health outcomes resulting from Hurricane Katrina and the disaster response that followed. This understanding can inform future disaster response.

Design: We conducted 10 in-depth interviews with individuals who lived in New Orleans at the time of Hurricane Katrina. We conducted thematic analysis on the interview content and identified patterns across all 10 interviews.

Findings: Four primary patterns emerged across all interviews. These were: (1) Federal Emergency Management Agency's (FEMA) response to the crisis created greater physical and mental health hazards for interviewees; (2) Hurricane Katrina led to long-term mental health issues for interviewees, even those who evacuated before the storm; (3) displacement from homes following the storm typically resulted in overcrowded living conditions, which increased interviewees' risk of infectious disease; and (4) the discrimination faced by interviewees in the months and years following Hurricane Katrina had a profound and lasting impact on their well-being.

Originality: Numerous studies have been conducted to understand the mental health impacts of disaster and a limited number have looked at the physical health impacts or the threat of infectious disease. This study is unique because it incorporates both mental and physical health impacts, but also examines how disaster response itself plays a role in health outcomes for survivors. Additionally, this paper also incorporates the role of racial inequities in disaster response and how those inequities impact survivor health.