The purpose of this guide is to assist community and university planners in developing and implementing a medication Point of Dispensing plan and conducting a Point of Dispensing drill. Key planning strategies addressed include community assessment, resource coordination, community partnerships, physical plant considerations, and multifunction considerations that will assist community planners to better prepare for bioterrorism or naturally occurring infectious disease events.
A mass casualty incident (MCI) demands rapid and efficient triage of victims. The Simple Triage and Rapid Treatment (START) protocol has been proposed to identify salvageable victims from those with imminent mortality. This study evaluates the efficacy of START triage to predict likelihood of mortality of an MCI trauma victim.
Trauma patients were randomly selected using the trauma database at a local Level II trauma center. Survival was defined as a discharge from the hospital with the primary endpoint being death. For respiratory rate <30, pulse <100, and Glasgow Coma Scale score >14, one point was given to the victim for each category. Persons who did not meet these criteria were given a score of zero. The scores were then tabulated and analyzed with respect to the primary endpoint.
Of the 355 persons analyzed, 341 (96%) survived and 14 (3.9%) were categorized as deceased. For patients with a tabulated score ≤1, the positive predictive value (PPV) and negative predictive value (NPV) were 0.4 and 0.98, respectively. For patients with a tabulated score of ≥2, the PPV and NPV were 0.08 and 0.99, respectively.
Of the total victims, 75.77% with a respiratory rate <30, palpable radial pulse, and intact mental status survived. The deceased victims with tabulated scores of 1, 2, and 3 had mortalities of 50%, 28%, and 21%, respectively. The trend toward lower tabulated scores in the deceased victims suggests efficacy with START triage.
The role of physicians in the detection, reporting, and response to infectious disease outbreaks, anomalous biologic events, or other public health emergencies is critical to the community's safety.
In an effort to assess the level of preparedness of local physicians to respond to such events, the City of Fort Worth Public Health Department, the Fort Worth/Tarrant County Health Authority, and the Tarrant County Medical Society collaborated in designing and administering a cross-sectional study in spring 2006.
The results serve as a baseline of the local clinical community's preparedness, with 91% of local physicians reporting their knowledge as “fair-poor,” 80% desiring more information, and 83% favoring more training opportunities.
Information obtained through this assessment is used to help cultivate educational interventions that will enhance the participation, integration, and mobilization of clinicians in the event of a community emergency.
In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events—a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events.
The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel.
The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's α coefficient 0.6 α-0.94.
The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low.
On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.
Hurricane Katrina, a category 4 storm, struck the U.S. Gulf states in late August, 2005, resulting in the most costly and second most deadly natural disaster in recent United States history. The storm and subsequent flooding due to levee failure necessitated the evacuation of 80% of the city of New Orleans' 484,674 residents. Most of the city's hospitals and other health care resources were destroyed or inoperable. The hurricane devastated many communities, stranding people in hospitals, shelters, homes, and nursing homes. Nurses and other health care providers deployed to New Orleans to provide medical assistance experienced substantial challenges in making triage and treatment decisions for patients whose numbers far exceeded supplies and personnel. This article describes the experiences and solutions of nurses and other personnel from 3 Disaster Medical Assistance Teams assigned to the New Orleans airport responsible for perhaps the most massive patient assessment, stabilization, and evacuation operation in U.S. history. As the frequency of disasters continues to rise, it is imperative that the nursing profession realize its value in the disaster arena and continually take leadership roles.
More disasters worldwide are now classified as complex emergencies, thereby increasing the threat to life and limb and potentially increasing the psychosocial impact of the experience for aid workers.
This study examines the concept of support as perceived by aid workers who had recent experience in complex emergencies.
Using a phenomenological approach, 6 professional aid workers were interviewed about their experience.
Aid workers who work in complex emergencies do not feel supported at the pre-deployment, during deployment, and after deployment phases. Failure to provide this support may cause disappointment, reduced self-worth, anger with the organization, and feeling of lack of achievement regarding self and the mission.
While the study may be limited by the volunteer sample and potential bias in data collection, the findings reiterate a proverbial but important issue in relation to aid relief staff in complex emergencies.
Mass casualty incidents involving contaminated children are a rare but ever-present possibility. In this article we outline one such event that resulted in 53 pediatric patients and 3 adults presenting to the emergency department of a children's hospital for decontamination and treatment. We pay special attention to the training that allowed this responses to occur. We also outline the institutional response with emphasis on incident command, communication, and resource utilization. Specific lessons learned are explored in detail. Finally, we set forth a series of recommendations to assist other institutions should they be called upon to care for and decontaminate pediatric patients.
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