Conflict in the South Caucasus’ Nagorno Karabagh region has damaged health facilities and disrupted the delivery of services and supplies as well as led to depletion of human and fixed capital and weakened the de facto government's ability to provide training for health care providers.

In response to documented medical training deficits, the American University of Armenia organized a first aid training course (FATC) for primary health care providers within the scope of the USAID-funded Humanitarian Assistance Project in Nagorno Karabagh. This paper reports the follow-up assessments conducted to inform policy makers regarding FATC knowledge and skill retention and the potential need for periodic refresher training.

Follow-up assessments were conducted six months and 18 months following the FATC to assess the retention of knowledge, attitudes, and self-reported practices. Eighty-four providers participated in the first follow-up and 210 in the second. The assessment tool contained items addressing the use and quality of the first aid skills, trainee's evaluation of the course, and randomly selected test questions to assess knowledge retention.

At both follow-up points, the participants’ assessment of the course was positive. More than 85% of the trainees self-assessed their skills as “excellent” or “good” and noted that skills were frequently practiced. Scores of approximately 58% on knowledge tests at both the first and second follow-ups indicated no knowledge decay between the first and second survey waves, but substantial decline from the immediate post-test assessment in the classroom.

The trainees assessed the FATC as effective, and the skills covered as important and well utilized. Knowledge retention was modest, but stable. Refresher courses are necessary to reverse the decay of technical knowledge and to ensure proper application in the field.

ThompsonME, HarutyunyanTL, DorianAH. A First Aid Training Course for Primary Health Care Providers in Nagorno Karabagh: Assessing Knowledge Retention. Prehosp Disaster Med. 2012;27(6):1-6.

Quantitative benchmarking of trauma-related prehospital response for Multiple Casualty Events (MCE) is complicated by major difficulties due to the simultaneous occurrences of multiple prehospital activities.

Attempts to quantify the various components of prehospital medical response in MCE have fallen short of a comprehensive model. The objective of this study was to model the principal parameters necessary to quantitatively benchmark the prehospital medical response in trauma-related MCE.

A two-step approach was adopted for the methodology of this study: an extensive literature search was performed, followed by prehospital system quantitative modeling. Studies on prehospital medical response to trauma injuries were used as the framework for the proposed model. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for the study.

Two parameters, the Injury to Patient Contact Interval (IPCI) and Injury to Hospital Interval (IHI), were identified and proposed as the principal determinants of the medical prehospital response in trauma-related MCE. IHI is the time interval from the occurrence of injury to the completion of transfer of care of critical (T1) and moderate (T2) patients. The IHI for each casualty is compared to the Maximum Time Allowed described in the literature (golden hour for T1 and Friedrich's time for T2). In addition, the medical rescue factor (R) was identified as the overall indicator for the prehospital medical performance for T1 and T2, and a numerical value of one (R = 1) was proposed to be the quantitative benchmark.

A new quantitative model for benchmarking prehospital response to MCE in trauma-related MCE is proposed. Prospective studies of this model are needed to validate its applicability.

Bayram J, Zuabi S. Disaster metrics: a proposed quantitative model for benchmarking prehospital medical response in trauma-related multiple casualty events. Prehosp Disaster Med. 2012;27(2):-7.

Firefighters are often exposed to stressful duty-related events and may experience extreme trauma. Such work-related stress can result in posttraumatic stress disorder (PTSD). It is therefore important to understand the traumatic stress experienced by firefighters in the course of their work and to promote appropriate intervention when necessary.

Data were collected from 118 workers (all males) in the Fire Department of Akita City, Japan who had participated in the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai) rescue effort from March 11 through March 31, 2011. Study participants completed self-report surveys at three time intervals: shortly after return from the rescue effort, approximately two weeks after return from the rescue effort, and approximately one month after return from the rescue effort. The surveys included questions of demographics, physical complaints, medical history, and the Impact of Event Scale-Revised (IES-R) Japanese version, in which a cut-off point of 24/25 was set to screen for PTSD.

A total of 117 participants undertook the initial survey with a range of 0-36 points obtained on the IES-R score. For the initial survey, two of 117 participants scored ≥25 points. For the intermediate survey phase, a range of 0-19 was obtained for 116 participants and for the final survey phase, a range of 0-11 points was obtained for 114 participants.

Contrary to expectations, the survey results showed no participant was judged to require prompt consultation for PTSD. The firefighters who participated in this study were in good mental health. However, more detailed study is required to ascertain whether these findings adequately and clearly reflect the mental health status of these participants.

FushimiM . Posttraumatic Stress in Professional Firefighters in Japan: Rescue Efforts after the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai). Prehosp Disaster Med.2012;27(5):1-3.

The interaction between the acute medical consequences of a Multiple Casualty Event (MCE) and the total medical capacity of the community affected determines if the event amounts to an acute medical disaster.

There is a need for a comprehensive quantitative model in MCE that would account for both prehospital and hospital-based acute medical systems, leading to the quantification of acute medical disasters. Such a proposed model needs to be flexible enough in its application to accommodate a priori estimation as part of the decision-making process and a posteriori evaluation for total quality management purposes.

The concept proposed by de Boer et al in 1989, along with the disaster metrics quantitative models proposed by Bayram et al on hospital surge capacity and prehospital medical response, were used as theoretical frameworks for a new comprehensive model, taking into account both prehospital and hospital systems, in order to quantify acute medical disasters.

A quantitative model called the Acute Medical Severity Index (AMSI) was developed. AMSI is the proportion of the Acute Medical Burden (AMB) resulting from the event, compared to the Total Medical Capacity (TMC) of the community affected; AMSI = AMB/TMC. In this model, AMB is defined as the sum of critical (T1) and moderate (T2) casualties caused by the event, while TMC is a function of the Total Hospital Capacity (THC) and the medical rescue factor (R) accounting for the hospital-based and prehospital medical systems, respectively. Qualitatively, the authors define acute medical disaster as “a state after any type of Multiple Casualty Event where the Acute Medical Burden (AMB) exceeds the Total Medical Capacity (TMC) of the community affected.” Quantitatively, an acute medical disaster has an AMSI value of more than one (AMB / TMC > 1). An acute medical incident has an AMSI value of less than one, without the need for medical surge. An acute medical emergency has an AMSI value of less than one with utilization of surge capacity (prehospital or hospital-based). An acute medical crisis has an AMSI value between 0.9 and 1, approaching the threshold for an actual medical disaster.

A novel quantitative taxonomy in MCE has been proposed by modeling the Acute Medical Severity Index (AMSI). This model accounts for both hospital and prehospital systems, and quantifies acute medical disasters. Prospective applications of various components of this model are encouraged to further verify its applicability and validity.

Bayram JD, Zuabi S. Disaster metrics: quantification of acute medical disasters in trauma-related multiple casualty events through modeling of the Acute Medical Severity Index. Prehosp Disaster Med. 2012;27(2):1-6.

Dialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear.

The impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated.

Data from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations.

The rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics.

Hospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.

Howard D, Zhang R, Huang Y, Kutner N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):1-5.

The objective of this study was to determine the resource utilization of a tertiary care Japanese emergency department (ED) that was not immediately adjacent to the area of the 2011 Great East Japan earthquake and tsunami.

A retrospective chart review was performed at a tertiary care university-based urban ED located approximately 290 km from the primary site of destruction secondary to an earthquake measuring 9.0 on the Richter Scale and the resulting tsunami. All patients who presented for a period of twelve days before and twelve days after the disaster were included. Data were collected using preformed data collection sheets, and stored in an Excel file. Abstracted data included gender, time in the ED, intravenous fluid administration, blood transfusion, oxygen, laboratories, electrocardiograms (ECGs), radiographs, ultrasound, diagnoses, surgical and medical referrals, and prescriptions written. Ten percent of the charts were reviewed for accuracy, and an error rate reported. Data were analyzed using 2-tailed t-tests, Fisher's exact tests or rank sum tests. Bonferroni correction was used to adjust P values for multiple comparisons.

Charts for 1193 patients were evaluated. The error rate for the abstracted data was 3.2% (95% CI, 2.4%-4.1%). Six hundred fifty-seven patients (53% male) were evaluated in the ED after the earthquake, representing a 23% increase in patient volume. Mean patient time spent in the ED decreased from 61 minutes to 52 minutes (median decrease from 35 minutes to 32 minutes; P = .005). Laboratory utilization decreased from 51% to 43% (P = .006). The percentage of patients receiving prescriptions increased from 48% to 54% (P = .002). There was no change in the number of patients evaluated for surgical complaints, but there was an increase in the number treated for medical or psychiatric complaints.

There was a significant increase in the number of people utilizing the ED in Tokyo after the Great East Japan earthquake and tsunami. Time spent in the ED was decreased along with laboratory utilization, possibly reflecting decreased patient acuity. This information may help in the allocation of national resources when planning for disasters.

ShimadaM, TanabeA, GunshinM, RiffenburghRH, TanenDA. Resource Utilization in the Emergency Department of a Tertiary Care University-Based Hospital in Tokyo Before and After the 2011 Great East Japan Earthquake and Tsunami. Prehosp Disaster Med. 2012;27(6):1-4.

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved.

A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences.

AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program.

The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

StokesNA , ScapigliatiA , TrammellAR , ParishDC . The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations. Prehosp Disaster Med.2012;27(5):1–6.

A principal strategy for the integration of mental health and psychosocial support in emergency settings is the training of front-line workers in international consensus-based guidelines.

This paper presents a pilot study evaluating changes in knowledge and understanding as a result of a brief training course in Nepal.

Evaluation questionnaires were distributed to participants in two-day courses (n = 109) before, directly after, and at two months following completion.

The course resulted in a post-training increase in correct answers of 21%, which further increased to 25% at two months.

A short training course based on widely endorsed guidelines to front-line staff can significantly increase mental health literacy for complex emergencies. While promising, the trend of knowledge gain is modest at most, and suggests a need for more intensive or more targeted training courses.

Jordans MJD, Luitel NP, Poudyal B, Tol WA, Komproe IH. Evaluation of a brief training on mental health and psychosocial support in emergencies: a pre- and post-assessment in Nepal. Prehosp Disaster Med. 2012;27(3):1-4.

Road traffic accident (RTA) is a common cause of pediatric trauma death and disability, constituting a worldwide loss of financial resources and potential manpower. This study was designed to determine the causes, prehospital care, presentation, and injuries that resulted in deaths among pediatric victims of RTA in Nigeria, and to make suggestions, based on the study data, to reduce RTA deaths.

This is a retrospective analysis of pediatric RTA presenting to a Nigerian referral center. The records of all pediatric RTA between January 2006 and December 2010 at the University of Benin Teaching Hospital were analyzed for age, gender, causes of death, injury, rescue team prehospital treatment, injury to hospital arrival time, clinical condition on arrival, treatment, duration of hospitalization before death, challenges, and postmortem findings.

Twenty-six (18%) of 143 pediatric RTA, comprising 18 males and 8 females, between less than one and 18 (mean 9.3 ± 5.2) years of age died. There was no significant statistical demographic difference observed when 15 (58%) deaths recorded among 67 (46.9%) children involved in motor vehicle accidents were compared with 11 (42%) involved in 76 (53.1%) motorcycle accidents (P = .31). More severe injuries resulting in the majority of deaths were associated with alcohol intoxication (P < .0001). Fourteen (54%) of the deaths were pedestrians, eight of whom were selling wares on the roadside; six were crossing roads that had no traffic signs or traffic control. Of the eight vehicle passengers who died, only two wore seat belts or used pediatric car seats, with no statistical significance compared to those who did not use seat belts or car seats (P = .37). Four of 14 front seat passengers and four of 32 rear seat passengers died (P = .222). Of motorcycle passengers, none of those who wore protective crash helmets died, while four died who were not wearing helmets. Passers-by and sympathizers served as rescuers provided emergency treatment, and presented the victims between one hour and four days after the accidents. Head injury in 14 (54%) cases was the most common cause of death.

Pediatric RTA deaths in this study were due mainly to preventable causes. There is a need to stress road safety education to children, drivers, the general public and government policy formulators, and to adopt RTA preventive measures in this region of Nigeria.

Osifo OD, Osagie TO, Iribhogbe PE. Pediatric road traffic accident deaths presenting to a Nigerian referral center. Prehosp Disaster Med. 2012;27(2):1-6.

The Revised Trauma Score (RTS) has been proposed as an entry criterion to identify patients with mid-range survival probability for traumatic hemorrhagic shock studies.

Determination of which of four RTS strata (1-3.99, 2-4.99, 1-4.99, and 2-5.99) identifies patients with predicted and actual mortality rates near 50% for use as an entry criterion in traumatic hemorrhagic shock clinical trials.

Existing database analysis in which demographic and injury severity data from two prior international Diaspirin Cross-Linked Hemoglobin (DCLHb) clinical trials were used to identify an RTS range that could be an optimal entry criterion in order to find the population of trauma patients with mid-range predicted and actual mortality rates.

Of 208 study patients, the mean age was 37 years, 65% sustained blunt trauma, 49% received DCLHb, and 57% came from the European Union study arm. The mean values were: ISS, 31 (SD = 18); RTS, 5.6 (SD = 1.8); and Glasgow Coma Scale (GCS), 10.4 (SD = 4.8). The mean TRISS-predicted mortality was 34% and the actual 28-day mortality was 35%. The initially proposed 1-3.99 RTS range (n = 41) had the highest predicted (79%) and actual (71%) mortality rates. The 2-5.99 RTS range (n = 79) had a 62% predicted and 53% actual mortality, and included 76% blunt trauma patients. Removal of GCS <5 patients from this RTS 2-5.99 subgroup caused a 48% further reduction in eligible patients, leaving 41 patients (20% of 208 total patients), 66% of whom sustained a blunt trauma injury. This subgroup had 54% predicted and 49% actual mortality rates. Receiver operator curve (ROC) analysis found the GCS to be as predictive of mortality as the RTS, both in the total patient population and in the RTS 2-5.99 subgroup.

The use of an RTS 2-5.99 inclusion criterion range identifies a traumatic hemorrhagic shock patient subgroup with predicted and actual mortality that approach the desired 50% rate. The exclusion of GCS <5 from this RTS 2-5.99 subgroup patients yields a smaller, more uniform patient subgroup whose mortality is more likely related to hemorrhagic shock than traumatic brain injury. Future studies should examine whether the RTS or other physiologic criteria such as the GCS score are most useful as traumatic hemorrhagic shock study entry criteria.

Sloan EP, Koenigsberg M, Clark JM, Desai A. The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies: data from the DCLHb clinical trials. Prehosp Disaster Med. 2012;27(4):1-15.

Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners’ acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.

A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.

A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001).

Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.

Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.

Cicero MX, Auerbach MA, Zigmont J, Riera A, Ching K, Baum CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):1-6.

Mobile decontamination units are intended to be used at the accident site to decontaminate persons contaminated by toxic substances. A test program was carried out to evaluate the efficacy of mobile decontamination units.

The tests included functionality, methodology, inside environment, effects of wind direction, and decontamination efficacy.

Three different types of units were tested during summer and winter conditions. Up to 15 test-persons per trial were contaminated with the imitation substances Purasolve ethyl lactate (PEL) and methyl salicylate (MES). Decontamination was carried out according to standardized procedures. During the decontamination trials, the concentrations of the substances inside the units were measured. After decontamination, substances evaporating from test-persons and blankets as well as remaining amounts in the units were measured.

The air concentrations of PEL and MES inside the units during decontamination in some cases exceeded short-term exposure limits for most toxic industrial chemicals. This was a problem, especially during harmful wind conditions, i.e., wind blowing in the same direction as persons moving through the decontamination units. Although decontamination removed a greater part of the substances from the skin, the concentrations evaporating from some test-persons occasionally were high and potentially harmful if the substances had been toxic. The study also showed that blankets placed in the units absorbed chemicals and that the units still were contaminated five hours after the end of operations.

After decontamination, the imitation substances still were present and evaporating from the contaminated persons, blankets, and units. These results indicate a need for improvements in technical solutions, procedures, and training.

RibordyP , RocksénD , DellgarU , PerssonS , ArnoldssonK , EkåsenH , HäggbomS , NerfO , LjungqvistA , GrythD , ClaessonO . Mobile Decontamination Units—Room for Improvement?. Prehosp Disaster Med.2012;27(4):1–7.

The need to manage psychological symptoms after disasters can result in an increase in the prescription of psychotropic drugs, including antidepressants and anxiolytics. Therefore, an increase in the prescription of antidepressants and anxiolytics could be an indicator of general psychological distress in the community.

The purpose of this study was to determine if there was a change in the rate of prescription of antidepressant and anxiolytic drugs following Cyclone Yasi.

A quantitative evaluation of new prescriptions of antidepressants and anxiolytics was conducted. The total number of new prescriptions for these drugs was calculated for the period six months after the cyclone and compared with the same six month period in the preceding year. Two control drugs were also included to rule out changes in the general rate of drug prescription in the affected communities.

After Cyclone Yasi, there was an increase in the prescription of antidepressant drugs across all age and gender groups in the affected communities except for males 14-54 years of age. The prescription of anxiolytic drugs decreased immediately after the cyclone, but increased by the end of the six-month post-cyclone period. Control drug prescription did not change.

There was a quantifiable increase in the prescription of antidepressant drugs following Cyclone Yasi that may indicate an increase in psychosocial distress in the community.

UsherK, BrownLH, BuettnerP, GlassB, BoonH, WestC, GrassoJ, Chamberlain-SalaunJ, WoodsC. Rate of Prescription of Antidepressant and Anxiolytic Drugs after Cyclone Yasi in North Queensland. Prehosp Disaster Med. 2012;27(6):1-5.

The first objective was to examine the outcome of how comfortable a potential EMS-caller would be receiving care from an out-of-hospital-care EMS professional who might have a legal conviction. A second objective was to test for correlates that would explain this outcome.

In the autumn of 2010, a structured phone survey was conducted. To maximize geographical representation across the contiguous United States, a clustered, stratified sampling strategy was used based upon US Postal Service zip codes.

Of the 2,443 phone calls made, 1,051 (43%) full survey responses were obtained. Data cleaning efforts reduced the total to 929 in the final model regression analysis. Results revealed significant public discomfort in receiving care from EMS professionals who may have such a conviction. In addition, respondents who are less educated and older more strongly (1) agree that EMS professionals should have their licenses revoked for wrongdoing; (2) agree EMS professionals should be screened before being hired; (3) perceive EMS credentials to be important; (4) support a lawsuit for improper care; and (5) are collectively less comfortable with being cared for by an EMS professional who may have a legal conviction. Reliable scales were found for future research use.

There is significant public discomfort in receiving care from EMS professionals who may have a legal conviction. The results of this study provide increased impetus for the careful screening of EMS professionals before they are hired or allowed to be volunteers. Beyond this due diligence, the results serve as a reminder for increased EMS provider awareness of the importance of exhibiting professionalism when dealing with the public.

Blau G, Gibson G. Correlates of perceived care comfort with an EMS professional having a legal conviction. Prehosp Disaster Med. 2012;27(4):1-6.

Health registers have been established in the United Kingdom (UK) and elsewhere following mass exposure to novel agents or known agents, but there is no consensus on the criteria for establishing such registers.

This study aimed to develop a decision framework to assess the need for establishing a health register for major chemical, biological, radiological, and nuclear (CBRN) incidents.

The study comprised three stages. In the first stage, the study team prepared a list of potential criteria that may be used to assess the need for setting up a health register based on literature review and personal experiences in previous incidents. In the second stage, the potential criteria were evaluated in two Delphi rounds involving experts and key decision makers from the UK Health Protection Agency (HPA) and academic organizations. In the final stage, the criteria were converted into a decision framework, and its utility was tested using four fictional scenarios.

A total of 11 statements were proposed by the study group. These criteria were revised following feedback from 16 experts in the first Delphi round. All 11 statements achieved consensus at the end of the second Delphi round. Pilot testing of the agreed criteria on four fictional scenarios confirmed validity and reliability for use in the decision process.

A decision framework to assess the need for setting up a health register after a major incident was agreed upon and tested using fictional scenarios. Further areas of work for practical implementation of the criteria and related planning for systems and protocols have been identified.

ParanthamanK, CatchpoleM, SimpsonJ, MorrisJ, MuirheadCR, LeonardiGS. Development of a Decision Framework for Establishing a Health Register Following a Major Incident. Prehosp Disaster Med. 2012;27(6):1-7.

It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters.

As part of a national survey, the present study was designed to evaluate leadership issues and use of standards in Australian DMATs.

Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.

The response rate for this survey was estimated to be approximately 50% (59/118). Most of the personnel had deployed to the Asian Tsunami affected areas. The DMAT members were quite experienced, with 53% (31/59) of personnel in the 45-55 years of age group. Seventy-five percent (44/59) of the respondents were male. Fifty-eight percent (34/59) of the survey participants had significant experience in international disasters, although few felt they had previous experience in disaster management (5%, 3/59). There was unanimous support for a clear command structure (100%, 59/59), with strong support for leadership training for DMAT commanders (85%, 50/59). However only 34% (20/59) felt that their roles were clearly defined pre-deployment, and 59% (35/59) felt that team members could be identified easily. Leadership was identified by two team members as one of the biggest personal hardships faced during their deployment. While no respondents disagreed with the need for meaningful, evidence-based standards to be developed, only 51% (30/59) stated that indicators of effectiveness were used for the deployment.

In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.

Aitken P, Leggat PA, Robertson AG, Harley H, Speare R, Leclercq MG. Leadership and use of standards by Australian disaster medical assistance teams: results of a national survey of team members. Prehosp Disaster Med. 2012;27(2):1-6.

Ensuring a stable Emergency Medical Services (EMS) workforce is a growing concern, and effective recruiting strategies are needed to expose young adults to the EMS profession. The objective of this study was to assess the exposure of high school allied health students to EMS as a career option, as well as measure their attitudes and beliefs about the EMS profession.

Few high school allied health students are exposed to EMS educational and career opportunities.

A convenience sample of allied health students in a rural high school system was surveyed about exposure to EMS, career intentions, factors impacting career decisions, and attitudes and beliefs about EMS. Descriptive statistics were calculated, and intention to pursue an EMS career was modeled using logistic regression.

Of 171 students enrolled in allied health courses across six high schools, 135 (78.9%) agreed to participate; 85.2% were female. Almost all (92.6%) respondents intended to pursue a health career, but only 43.0% reported that their allied health course exposed them to EMS as a profession. Few participants (37.7%) were knowledgeable about EMS associate degree or baccalaureate degree (27.4%) programs. Only 20.7% of the respondents intended to pursue EMS as a career, although 46.0% wanted to learn more about the profession. Most (68.2%) students expressed interest in an emergency medical technician (EMT) course if one were offered, and 80.0% were interested in a ride-along program. Independent predictors of pursuing an EMS career included exposure to EMS outside of high school (OR = 7.4, 95% CI = 1.7-30.4); media influence on career choice (OR = 9.6, 95% CI = 1.8-50.1); and the belief that EMS was mentally challenging (OR = 15.9, 95% CI = 1.1-216.6). Negative predictors included the beliefs that an EMS career was stimulating (OR = 0.05, 95% CI = 0.00-0.53) and physically challenging (OR = 0.06, 95% CI = 0.00-0.63); as well as prior exposure to an EMS job advertisement (OR = 0.14, 0.03-0.53).

Overall, there was a lack of exposure to career and educational options in EMS among allied health students in the school system studied, and few students intended to pursue an EMS career after graduation. However, the majority of students indicated they would like to learn more about EMS, and would enroll in an EMT course and ride-along program if available. These findings suggest that, with exposure to the profession, more allied health students could choose EMS as a career.

Holloman JB, Hubble MW. High school allied health students and their exposure to the profession of EMS. Prehosp Disaster Med. 2012;27(3):1-7.