Introduction: Due to recent disasters, disaster planners increasingly are focusing on healthcare worker preparedness and response in the event of a disaster. In this study, factors associated with pediatric healthcare workers’ willingness to respond are identified.

Hypothesis: It was hypothesized that personal factors may affect a pediatric healthcare worker’s willingness to respond to work in the event of a disaster.

Methods: Employees of a tertiary, pediatric care hospital in Los Angeles were asked to complete a brief, 24-question online survey to determine their willingness to respond in the event of a disaster. Information on demographics, employment, disaster-related training, personal preparedness, and necessary resources was collected. A logistic regression model was performed to derive adjusted odds ratios (OR) and their corresponding 95% confidence intervals (95% CI).

Results: Eight hundred seventy-seven pediatric healthcare employees completed the survey (22% response rate). Almost 50% (n = 318) expressed willingness to respond in the event of a disaster. Men were more likely to be willing to respond to a disaster than were women (OR = 2.4; 95%CI = 1.6–3.6), and single/divorced/widowed employees were more willing to respond than married or partnered employees (OR = 1.5; 95%CI = 1.1–2.1). An inverse relationship was observed between number of dependents and willingness to respond (OR = 0.45; 95%CI = 0.25–0.80, ≥3 dependents compared to 0). An inverse dose response relationship between commuting distance and number of necessary resources (ptrend = 0.0485 and 0.0001, respectively) was observed. There was no association between previous disaster experience, disaster training, or personal preparedness and willingness to respond.

Conclusions: Number of dependents and resources were major factors in willingness to respond. Healthcare facilities must clearly communicate their disaster plans as well as any provisions they may make for their employees’ families in order to improve willingness among hospital employees.

Introduction: Ensuring the capacity of the public health, emergency preparedness system to respond to disaster-related need for mental health services is a challenge, particularly in rural areas in which the supply of responders with relevant expertise rarely matches the surge of demand for services.

Problem: This investigation established and evaluated a systems-based partnership model for recruiting, training, and promoting official recognition of community residents as paraprofessional members of the Maryland Medical Professional Volunteer Corps. The partners were leaders of local health departments (LHDs), faith-based organizations (FBOs), and an academic health center (AHC).

Methods: A one-group, quasi-experimental research design, using both post-test only and pre-/post-test assessments, was used to determine the feasibility, effectiveness, and impact of the overall program and of a one-day workshop in Psychological First Aid (PFA) for Paraprofessionals. The training was applied to and evaluated for 178 citizens drawn from 120 Christian parishes in four local health jurisdictions in rural Maryland.

Results: Feasibility—The model was demonstrated to be practicable, as measured by specific criteria to quantify partner readiness, willingness, and ability to collaborate and accomplish project aims. Effectiveness—The majority (93–99%) of individual participants “agreed” or “strongly agreed” that, as a result of the intervention, they understood the conceptual content of PFA and were confident about (“perceived self-efficacy”) using PFA techniques with prospective disaster survivors. Impact—Following PFA training, 56 of the 178 (31.5%) participants submitted same-day applications to be paraprofessional responders in the Volunteer Corps. The formal acceptance of citizens who typically do not possess licensure in a health profession reflects a project-engendered policy change by the Maryland Department of Health and Mental Hygiene.

Conclusions: These findings are consistent with the conclusion that it is feasible to consider LHDs, FBOs, and AHCs as partners to work effectively within the span of a six-month period to design, promote, conduct, and evaluate a model of capacity/capability building for public mental health emergency response based on a professional “extender” rationale. Moreover, consistently high levels of perceived self-efficacy as PFA responders can be achieved with lay members of the community who receive a specially-designed, one-day training program in crisis intervention and referral strategies for disaster survivors.

Introduction: In confined-space airway emergencies, prehospital personnel may need to perform cricothyrotomy when conventional airway techniques cannot be utilized or have failed. This study is a prospective, cross-over, randomized controlled trial that compares two widely-known techniques using two commercially available kits.

Methods: Twenty residents at Palmetto Health Richland Department of Emergency Medicine participated in the study. Their performance was assessed using the time required to placement and correctness of placement for each device. The residents performed the procedures on an Air-Man™ manikin that had been situated in a confined space. The residents also indicated which kit they would prefer in a confined-space, emergency airway situation.

Results: All of the devices were placed in the airway. The mean time to placement for the Melker™ and Quicktrach™ kits was 108.5 seconds and 23.9 seconds, respectively. This yielded a mean difference of 84.5 seconds, which provided a t-statistic of 8.88 (p < 0.0001). There was no evidence of a carry-over effect (p = 0.292) or a period effect (p = 0.973). All residents preferred using the Quicktrach™ kit.

Conclusions: Use of the Quicktrach™ kit resulted in the fastest time to placement, was placed correctly in the airway, and was preferred by each of the residents. Its small, simple, and sturdy design, with few parts and easy manipulation, allow the Quicktrach™ to be a valuable option in prehospital situations involving confined spaces. The Melker™ kit, with its many parts, and need for greater manipulation, is not as easily utilized or preferred in a confined space scenario.

Introduction: Earthquake exposure has been associated with adverse consequences for coronary heart disease. However, the natural history and prognostic significance of earthquake-related, new-onset angina have not been characterized.

Objective: The objective of this study was to evaluate the association between episodes of depressive symptoms and one-year prognosis after the first admission to the hospital among adults with new-onset angina before and after the Sichuan earthquake.

Methods: One hundred forty-one first hospitalized patients with new-onset angina before and after the Sichuan earthquake underwent psychological assessments during their first admission to the hospital following the earthquake. Patients were followed for 12 months to determine survival status. The independent relationships between baseline variables and readmission risk after the earthquake were examined. Baseline somatic and psychosocial variables were collected with the aid of standard, validated questionnaires.

Results: The proportion of patients with moderate/severe depression symptom in the earthquake-related group is higher than among their counterparts (23.7% vs. 8.9%, p = 0.026). Patients with new-onset angina after the Sichuan earthquake had a higher risk of readmission (22.4% vs. 8.9%, p = 0.041) and longer total hospitalization (average of 13.4 ±6.8 vs. 10.7 ±5.5 days, p = 0.015). The risks for readmission was associated with moderate/severe depression (adjusted hazard ratio, 9.18 [95% confidence interval (CI) = 3.09–27.23, p = 0.0000]) and low ejection fraction (adjusted hazard ratio, 6.66 [95%CI = 2.131–20.781, p = 0.001]).

Conclusions: Among patients diagnosed with new-onset angina, those with first episode after the Sichuan earthquake generated more moderate/severe depressive symptoms and had a higher risk for readmission and longer hospital stay. Depressive symptoms upon admission and low ejection fractions were significant predictors of 12-month risk for readmission, which indicates that antidepressants should be prescribed.

Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.

Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype (“Wireless Internet Information System for medicAl Response to Disasters” or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher’s Exact Testing of Proportions with differences and 95% confidence intervals reported.

Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5–24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9–72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3–17.3%]).

Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.

Introduction: This project examined the use of first aid by bystanders at road traffic crashes (RTC) and was undertaken in the context of increasing average ambulance response times to RTC throughout Australia and the potential impact of early first aid intervention on the mortality and morbidity associated with RTC. The aim of this project was to acquire knowledge about the prevalence of first aid training; the incidence of being a bystander and of providing first aid; the range of first aid skills being utilized; the motivation to intervene; and, the perceived impact of first aid training.

Methods: An Internet-based survey was distributed to a potential population of 12,500 road users and a total of 773 responded. Descriptive and comparative statistical analysis of quantitative data and thematic analysis of qualitative data were completed.

Results: Seventy-seven percent (77%) of participants had first aid training at some stage in their lives; 28% held a current first aid certificate; 11% had provided first aid at RTC; 75.3% who had provided first aid were travelling in a vehicle. Having first aid training increased the likelihood of intervention and of owning a first aid kit or pocket mask.

Conclusions: First aid training, even if it is not current, is an enabler for providing first aid at RTCs. The first aid skills most commonly used were changing posture, opening an airway, and providing comfort and reassurance. Key concerns for first aiders included a feeling of a lack of follow-up, and lack of an opportunity to debrief. Strategies to increase first aid training, to improve information and support, and to increase the knowledge of first aider’s are discussed.

Introduction: The aim of this study was to describe the current state of disaster preparedness in hospitals in the public sector in the Western Cape, South Africa with the advent of the FIFA 2010 Soccer World Cup. The objectives included the completion of a self-reported assessment of readiness at all Western Cape public sector hospitals, to identify best practice and shortfalls in these facilities, as well as putting forward recommendations for improving disaster preparedness at these hospitals.

Methods: The National Department of Health, as part of the planning for the FIFA 2010 World Cup, appointed an expert committee to coordinate improvements in disaster medicine throughout the country. This workgroup developed a Self Reported Hospital Assessment Questionnaire, which was sent to all hospitals across the country. Data only were collected from public hospitals in the Western Cape and entered onto a purpose-built database. Basic descriptive statistics were calculated. Ethical approval was obtained from the Health Sciences Faculty Research Committee of the University of Cape Town.

Results: Twenty-seven of the 41 (68%) public hospitals provided completed data on disaster planning. The study was able to ascertain what infrastructure is available and what planning already has been implemented at these institutions.

Recommendations: Most hospitals in the Western Cape have a disaster plan for their facility. Certain areas need more focus and attention; these include: (1) increasing collaborative partnerships; (2) improving HAZMAT response resources; (3) specific plans for vulnerable populations; (4) contingency plans for communication failure; (5) visitor, media and VIP dedicated areas and personnel; (6) evacuation and surge capacity plans; and (7) increased attention to training and disaster plan exercises.

A disaster is a situation that overwhelms the local population’s capacity to respond, thus necessitating a request for assistance from outside the impacted area. In these circumstances, needs usually outweigh resources. The objective of response is to do the greatest good for the greatest number of people (the utilitarian principle). As such, some unique ethical considerations will arise that are not seen in day-to-day practice.

The adoption of medical ethics principles is important in such situations, but certain provisions must be accepted. In large-scale, complex disasters, it may be impossible to provide optimal care to each patient. This paper will discuss some of the challenges for healthcare personnel at “ground zero”, how training in preventive ethics may help, and what principles can be applied when working in disaster-affected areas or when responding to disasters.

Background: Trauma is a major health issue worldwide, but especially so in developing countries such as Nigeria, where no comprehensive, national, injury data exist. There is a need to better define the epidemiology of injury as a basis for formulation of violence and injury prevention strategy.

Methods: This is a systematic analysis of published data on the epidemiology of injuries.

Objectives: The objective of this study was to describe the prevalent causes of injury among adults and children, and the causes of injury mortality.

Results: The medical records of 15,694 patients from the age of two weeks to 95 years formed the analysed data set. The mean value of their ages was 27 ±13 years and the gender ratio (M:F) 2:1. The injury burden is 11.2/100,000 population. The prevalent causes of injury are: (1) road traffic crashes (RTCs) = 68.4 % of 9939 patients; (2) fall = 5.5%; (3) gunshot injury = 3.2%; and (4) burns = 2.4%. Among children, the leading causes are: (1) RTC = 33.9% of 2,199 patients; (2) fall = 29.1%; (3) foreign body related = 5.5%; (4) bites = 4.9%; and (5) burns = 4%. Mortality resulted mainly from head injury, 26.6% of 575, and hemorrhage 8.3%.

Conclusions: Road traffic incidents are the leading cause of injury among adults and children. Falls are six times more prevalent among children than for adults. Burns and firearm injuries are relatively uncommon. Injury mortality results mainly from head injury and hemorrhage.

Objective: The objective of this study was to describe the injuries and distribution of casualties resulting from the crash of Turkish Airlines flight TK 1951 near Schiphol Airport in the Netherlands on 25 of February 2009.

Methods: This was a retrospective, descriptive study. Based on a review of the hospital records for all casualties of the airplane crash, triage at the scene, time to emergency department, Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), mortality, length of hospital stay and surgical procedures were abstracted.

Results: Of the 135 passengers, nine died on-scene. A total of 126 survivors were examined in 15 hospitals; data for all survivors were available for the study. Median time between crash and arrival at an emergency department was 3.5 hours (range 1.25-5.5 hours). Six passengers were uninjured and 66 were admitted to hospital. A total of 305 injuries were recorded. The majority were head and facial injuries (92), spinal injuries (35), and fractures of extremities (38). Eighteen percent of the patients had a spinal injury. The mean ISS was 6.3 (range = 1–57). The ISS score was >15 for 13 patients. Surgical procedures (80) were necessary in 23 patients. There was no in-hospital mortality.

Conclusions: Although the accident was in an urban area, there was a significant delay between the time of the accident and the arrival of the casualties at hospital emergency departments. The Turkish Airlines crash provides extensive information for research into mass-casualty or disaster management, triage, plane crash injuries, and survivability. The “Medical Research Turkish Airlines Crash” (MOTAC) study group currently is investigating several of these issues.

Objectives: This is an evaluation of the efficacy of metoclopramide (MTCP) or diphenhydramine (DPH) to relieve symptoms of motion sickness in patients being transported via ambulance in a mountainous setting.

Methods: This is a prospective, randomized, double-blinded, placebo-controlled study of patients transported by ambulance in the Sierra Nevada mountains of Fresno County. Consenting patients who met the inclusion criteria were asked to rate their motion sickness every five minutes using a visual analog scale (VAS) during transport. If motion sickness occurred, they were randomized to receive MTCP (20 mg IV), DPH (50 mg IV), or placebo (normal saline), and remaining symptoms were recorded every five minutes. If signs and symptoms of motion sickness persisted after 15 minutes, a rescue dose of MTCP was offered.

Results: Twenty-six patients were enrolled in the study. Twenty-two (84.6%) developed motion sickness and were randomized to MTCP, DPH, or placebo. Eight patients received MTCP, seven received DPH, and seven received placebo. The MTCP group showed a statistically significant decrease in the mean VAS score at 15 minutes compared to the DPH and placebo groups. There was no significant difference in the decrease in VAS score between the placebo and the DPH group. Twelve out of 22 patients requested a rescue dose of MTCP after 15 minutes. At 25 minutes, there was no significant difference in the VAS score between the three groups.

Conclusion: During ambulance transport in a mountainous setting, the administration of MTCP is superior to both DPH and placebo in the treatment of motion sickness. Diphenhydramine is not superior to placebo.