On January 12th 2010 an earthquake of 7.0 magnitude struck Haiti. The region suffered an estimated 230,000 fatalities with approximately 250,000 injured and more than one million people who lost their houses. The government of Israel dispatched a military task force consisting of 230 people. 121 of them were medical personnel from the IDF Medical Corps. The force's primary mission was to establish a field hospital in Haiti and to give medical support to as many people as possible. We left Israel about 50 hours after the Earthquake and the field hospital started operating at Porte-Au-Prince 89 hours after the earthquake.

During our 10 days of operating, 1111 patients were treated at our hospital. 363 of them were pediatric patients (younger than 18 years). 272 pediatric patients were treated by the pediatric division, 79 (29%) were hospitalized and 57 (21%) required surgery.

There were 16 deliveries, 5 Neonates, 244 Operations and 17 Intra-hospital deaths. We noticed a change of pattern of the hospital activity, regarding the cause of the admission after the sixth day. On the ninth day most of the patients who came to our hospital were due to a non-traumatic cause. At the pediatric department, the common treatments included wound debridement and dressing, I.V. rehydration and antibiotic treatment, and a neonatal unit, the sole one in the inflicted area. Operations when needed were done by the orthopedic team and the pediatric surgeon.

Operating a field hospital for a population inflicted by natural disaster is a complex mission and since pediatric care has its own unique, challenging characteristics, operating a pediatric division in such a field hospital is a continuous challenge, which includes preparedness in uncertainty and the necessity to have dynamic treatment strategy according to the unique circumstances.

During 2008 Russian Federation realized major aggression against its direct neighbor, the sovereign republic of Georgia. It was Russia's attempt to crown its long time aggressive politics by force, using military forces. EMS physicians from Tbilisi went to the Gori district on August 8 at first light, 14 brigades were sent. At noontime of August 8, their number was increased up to 40. 6 brigades of disaster medicine experts joined them as well.

Destination site for the beginning was the village Tkviavi, where a military field hospital was assembled and a Military Hospital in Gori. Later 6 brigades were withdrawn towards the village Avnevi. During fighting, wounded victims were evacuated from the battlefield, where initial triage was done. Evacuated victims were brought to the military hospital where the medical triage, emergency medical care and transportation to Gori military hospital or to Tbilisi hospitals was done. A portion of the wounded was directly taken to Gori military hospital and later to different civil hospitals in Tbilisi. Corpses were transported to Gori morgue as well. On August 9, the emergency care brigades and field hospital left Tkviavi and moved to the village Karaleti, then to Gori. On August 12, the occupied territory was totally evacuated by civil and military medical personnel. Although withdrawal of wounded was done on following days. Up to 2232 military and civil persons were assisted by EMS brigades during war period (8–12 August), from them 721 patients were transported among which 120 were severely injured.

Close collaboration between military and civil EMS gave the system opportunity to work in an organized manner. On the battlefield prepared military rescuers were active taking out wounded victims to the field or front-line hospitals from which civil emergency care brigades transported them to Tbilisi hospitals. Only 3 fatalities occurred during transportation.

The experiences Afghan medical personnel gained from the “Emergency Care for Trauma” course are described in this presentation.

The course was conducted 14–15 April, 2010 in Kabul, Afghanistan. It was evaluated retrospectively for: (1) course curriculum; (2) training instructors; (3) participant characteristics; (4) participant evaluations and course of events; (5) preparation; (6) execution; and (7) results.

The course included 13 hours of theoretical discussion, six hours of skill practice stations, and 19 hours of training. The organization committee was composed of a president, two secretaries, six trainers, and six assistant trainers. There were three language interpreters. A total of 24 medical personnel attended the course. Pre- and post-tests were administered to the participants in order to evaluate the effectiveness of the course. Simultaneous translation was performed during the training sessions. The correct response rates for test questions increased from 34.6% prior to the course, to 80.3% after the course. At the end of course, reviews from the participants were discussed.

The participants suggested that the course should be repeated every six months. It was decided that there should be more time for the practical portion of the course. It was determined that the course would be integrated into the Afghan health system.

Post-graduate courses are important components of the modern health care system. In many developed countries, these courses have become compulsory and are conducted regularly. However, standardized and regularly performed courses should be supported in developing countries.

The January 12 2010 7.0-magnitude earthquake's epicenter hit just 10 miles west of Porte-au-Prince and its 2 million inhabitants at 4:53 pm.

Although assistance arrived to major ports and cities from all corners of the globe, access from rural and remote areas to centralized hospitals remained difficult. Many of the injured were without access to transportation even a month after the earthquake. Earthquake victims in remote areas have less access to wound care and running water, and therefore more pone to infection and tetanus.

Our group was comprised of a civilian mobile medical team able to negotiate difficult terrain by foot with vehicle support provided by the 82nd Airborne military. The military support supplied vehicles and experience needed to tackle the difficult terrain. Because the vaccines are temperature sensitive, delivery of them to remote areas with long travel times in hot climates is logistically difficult and requires coordination. In order to assure vaccines would not be wasted, they were picked up from the WHO the morning of deployment and stored in coolers without direct contact with ice. An advance team would arrive to the target site first to coordinate with local community leaders and gather patients with tetanus prone wounds in a central area. A second team would transport the amount of vaccine needed as estimated by the advance team.

Our group vaccinated approximately 300 people without access to the centralized hospitals per day using this system, with no vials of vaccine wasted or spoiled.

Heat stress is an occupational hazard for all personnel requiring Personal Protective Equipment (PPE). Even “breathable PPE” increases measurable heat stress in active troops and surgical personnel. A novel negative-pressure, semipermeable surgical cooling vests for use in the operating theater was jointly developed by Mountain Laurel Biomedical, Hamilton Sundstrand, and Hartford Hospital.

Surgical personnel alternated between wearing cooling garment vs no cooling under their surgical gowns (PPE) during surgical procedures lasting up to several hours. Tympanic temperatures were monitored for safety. A questionnaire was completed after the conclusion of surgery to assess perception of comfort. Trials began at ∼18 deg C, but ambient temperature was increased to 24 deg C (40–50% RH) for the third series of trials. Results: The study was terminated prematurely. After wearing the cooling vest, surgeons refused to complete additional control trials due to the heat. They demanded to use the cooling device for all surgery, even outside the protocol! Vest wearers remained dry and reported a statistically significant (p < 0.0001) greater level of comfort compared to control subjects. The weight, fit, and mobility restriction of the vest was not clinically significant.

Active cooling and drying using a negative pressure cooling vest improves subjective thermal comfort with minimal perceived impact on mobility during surgical procedures. This technology may have utility in other fields that utilize PPE. The Chemical Biological Warfare (CBW) ensemble, in particular, is a promising candidate. Heat stress from PPE ensemble even if “breathable” -Cooling at ∼100 watts with 18 deg C water -Semipermeable membrane allows condensation removal. Wearer stays cool and dry. -Negative pressure prevents coolant loss if punctured -Minimal perceived restriction of shoulder, neck, and waist range of motion - Light weight ∼1.5 lbs. (0.68 kg) - Quick disconnects allow options for cooling source.

The increasing threat of the use of chemical, biological, radiological, and nuclear (CBRN) agents requires significant military medical preparedness and response, including training. The initiatives for CBRN training by Gulhane Military Medical Academy, which is under the Health Command of the Turkish Armed Forces, will be discussed, and the training program and educational model for medical CBRN defense will be highlighted.

The training is given to military hospital staff once or twice a year. Hospital staff is trained over a period of five days, with practical issues regarding medical CBRN defense covered during the last two days. A questionnaire is given to trainees at the beginning and at the end to ascertain the adequacy of the course.

So far, this medical CBRN training has been given to 150 military health staff including physicians, nurses, and medical non-commissioned officers. According to the survey, they benefited greatly from this training, and there was a statistically significant increase in CBRN knowledge when the initial and final scores of the survey were compared (x2 = 3.089; p = 0.002).

Through this planned trainings, staff are trying to become well-trained in detection, personal protection, decontamination, and the organization aspects of CBRN defense to apply the proper prophylactic measures, diagnosis, and treatment. Feedback suggests this program also helped “train the trainers”, providing extensive information to other staff working in military hospitals.

Chemical, biological, radiological and nuclear (CBRN) cases are seen as an increasing risk because of the increasing threat of international terrorism. Decontamination is one of the basic components of the intervention for CBRN exposure. The introduction portable decontamination unit in the hospital setting is described in this presentation.

The general properties, facilities, and capabilities of the portable decontamination unit, which is present in the GATA CBRN Department of the Turkish Armed Force's Health Command, were evaluated.

The portable decontamination unit in the hospital has a metal frame that is 54 m2 wide. It is composed of two tents that weigh about 300 kg. The metal frame, metal legs, and tent cloth are stored in carrying bags. Four people can construct the tents in 10 minutes. An educated squad of four people can prepare the decontamination system and instructions in 25–30 minutes. The unit consists of two lines: one for outpatients and another for inpatient decontamination, which includes a rail system. Each decontamination line contains an undressing, shower, and dressing section.

Along with metal-framed decontamination tents, there also are inflatable tents. The inflatable decontamination units can be pitched in 5–7 minutes by an electrical air compressor. Metal-framed tents are easy to carry, as the frame, metal legs, and tent cloth are stored in carrying bags. By pitching the decontamination tent on a smooth ground in front of the hospital entrance, decontamination of patients can be completed before they reach the hospital. Another decontamination unit is in place next to the emergency department.

Terrorist attacks that result in mass casualties demonstrate the importance of CBRN preparedness. A decontamination unit and an appropriate CBRN preparedness plan should be constituted into the basic treatment system.

The world must be resilient against major disasters, whether they are caused by natural hazards or human-related mechanisms. Nowadays, outbreaks of emerging infectious diseases, such as new strains of influenza, are a world wide problem. Special consideration is necessary against chemical, biological, radiological, or nuclear (CBRN) hazards.

The hardware/mechanical preparedness, measurements of the severe influence in mental/psychological aspects, official public system, incident command system, public education system, and the needs of vulnerable populations should be established prior to a disaster. It is also important to prepare the necessary medical resources. The technical skills needed for triage, emergency care, and appropriate transportation should be trained for.

Measures should be prepared both from the macroscopic viewpoint as well as microscopic approach. A “Disaster Medicine Compendium” consisting of 20 volumes with more than 5,000 pages, was developed in 2005. Currently, a new version is being prepared.

Poisoning is a public health problem that effects all ages, genders, and ethnicities, but certain populations are at increased risk. Unintentional poisoning disproportionately affects lower- and middle-income countries. The epidemiological pattern of poisoning can differ significantly within countries. In Thailand, national poisoning data is collected by voluntary reporting to a poison control center in the capital, Bangkok. Limited poisonings are reported from Chiang Mai, a province in Northern Thailand, though it has the highest suicide rate in the country.

The aim of this study is to describe poisoning epidemiology, examine differences between intentional and unintentional poisonings and, to develop a multivariate predictive model of intentional poisonings in Northern Thailand.

A total of 550 poisoning admissions were identified at Chiang Mai's University Hospital from 01 January 2005 to 31 December 2005. Demographic data were collected retrospectively by manual chart review. Chi-square and t-tests were used to examine differences in poisoning by intent. A step-wise logistic regression analysis was performed to develop a predictive model of intentional poisonings. Factors significantly associated with intentional poisoning were used in a logistic progression model to identify predictors of intentional poisoning.

Younger age was significantly associated with intentional poisoning. There was no demonstrated difference in gender and poisoning intent. Predictors of intentional poisonings were use of chemical agents, high-risk medications (analgesics and psychiatric), unemployment, and younger age.

Interventions should focus on factors that put young adults and the unemployed at greater risk for intentional poisonings. Further interventions are also needed to limit access to potentially lethal doses of chemical agents and high risk medications.

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.

Members of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.

New York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.

Providing surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.

On 11 June 2009, an Influenza A (H1N1) pandemic was declared by the World Health Organization (WHO). The Major Medical Incident Regional Command and Control Protocol in the County Council of Östergötland, Sweden was activated. After vaccinations were competed, it was decided that the operation should be evaluated in a retrospective study. This study aims to increase knowledge regarding regional management of a pandemic flu.

All protocols from regional command meetings were studied together with central data regarding, logistics, vaccination site reports, incident reports, and all written correspondence between involved departments. Information from results of a questionnaire that was distributed to all vaccination site managers were summarized and studied. In addition, an interview was performed with the chief of medical operations.

Out of the approximately 426,000 inhabitants of the county, a total of 224,780 (53%) were vaccinated during a five and a half month period. The mean pace was 1,246 vaccinated per day (range 0–9643). Regional command had 41 recorded meetings resulting in a collected number of about 740 working hours. Three hundred sixty-six employees were involved in the vaccination, working 38,741 hours. Twenty-eight safety and 52 security incidents were reported. Uncertainty about vaccine delivery and keeping the public's interest were reported to be of concern for the management.

Even with the large scale of the operation, there were only a few security and safety issues. Although the goal of vaccinating 75–80% of the inhabitants was not reached, it could be assumed that the pandemic was dampened. Given the public's high initial interest, it could be considered that vaccination should not start until a large number of doses have been delivered.

The medical incident command structure and protocol successfully can be adapted to a mass vaccination event. Information from the Östergötland County Council operation yielded significant experience for future mass vaccinations.

India has witnessed many major infectious public health emergencies (PHE) during 21st century. They include outbreaks of Severe Acute Respiratory Syndrome (SARS) 2002–03, avian flu in 2006, chikungunya in 2006–07, and the H1N1 pandemic in 2009. Periodic dengue and Japanese Encephalitis epidemics also are common. The premier institute of the country, PGIMER Chandigarh, always has received a huge inflow of patients from North India during such emergencies. These patients pose special challenges to hospital administration in terms of effective and efficient management of crisis situation, and require special measures. The authors' experience has shown that the major challenges faced are allocation of scares resources, capacity building, motivation of employees, infection control, and inter-sectoral coordination. The response during the initial phase is erratic due to a lack of clear guidelines and prior preparedness. Learning from these experiences, a contingency plan was prepared after consultation with all stakeholders. It was implemented during 2009 influenza pandemic. The contingency plan identifies: (1) area responsibilities; (2) disaster and screening areas for the handling of patients; (3) isolation and critical care facilities; (4) deployment of manpower; (5) allocation of drugs, consumables, equipment, and sterile supplies; (6) communication and reporting system; (7) awareness, education, and training; and (8) decision-making hierarchy and effective inter-sectoral collaboration. Also, a disaster plan has been prepared that includes standard operating procedures (SOPs) to be followed during infectious PHEs. A hospital infection control manual also has been prepared to address the issue of hospital acquired infections. The contingency plan and SOPs were effective during recent 2009 influenza pandemic in streamlining the response.

A well-documented contingency plan prepared in consultation with concerned stakeholders and implemented by a motivated and committed administration is essential in ensuring uninterrupted services during PHEs. It emphasizes that sound PHE plan is never an accident; it is always a result of high intentions, sincere efforts, intelligent direction, and skillful execution.

In this study, the mean daily and annual radiation exposure of the radiology department staff, other hospital health staff, and public volunteers was compared at Maresal Cakmak Military Hospital in Erzurum, Turkey.

The NEB.211 Dose–Rate Meter with a Gaiger–Müller counter was used to measure the amount of radiation. Six radiology department health staff carried the NEB.211 device during seven working hours. At the end of the day, total absorbed dosages were noted. The same measurements were also done for the six health staff of the other departments and six non-hospital volunteers. Seventeen additional hours were noted for the non-hospital volunteers. The mean value of 17 hours of daily measurements (3.31 mSv) was added to the both group's working hours measurements and the total daily radiation amounts were calculated.

There was no statistical difference between each three groups in working hours (p = 0.087), daily and annual equivalent dosages (for both p = 0.099).

The radiology department health staff was exposed to radiation under the border of equivalent dosage which is determined by Turkish Automic Energy Authority. Public volunteers were seen as they were exposed the radiation over the determined border of equivalent dosage. Nonetheless, with changes depending on living standards, the physical properties of living spaces and geographical circumstances per capita exposed annual dosage is about 2.4–2.8 mSv throughout the world. There was no significant statistical difference between the amounts of equivalent dosage which were exposed to the radiology department health staff, the other hospital staff and public members.

The European Center for Disease Control and Prevention (ECDC) identified young children as a group at higher risk of developing severe pandemic influenza A (H1N1) 2009 infection compared with the general population. Since children have high attack rates and seem essential in augmenting local outbreaks of influenza, vaccination of children was an important objective in the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign. Children < 13 years of age were recommended to take two doses of the pandemic vaccine (Pandemrix®).

The objective of this study was to compare the vaccination coverage among children 1–12 years of age in different councils in the County of Jämtland, Sweden that either implemented an active advocating or a passive vaccination strategy. The active strategy included direct information to parents promoting vaccination, individual appointments, collaboration between different care providers, and visits of vaccination teams to day care centers and schools, whereas no specific measures, except general information in press and media, were undertaken in councils using a passive approach.

All pandemic vaccinations in the County of Jämtland were registered in a Web-based registration software system. Vaccine coverage was determined by comparing the actual number of children residing in different councils with the number of vaccinated children.

A total of 4,162 of 6,000 children (69.3%) residing in councils using an active vaccination strategy were vaccinated compared with 5,059 of 9,373 children (53.9%) living in councils using a passive vaccination strategy (p < 0.0001)

Implementation of an active advocating vaccination strategy during the Swedish pandemic influenza A (H1N1) 2009 vaccination campaign resulted in a significantly higher vaccination coverage rate compared with a passive vaccination strategy.

Community Health Centers (CHCs) constitute the secondary level of health in India. However, these centers are fulfilling the tasks entrusted to them only to a limited extent. In order to provide quality care in these CHCs, Indian Public Health Standards (IPHS) are being prescribed to provide optimal expert care to the community and to maintain an acceptable standard of quality of care. These standards would help to monitor and improve the functioning of the CHCs.

The aim of this study is to apply the IPHS for evaluation of the CHCs of Rajasthan.

A cross-sectional observational study was conducted during August to October 2010. Four CHCs of Rajasthan were visited and data were collected in a pre-designed Performa. The quality of services provided in the selected CHCs as per the IPHS norms was assessed.

All the four CHCs were rendering the assured services of the outpatient department, 24-hour general emergency services, new born care, normal delivery, and referral (transport). All CHCs had full-time physicians, but only three (75%) had surgeons and obstetricians, two (50%) CHCs had pediatricians. One (25%) had anesthetists and one (25%) had a program manager. There was a blood storage facility at one (25%) CHC. Nursing staff were adequate. Basic laboratory facilities were available in all CHCs.

The present study revealed important deficiencies as per IPHS norms in the studied CHCs so that adequate measures can be taken to improve the healthcare facility.