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Field hospitals are a vital element in providing as many medical services as possible to a stricken population in times of disaster. Setting up a field hospital with advanced auxiliary medical services is possible as long as there is comprehensive and careful planning, training, and preparation done ahead of time. The main objective of the AMS department is to organize and assist in establishing the field hospital, ensure its smooth and efficient operation throughout the stay, and, at the close of a mission to disassemble the equipment for its return journey and then ensure it is in optimum working order for the next call up. The department is responsible for maintaining all medical devices in perfect working order with the focus being on safety compliance and patient welfare. The four core services provided by the department cover medical engineering, medical equipment and pharmacy, diagnostic imaging, and the clinical laboratory. All these services operate according to a predetermined workflow and clear working guidelines. In keeping with the goals of the humanitarian mission, the medical engineering service will handle the acquisition and maintenance of equipment capable of functioning in an electricity free environment. They will verify that all devices are robust and capable of operating under extreme weather conditions and comply with any specifications mandated by the different countries. The pharmacy service plays a vital role in ensuring medicine and its accompanying information is handled efficiently and safely. Data is accrued over the span of a mission to assist with ever more accurate future planning. The diagnostic imaging service must be able to provide both investigative and diagnostic examinations. This service is agile and can be provided in an imaging department tent, a dedicated container unit or bedside for patients who are not to be moved. The clinical laboratory service performs a full array of tests that facilitate in diagnosis and treatment of the patient. The services provided by the laboratory include biochemistry, hematology, and microbiology. The laboratory diagnoses the pathogens in infectious diseases and identifies the type of bacteria and its susceptibility to various antibiotics.
Critical care transport (CCT) teams must manage a wide array of medications before and during transport. Appreciating the medications required for transport impacts formulary development as well as staff education and training.
Problem
As there are few data describing the patterns of medication administration, this study quantifies medication administrations and patterns in a series of adult CCTs.
Methods
This was a retrospective review of medication administration during CCTs of patients with severe hypoxemic respiratory failure from October 2009 through December 2012 from referring hospitals to three tertiary care hospitals.
Results
Two hundred thirty-nine charts were identified for review. Medications were administered by the CCT team to 98.7% of these patients, with only three patients not receiving any medications from the team. Fifty-nine medications were administered in total with 996 instances of administration. Fifteen drugs were each administered to only one patient. The mean number of medications per patient was 4.2 (SD=1.8) with a mean of 1.9 (SD=1.1) drug infusions per patient.
Conclusions
These results demonstrate that, even within a relatively homogeneous population of patients transferred with hypoxemic respiratory failure, a wide range of medications were administered. The CCT teams frequently initiated, titrated, and discontinued continuous infusions, in addition to providing numerous doses of bolused medications.
WilcoxSR, SaiaMS, WadenH, McGahnSJ, FrakesM, WedelSK, RichardsJB. Medication Administration in Critical Care Transport of Adult Patients with Hypoxemic Respiratory Failure. Prehosp Disaster Med. 2015;30(4):1-5.
Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death.
Problem:
A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications.
Methods:
Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented.
Results:
The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions.
Conclusions:
Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.
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