Developing an e-learning platform addressing security and rescue forces to eradicate the lack of disaster preparedness underscored by diverse studies. In order to reach this aim the performance of a needs analysis is essential.

The audience of security and rescue forces was clustered in (emergency) physicians, fire-fighters, policemen, Paramedics and members of the Federal Agency for Technical Relief (THW). For each cluster a questionnaire was developed and corrected by specialists in disaster care. The questions were about previous knowledge, habits of studying; further training habits and internet requirements.

The questioner was posted online during 4 months and was filled in by 1142 persons (141 physicians, 194 fire-fighters, 108 policeman, 444 rescue workers and 255 members of the THW). The biggest lacks in previous knowledge were shown in reacting on CBRN-incidents. 64, 1% thought they were not able to act correctly in case of chemical contamination. The most important learning tools were books, lectures, seminars and the principle of learning by doing. The reasons for using an e-learning platform were saving time, high quality of the tutorials (77% thought it important), quicker reach of information, multimedia formats of the taught facts and links to further information. 55, 2% were slightly unsatisfied with the actual pool of further trainings. The most frequently used sources of information were the internet (78, 8% use it frequently) and colleagues.

The survey shows that lacks in disaster preparedness in Germany definitively exist but it also reflects that most of the security and rescue forces are motivated to do further trainings and use therefore new technologies. But they require a high quality of teaching and a reasonable use of them. There is a need for using innovative Methods, and user-friendly web-based instruction and information modules to address all security and rescue forces in Germany.

Most research into the outcomes of injury has focused on mortality rather than the physical, social, and psychological sequelae of non-fatal injuries. The health and long-term outcomes of a cohort of accidentally-injured patients were studied in order to assess the impact on quality of life.

The cohort of patients was derived from six previous studies spanning 1988–2003. Patients were followed-up with to ascertain if they were still alive, and survivors were sent a follow-up questionnaire in 2006. The questionnaire asked about current problems resulting from past injuries, use of health services, and measures of health related quality of life (the EQ-5D and SF-36 or Nottingham Health Profile (NHP)). A sample of 114 also received detailed face-to-face interviews.

A total of 2,418 patients were followed-up on between 4–15 years post-injury, of whom 311 had died. There were 580 completed follow-up questionnaires, and of these 64% reported health problems related to past injuries. The mean EQ-5D score at follow-up was 0.132 tariff points below the mean for a normal age-sex matched population, and SF-36 scores were 5–15 points worse than population norms. At all ages, EQ-5D and SF-36 scores were similar to those of the normal population aged 75. Interviewed patients also reported substantially more disability than the general population. Increasing injury severity was associated with almost all aspects of worse health at follow-up, and severe lower extremity injuries were strongly associated with poorer outcomes.

Injured patients continue to experience significant reductions in health and health-related quality of life for many years after their injury.

Disasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.

Using a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.

A total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.

Given that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.

It is believed that dopamine resistance sets in within 72–92 hours following therapy. However, in the authors' experience, spinal cord injury patients may require dopamine to maintain blood pressure over several weeks.

This study aims to: (1) assess the incidence and duration of of dopamine dependence in cervical cord injury patients; and (2) find the relation (if any) of dopamine dependent hypotension with outcome of spinal cord injured patients.

This was a prospective, observational study carried out over 2-month period in the neurosurgery intensive care unit (ICU) at JPN Apex Trauma Centre, AIIMS. All cervical spine injury patients who had hypotension during the hospital stay were included in the study. History, clinical findings, requirement of ionotropic support, management, and outcome were recorded for all enrolled subjects.

During the study period 48 patients were admitted with cervical spine injury in the ICU. Of these, 26 patients (54%) had hypotension and were constituted the study group. Eleven patients had complete spinal cord injury (power 0/5) and 15 patients had incomplete spinal cord injury. Twenty-four patients were on ventilator support and two were on oxygen masks. The mean dose of dopamine which the patient receives during the treatment was 7.5 mcg/kg/min with the maximum and minimum doses of 20mcg/kg/min and 2 mcg/kg/min. The mean duration of dopamine support was 17 days (Range 6–48 days). Eight patients (31%) required intermittent dopamine support and 18 patients (70%) required continuous support. The in-hospital mortality was 61% (n = 16). Mortality was significantly lower in patients who received intermittent ionotropic support as compared to those who required continuous ionotropic support (p < 0.01).

The patients with spinal cord injury are dependent on dopamine throughout their recovery period. The patients who required intermittent ionotropic support had significant better outcome compared to those who required continuous ionotropic support.

Emergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.

Emergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.

Data collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.

The implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.

Developing world disaster Health research - Present Evidence & future priorities

Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. The existing & available evidence on disasters in peer-reviewed journals about the developing world, was examined for quality and quantity in this systematic review.

The free PubMed database was searched using the MeSH (Medical Subject Heading) terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ and ‘conflict’ and then refined using the MeSH terms ‘developing country’. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation & region of the study.

Citations using MeSH search terms ‘disasters’, ‘disaster medicine, ‘rescue work’, ‘relief work’ & ‘conflict’ yielded 63,196 results. After these results were refined using the second MeSH term “developing country”, 438 articles were retained. Less than 1% (0.69%) citations in PubMed dealt with developing country disasters. Half of the manuscripts (46.5%) were found to be original research articles (36.1%) or reviews (10.4%), while more than a quarter (29.5%) were commentaries. 97.4% (149/153) of all ‘original research articles’ were Level IV or V evidence. A fifth (20.3%) of the authors of all manuscripts on developing world disasters were from the developing world (82/404); Predominant themes (29.1%) were missions, healthcare provision and humanitarian aid during the acute phase of developing world disasters.

Less than 1% of all disaster-related publications are about developing world disasters. Also, the developed world, authors four-fifths of the articles about developing world disasters, and contributes the predominant perspective. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters, than short-term humanitarian aid missions to the developing world.

To describe the demographics, mechanism, pattern, and severity of injury, prehospital and hospital care (first 24 hours) and the patient outcome in severely injured children in a NICU. This study was made to complete the study of Swedish children admitted to a paediatric intensive care unit (PICU) due to major trauma in the same region and during the same period.

The medical records of 124 traumatized children (0–16 years of age), admitted to the NICU in Gothenburg 1992–2001, were retrospectively examined. The Injury Severity Score (ISS), Glasgow Paediatric Coma Scale (GSC), Revised Trauma Score (T-RTS/RTS), Paediatric Trauma Score (PTS), Trauma Score Injury Severity Score (TRISS) and Paediatric Risk of Mortality Score (PRISM) estimated the severity of injury.

About 7/100 000 children with severe injuries were admitted to the NICU each year from 1992–2001 inclusive. Epidemiology showed a similar pattern as in other OECD countries. Severity of injury was recorded as an ISS median of 17. Mortality rate in our series was 6%.

Major trauma with admission to a NICU is rare in Swedish children. With management in conjunction with a pediatric centre, these children have a good survival rate.

To study advantages of external fixation in severe injuries of extremities in children.

305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.

Sets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.

The usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.

To describe results of experience in providing surgical aid to children in technological and natural disasters in various countries of the world: Haiti, Algeria, Armenia, Afganistan (three times), Georgia, Egypt, Russia, Indonesia (twice), Iran, Pakistan, India, Japan, Gaza strip, Chechnya, and Yugoslavia.

The Russian specialized team consisting of highly qualified pediatric specialists (traumatologists, neurosurgeons, plastic surgeons, specialists in wound treatment, anaesthesiologists-reanimatologists and others if necessary) work at local hospitals in the disaster zone. All of them work as volunteers. The most serious pediatric victims were concentrated in one or two regional hospitals. The volunteer specialists work on a twenty-four hour basis together with local doctors. Every day they examine patients, control wound bandaging, and perform surgeries. For long tubular bone fractures metalosteosynthesis is used. Modern techniques are used for Crush syndrome and for extended and purulent wounds (water-based ointments, early autoplasty). Currently, the main difficulty in many cases is primary treatment of extensive wounds with their complete closure and the many indications for amputations. Conservative and sparing techniques are not often used.

Pediatric victims in technologic and natural disasters must be helped by pediatric specialists. Our experience in the countries to which we have responded have revealed that there are not enough local specialists who can provide highly professional aid to children. There is no known coordinating structure in the world to efficiently organize specialized pediatric help to children in disasters and wars.

Sleep disturbances are common symptoms during the immediate and long-term aftermath of exposure of traumatic events. While stress affects sleep in all age groups, due to differences in physiological, psychological, and socio-behavorial risk factors, the clinical management of pediatric patients with sleep disturbances post-disaster might be different. This study aims to systematically review scientific literature on the clinical management of pediatric sleep disturbances post-disaster and its clinical implication in developing countries. Methods: A keyword-based, systematic review was conducted for scientific publication in academic and disaster literature databases (Medline, PUBMED, Academic Search Premier, Google Scholar, ELDIS, PsycINFO, PILOTS and RELIEFWEB) until October 2010. Abstracts of all the hits were inspected to remove non-relevant articles, and all relevant articles were reviewed and scored by two reviewers to determine relevancy before being included in the final study database. Quality, relevance, and applicability of the reported literature were examined critically with the EBM level of evidence and EPPHPPQ (2003) assessment tool.

The literature disproportionally emphasized the clinical effects and psychological impacts of traumatic events on pediatric patients, and most reported studies were reported as a subset within PTSD study literature. Management of younger children, gender differences, clinical effectiveness of cross-disciplinary management modalities, and experiences in middle- and low-income countries were extremely limited. While principles of sleep hygiene and clinical guidelines for management of adult sleep disturbance are available, the application of clinical effectiveness and appropriateness of these guidelines in pediatric population must be examined further.

Currently, there is limited literature on the acute management of pediatric sleep disturbances post-disaster in developing countries. Evidence-based studies are needed to identify the appropriate clinical approaches to support the pediatric population with sleep disturbances post-disaster.

Limited information is available on the health outcomes of the rural older population in developing countries is affected by disasters. In October 2010, Hainan Province experienced severe flooding following heavy rains. Nearly four million people were affected and many had undergone resettlement. This study investigated the impacts of the flooding on people living in the disaster-affected rural communities. The findings were compared with baseline information collected in 2010 about health issues in rural villages in Hainan. Health outcome comparisons also were made between ethnic groups (Han versus Li).

A two-stage cluster-sampling, cross-sectional post-disaster study was conducted. The entire Hainan Island was categorized into ranks of different severity in rainfall amount and associated damage in October (most severe, intermediate, least severe). The county with the most rainfall and the most severe ranking and the one with least rainfall and the least severe ranking were identified. In each county, one Han and one Li village were chosen by using a computer-generated random number, so four villages were sampled in total. More than 100 individuals ≥ 50 years of age were interviewed by face-to-face survey. Data on disaster-related injuries, socio-demographic information, non-communicable disease, lifestyle, and mental health were collected.

Findings indicated the severity of impact was associated with self-reported health outcomes of older population. Gender and ethnic differences were found in reported health outcomes. Predictors of adverse post-disaster health outcomes in older populations in rural communities were identified.

The results demonstrated significant differences in the impacts of flooding in rural populations. Targeted services and interventions should be planned to address the disparity and meet the physical and mental health needs post-disaster.