The provision of medical care in environments with high levels of ambient noise (HLAN), such as concerts or sporting events, presents unique communication challenges. Audio transmissions can be incomprehensible to the receivers. Text-based communications may be a valuable primary and/or secondary means of communication in this type of setting.

To evaluate the usability of text-based communications in parallel with standard two-way radio communications during mass-gathering (MG) events in the context of HLAN.

This Canadian study used outcome survey methods to evaluate the performance of communication devices during MG events. Ten standard commercially available handheld smart phones loaded with basic voice and data plans were assigned to health care providers (HCPs) for use as an adjunct to the medical team's typical radio-based communication. Common text messaging and chat platforms were trialed. Both efficacy and provider satisfaction were evaluated.

During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they “occasionally” or “frequently” found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that “occasionally” or “frequently” HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% “agreed” or “strongly agreed” that this was the case. The dispatcher responses (n = 21) to the same item also “agreed” or “strongly agreed” that this was the case 95.5% of the time.

The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.

LundA, WongD, LewisK, TurrisSA, VaislerS, GutmanS. Text Messaging as a Strategy to Address the Limits of Audio-Based Communication During Mass-Gathering Events with High Ambient Noise. Prehosp Disaster Med.2013;28(1):1-7.

End tidal CO2 (ETCO2) has been established as a standard for confirmation of an airway, but its role is expanding. In certain settings ETCO2 closely approximates the partial pressure of arterial CO2 (PaCO2) and has been described as a tool to optimize a patient's ventilatory status. ETCO2 monitors are increasingly being used by EMS personnel to guide ventilation in the prehospital setting. Severely traumatized and burn patients represent a unique population to which this practice has not been validated.

The sole use of ETCO2 to monitor ventilation may lead to avoidable respiratory acidosis.

A consecutive series of patients with burns or trauma intubated in the prehospital setting over a 24-month period were evaluated. Prehospital arrests were excluded. Absence of ETCO2 transport data and patients without an arterial blood gas (ABG) within 15 minutes of arrival were also excluded. Data collected included demographics, place and time of intubation, service performing intubation, ETCO2 maintained en-route to hospital, and ABG upon arrival. Further data included length of stay, mortality, and injury severity scores.

One hundred sixty patients met the inclusion criteria. Prehospital ETCO2 did not correlate with measured PaCO2 (R2 = 0.08). Mean ETCO2 was significantly lower than mean PaCO2 (34 mmHg vs 44 mmHg, P < .005). Patients arriving acidotic were more likely to die. Mean pH on arrival for survivors and decedents was 7.32 and 7.19 respectively (P < .001). Mortality, acidosis, higher base deficits, and more severe injury patterns were all predictors for a worse correlation between ETCO2 and PaCO2 and increased mean difference between the two values. Decedents and patients presenting with a pH <7.2 demonstrated the greatest discrepancy between ETCO2 and PaCO2. The data suggest that patients may be hypoventilated by prehospital providers in order to obtain a prescribed ETCO2.

ETCO2 is an inadequate tool for predicting PaCO2 or optimizing ventilation in severely injured patients. Adherence to current ETCO2 guidelines in the prehospital setting may contribute to acidosis and increased mortality. Consideration should be given to developing alternate protocols to guide ventilation of the severely injured in the prehospital setting.

CooperCJ, KraatzJJ, KubiakDS, KesselJW, BarnesSL. Utility of Prehospital Quantitative End Tidal CO2?. Prehosp Disaster Med. 2013;28(2):1-6.

To clarify the factors and reasons for the differences in the outcomes of rescue and relief efforts in Hiroshima and Nagasaki, mainly focusing on the numbers of rescue/relief staffs and casualties in the period within 72 hours of the atomic bombings in August 1945.

By retrieving the data and information from the records and reports concerning the disasters in the two cities, together with other publications as to the damages by the atomic bombings and subsequent rescue-relief activities, and restoration activities.

It seems that there was less damage in Nagasaki, where a stronger atomic bomb was used than in Hiroshima. There were crucial geographic factors that led to the different effects in terms of the numbers of victims; however, systematic organization and mobilization of rescue and relief staffs, maintenance of functional transportation, and advanced medical knowledge and public warning with regard to disaster all may have contributed to a lower death toll and increase in survivors in Nagasaki.

MatsunariY, YoshimotoN. Comparison of Rescue and Relief Activities Within 72 Hours of the Atomic Bombings in Hiroshima and Nagasaki. Prehosp Disaster Med. 2013;28(6):1-7.

The frequency of occurrence of natural disasters has increased over the past several decades, which necessitates a better understanding of human vulnerability, particularly in low-resource settings. This paper assesses risk factors for injury in the March 2010 floods and landslides in Eastern Uganda, and compares the effects of location, injury type, and severity.

A stratified cluster survey of the disaster-affected populations was conducted five months after onset of the disasters. Probability proportional to size sampling was used to sample 800 households, including 400 affected by floods in Butaleja District and 400 affected by landslides in Bududa District.

Flood- and landslide-affected populations were surveyed in July 2010 using a stratified cluster design. The odds of injury were 65% higher in the flood-affected groups than the landslide-affected groups in a logistic regression (OR = 0.35; 95% CI, 0.24-0.52; P < .001). The injury rate was greater in individuals under 42 years of age, and location of injury was a contributing factor. More people were injured in the flood-affected population as compared with the landslide-affected population, and injuries were more severe.

This study illustrates differences between populations injured by flood and landslide disasters that occurred simultaneously in Eastern Uganda in 2010. In areas where landslides are prone to occur due to massive rainfalls or floods, preventative measures, such as early warning systems and evacuation, are more likely to increase the likelihood of people surviving, while for areas with massive floods, immediate and effective medical attention can save lives and improve injury outcomes.

AgrawalS, GopalakrishnanT, GorokhovichY, DoocyS. Risk Factors for Injuries in Landslide- and Flood-Affected Populations in Uganda. Prehosp Disast Med. 2013;28(4):1-9.

On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of this study was to determine how the power outage impacted operations in a sample of hemodialysis centers in the impacted regions.

The sample consisted of all hemodialysis centers located in the District of Columbia and a total of five counties with the largest power losses in West Virginia, Virginia, and Maryland. A semi-structured interview guide was developed, and the charge nurse or supervisor in each facility was interviewed. The survey questions addressed whether their centers lost power, if so, for how long, where their patients received dialysis, whether their centers had backup generators, and if so, whether they had any problems operating them, and whether their center received patients from other centers if they had power.

Calls were placed to 90 dialysis centers in the sampled areas and a 90% response rate was achieved. Overall, hemodialysis operations at approximately 30% (n = 24) of the centers queried were impacted by the power outage. Of the 36 centers that lost power, 31% (n = 11) referred their patients to other dialysis centers, 22% (n = 8) accommodated their patients during a later shift or on a different day; the rest of the centers either experienced brief power outages that did not affect operations or experienced a power outage on days that the center is usually closed. Some centers in the study cohort reported receiving patients from other centers for dialysis 33% (n = 27). Thirty-two percent (n = 26) of the centers queried had backup generators on site. Eleven percent (n = 4) of the centers experiencing power outages reported that backup generators were brought in by their parent companies.

Comprehensive emergency planning for dialysis centers should include provisions for having backup generators on site, having plans in place for the timely delivery of a generator during a power outage, or having predesignated backup dialysis centers for patients to receive dialysis during emergencies. Most dialysis centers surveyed in this study were able to sustain continuity of care by implementing such pre-existing emergency plans.

AbirM, JanS, JubeltL, MerchantR, LurieN. The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations. Prehosp Disaster Med. 2013;28(6):1-4.

Social and political instability have become common situations in many parts of the world. Exposure to different types of traumatic circumstances may differentially affect psychological status.

The aim of this study was to compare the relationship between personal perceptions of control over the events happening in one's life and psychological distress in two groups who experienced physical trauma but differed as to whether the trauma was a result of political upheaval and violence. Views on the extent to which the state was interested in the individual were also assessed.

The sample consisted of 120 patients who were injured in the Cairo epicenter and 120 matched controls from the greater Cairo area whose injuries were from other causes. The Brown Locus of Control Scale and the Symptom Checklist-90-Revised (SCL 90-R) were administered approximately three months after the January 2011 start of the demonstrations and subsequent overthrow of the government.

The groups did not differ on locus of control. For both groups, externality was associated with greater distress, suggesting a relationship between perceived helplessness in controlling one's life and distress. The Cairo group scored significantly higher than the control group on the SCL 90-R Global Severity Index (GSI) and Positive Symptom Total (PST). Perceptions of state interest in the population were low; overall, 78% viewed the state as having little or no interest in them.

The relationship between exposure intensity and psychological distress is examined. In addition, differences in findings in populations experiencing political chaos compared with other types of disasters are considered.

Beliefs regarding personal control over one's life circumstances are more closely associated with psychological distress than the circumstances in which the trauma occurred.

PapanikolaouV, GadallahM, LeonG, MassouE, ProdromitisG, SkembrisA, LevettJ. Relationship of Locus of Control, Psychological Distress, and Trauma Exposure in Groups Impacted by Intense Political Conflict in Egypt. Prehosp Disaster Med. 2013;28(4):1-5.

Community disaster preparedness plans, particularly those with content that would mitigate the effects of psychological trauma on vulnerable rural populations, are often nonexistent or underdeveloped. The purpose of the study was to develop and evaluate a model of disaster mental health preparedness planning involving a partnership among three, key stakeholders in the public health system.

A one-group, post-test, quasi-experimental design was used to assess outcomes as a function of an intervention designated Guided Preparedness Planning (GPP). The setting was the eastern-, northern-, and mid-shore region of the state of Maryland. Partner participants were four local health departments (LHDs), 100 faith-based organizations (FBOs), and one academic health center (AHC)—the latter, collaborating entities of the Johns Hopkins University and the Johns Hopkins Health System. Individual participants were 178 community residents recruited from counties of the above-referenced geographic area. Effectiveness of GPP was based on post-intervention assessments of trainee knowledge, skills, and attitudes supportive of community disaster mental health planning. Inferences about the practicability (feasibility) of the model were drawn from pre-defined criteria for partner readiness, willingness, and ability to participate in the project. Additional aims of the study were to determine if LHD leaders would be willing and able to generate post-project strategies to perpetuate project-initiated government/faith planning alliances (sustainability), and to develop portable methods and materials to enhance model application and impact in other health jurisdictions (scalability).

The majority (95%) of the 178 lay citizens receiving the GPP intervention and submitting complete evaluations reported that planning-supportive objectives had been achieved. Moreover, all criteria for inferring model feasibility, sustainability, and scalability were met.

Within the span of a six-month period, LHDs, FBOs, and AHCs can work effectively to plan, implement, and evaluate what appears to be an effective, practical, and durable model of capacity building for public mental health emergency planning.

McCabeOL, PerryC, AzurM, TaylorHG, GwonH, MosleyA, SemonN, LinksJM. Guided Preparedness Planning with Lay Communities: Enhancing Capacity of Rural Emergency Response Through a Systems-Based Partnership. Prehosp Disaster Med. 2012;28(1):1-8.

Community Assessment for Public Health Emergency Response (CASPER) is a group of tools and methods designed by the US Centers for Disease Control and Prevention (CDC) to provide rapid, reliable, and accurate population-based public health information. Since 2003, North Carolina public health professionals have used CASPERs to facilitate public health emergency responses and gather information on other topics including routine community health assessments.

To date, there has been no evaluation of CASPER use by public health agencies at the state or local level in the US.

Local health departments of North Carolina reported when and how CASPERs were used during the period 2003 to 2010 via an online survey. Data on barriers and future plans for using CASPERs also were collected.

Fifty-two of North Carolina's 85 local health departments (61%) completed the survey. Twenty-eight departments reported 46 instances of CASPER use during 2003 to 2010. The majority of CASPERs were performed for community health assessments (n = 20, 43%) or exercises (n = 11, 24%). Fifty-six percent of respondents indicated they were “likely” or “very likely” to use CASPERs in the future; those who had prior experience with CASPERs were significantly more likely (P = .02) to report planned future use of CASPERs compared to those without prior experience with the tool. Lack of training, equipment, and time were the most frequently reported barriers to using CASPERs.

Local public health agencies with clear objectives and goals can effectively use CASPERs in both routine public health practice and disaster settings.

HorneyJ, DavisMK, DavisSEH, FleischauerA. An Evaluation of Community Assessment for Public Health Emergency Response (CASPER) in North Carolina, 2003-2010. Prehosp Disaster Med. 2013;28(2):1–5.