Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended.     

重大自然灾害后危重伤病员紧急医疗后送的分析与体会

目的:总结分析重大自然灾害后危重伤病员的紧急医疗后送工作,提高灾后危重伤病员后送能力,有效降低死亡率和致残率。方法:分析兰州军区兰州总医院在玉树地震及舟区泥石流灾害后危重伤病员紧急医疗后送中的相关资料,总结经验。结果:全部伤病员均安全送抵目的地,保证了伤病员的有效救治。结论:严密的组织、完善的后送装备的准备及严格的后送管理是确保危重伤病员紧急医疗后送工作成功的关键。     

武警部队处置突发事件中医疗后送救治阶梯设置

突发事件具有冲突程度不一、不确定因素多等特点,武警部队处置突发事件行动中官兵救治需求不定且时效要求高,加之事件现场施救条件恶劣和参与救治力量多元,对医疗后送工作提出更高的要求。科学合理的医疗后送救治阶梯是有效救治官兵生命,减少死亡率、伤残率,做好医疗后送工作的重要保证。通过总结以色列等国和我军医疗救治阶梯设置的经验,结合武警部队处置突发事件医疗后送救治阶梯设置的现状,对医疗后送救治阶梯进行研究。     

浅谈突发公共卫生事件应对中健康促进工作的策略

突发公共卫生事件,是指一些突然发生的,可能或者已经造成社会重大传染病疫情、不明原因的群体性疾病或者造成大量人群食物中毒或者其他严重影响公众健康的紧急事件。在我国2003年颁布的《突发公共卫生事件紧急条例》中对其特征进行了定义:一是具有突发性;二是在公共卫生领域发生;三是严重危害公众健康。在面对突发公共卫生事件发生后,应该及时对事件进行分析、处置,开展广泛深入的健康教育和健康促进工作,可促进公众正确应对灾害,提高自我的防护意识和能力,可以对事件造成的损失进行补救,减少对社会、经济、政治和人民群众生命财产的损害,有利于维护公众健康和社会秩序。对于突发公共卫生事件,除了在发生之后及时应对以外,在平时要开展健康促进工作,对突发公共卫生事件进行预防,并且在其不可避免的发生时,将其危害降到最低。该文对突发公共卫生事件应对中健康促进工作进行探讨。     

Investment in preventing and preparing for biological emergencies and disasters: social and economic costs of disasters versus costs of surveillance and response preparedness

Biological emergencies such as the appearance of an exotic transboundary or emerging disease can become disasters. The question that faces Veterinary Services in developing countries is how to balance resources dedicated to active insurance measures, such as border control, surveillance, working with the governments of developing countries, and investing in improving veterinary knowledge and tools, with passive measures, such as contingency funds and vaccine banks. There is strong evidence that the animal health situation in developed countries has improved and is relatively stable. In addition, through trade with other countries, developing countries are becoming part of the international animal health system, the status of which is improving, though with occasional setbacks. However, despite these improvements, the risk of a possible biological disaster still remains, and has increased in recent times because of the threat of bioterrorism. This paper suggests that a model that combines decision tree analysis with epidemiology is required to identify critical points in food chains that should be strengthened to reduce the risk of emergencies and prevent emergencies from becoming disasters.     

Disasters and public health: an approach from the theoretical framework of epidemiology

Throughout the 1990-2000 period, disasters (catastrophes) caused an average of 75,000 deaths yearly, injuring an average of 256 million people a year and causing economic losses totaling more than 650 billion euros. The magnitude of this problem, its impact on public health and on the degree of development of the populations involved are of such major importance as to warrant special interest from the public health standpoint, especially as a result of what are known as complex emergencies. The objective of this study is that of reviewing the definitions, the main concepts and the basic characteristics of disaster epidemiology. An analysis is also made of the risk factors involved in disasters, the impacts on public health of the main types of disasters and the main preventive strategies in terms of the different stages of the disaster cycle.     

Disaster medicine: lessons from Enschede and Volendam]

Two major disasters hit the Netherlands recently: on May 13th 2000, a local fireworks depot exploded in the middle of the city of Enschede and on New Year's Eve 2001, fire destroyed a pub full of people in Volendam. Lessons from the involvement of medical services in these disasters include: disaster medicine must be seen as an extension of emergency care. Hospital staff should be familiar with the procedures in case of a disaster, and regular practice on a regular basis is mandatory. Logistics, as well as individual care of the victims, differ in detail from everyday practice, notably during the first hour following the disaster. Attention should be paid to the provision of psychological aftercare soon after the event for the victims and their families, as well as for health care workers.     

Knowledge and Behaviors of Parents in Planning for and Dealing with Emergencies

In recent years, a number of large-scale disasters have occurred both locally and internationally, heightening our awareness of potential dangers. If a disaster were to occur at a school, there is the potential for a large number of children to be injured or affected in some way. The school community includes not only the staff and students who are on campus each day, but also students’ parents and the surrounding neighborhood. How parents react during emergencies and disasters at schools is likely associated with their knowledge and perceptions of emergencies and disasters. Parents’ preparedness levels and their planned response to a school-based emergency and how schools plan and manage for these reactions have not been explored. Utilizing a mixed methods design that included surveys, semi-structured interviews and focus groups with members of the communities in two South Los Angeles school districts, this study aims to provide an overview of parents’ levels of emergency and disaster preparedness and the challenges they face in preparing for these events. Additionally, parents’ planned responses to a school-based emergency or disaster are discussed as well as the challenges that schools may face as a result. Data from this study confirm that there are a number of challenges related to parents’ planned response to a school-based emergency, including an expected inundation of parents to the schools, lack of communication between schools and parents and language barriers. Recommendations for schools are provided to take advantage of parent populations to better integrate them into schools’ emergency planning processes.     

Preparation and response in case of natural disasters: Cuban programs and experience

Inadequate preparation for national disasters is frequently particularly devastating in lower income countries. The Cuba's location has a diversity of potential natural disasters, including hurricanes, non-tropical depressions, tropical storms, tropical cyclones, and severe local storms, all with intense rains and winds, earthquakes and droughts. Cuban preparation, at all levels, is geared to these predominant threats. Planning for natural disasters is integral to the political and economic life of Cuba, nationally and locally. On several occasions, United Nations (UN) officials have pointed to Cuba as a model for developing countries preparing for hurricanes and other natural disasters. A global policy for managing the risks of natural disasters could improve continuity of assistance for development and reduce the necessity of humanitarian aid. Planning in advance of disasters is a feasible way of helping people, by reducing expenses of emergencies, recuperation, and reconstruction. As climate changes accelerate, many researchers fear a period of irreversible and uncontrollable change. While the atmosphere continues to warm, it generates more intense rains, more frequent heat waves, and more ferocious storms. Thus, achieving better protection of developing countries from an increasing onslaught of natural disasters will only grow in importance. Even though Cuba's contribution to know-how has been recognized by United Nations' officials, progress toward more adequate preparation worldwide has been slow. To support other countries beyond conveying the lessons, Cuba now offers specially trained personnel to cooperate immediately with any country suffering a natural disaster.     

移动式生命支持系统——一种快速院前处置和途中连续救治装备

目的：设计一种移动式生命支持系统,能适应突发灾害事故或未来局部战争中伤员现场救护和后送的需要。方法：分析突发灾害事故或未来局部战争伤痛员的特点和勤务救治要求,结合内嵌设备结构及急救器材与药品的配置,采用先进的计算机辅助设计软件,对系统框架整体结构、设备安放位置、固定方法、干涉情况、操作性能等进行仿真设计。结果：设计的系统能推、能抬,能加载在多种运载工具上,进而快速投放至急救现场展开急救．使危重病现场救治规则、卫勤保障原则更趋于合理,提高抢救成功率。结论：设计的系统结构新颖,布局合理,功能齐全,操作方便,为突发灾害事故或未来局部战争中伤病员现场抢救．以及伤病员长距离转移过程中不间断急救复苏．提供了一种新型的综合急救装备。     

Ethical issues raised in addressing the needs of people with serious mental disorders in complex emergencies

Recent manmade and natural disasters highlight weaknesses in the public health systems designed to protect populations from harm and minimize disruption of the social and built environments. Emergency planning and response efforts have, as a result, focused largely on ensuring populations' physical well-being during and after a disaster. Many public health authorities, including the World Health Organization, have recognized the importance of addressing both mental and physical health concerns in emergency plans. Individuals with mental disorders represent a notable proportion of the overall population, and anticipating their needs is critical to comprehensive emergency planning and response efforts. Because people with serious mental disorders historically have been stigmatized, and many individuals with mental disorders may be unable to care for themselves, ethical guidance may be of assistance to those engaged in emergency planning and response. This article considers several broad categories of ethical issues that arise during emergencies for people with serious mental disorders and offers recommendations for ways in which emergency planners and other stakeholders can begin to address these ethical challenges.     

Creating a Regional Pediatric Medical Disaster Preparedness Network: Imperative and Issues

Over the past few decades, the number of disasters, both natural and human initiated has increased. As a result, since the September 11, 2001 attacks on the World Trade Center and Pentagon, there has been a new emphasis on disaster preparedness. However, the preparedness emphasis has been primarily directed toward adults and little attention has been specifically given to the needs of children.One reason for the lack of attention to pediatric needs in disaster planning is that childhood is seldom viewed as a separate and special stage of growth, fundamentally different from adulthood. The expectation during emergencies is that the care provided for adults is appropriate for children.The purpose of this paper is to examine the types of and increase in disasters and discuss the importance of specifically addressing the special needs of children in disaster planning. Further the paper argues for a regional network approach to emergency pediatric care that would increase surge capacity for children during disasters and other emergencies.     

Social Vulnerability Index for the Older People—Hong Kong and New York City as Examples

Many world cities have suffered large-scale disasters, causing a significant loss of lives, property damage, and adverse social and economic impact. Those who are most vulnerable during and in the immediate aftermath of disaster crises are the elderly. Therefore, it is imperative to identify them and determine their specific needs in order to support them. Although several Social Vulnerability Indexes (SVIs) have been developed to assess different types of disaster vulnerability across geographic and population levels, few have been tailored to the older population. Building on the research of Gusmano et al., this study modifies and uses an SVI specifically designed to assess the vulnerability of older populations to emergencies and disasters across seven domains, namely, population size, institutionalization, poverty, living alone, disability, communication obstacles, and access to primary care. Moreover, it is acknowledged that availability of data largely depends on the local context and is always a barrier to production of indices across countries. The present study offers suggestions on how modifications can be made for local adaptation such that the SVI can be applied in different cities and localities. The SVI used in this study provides information to stakeholders in emergency preparedness, not only about natural disasters but also about health hazards and emergencies, which few existing SVI address.     

Emergency planning and long-term care: least paid, least powerful, most responsible

As disasters can occur anywhere, planning to avoid emergencies is an international concern. Our research specifically addresses planning for the needs and safety of a vulnerable population, long-term care residents. Our initial purposes in this evaluation research were to assess the utility of a template to gather emergency management information for individual long-term care communities, to report on how prepared they are to cope with emergencies that have occurred elsewhere in areas like ours, and to assess the effectiveness of employing gerontology students in the planning process. As we began analyzing our data, we realized that it is imperative to consider whether it is possible for long-term care communities to respond effectively to disasters. In our findings we focus on the impact of gender in the planning process, the importance of size with regard to template utility, the positive and negative consequences of student aid, and the fact that gathering plans for individual long-term care communities may have detracted from collaborative community planning.     

Nursing home evacuation plans

Objectives. I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes cited for deficiencies in their evacuation plans.Methods. Evacuation plans were assessed according to criteria developed by an expert panel funded by the Office of the Inspector General. Deficiency citations came from the Online Survey, Certification, and Recording database, collected from 1997 to 2005. Four specific citations, for written emergency plans, staff training, written evacuation plans, and fire drills, were examined with multivariate logistic regression.Results. Most plans had water supply provisions (96%). Only 31% specified an evacuation route. The rate of citations was relatively stable throughout the study period: each year approximately 0.6% of facilities were found to be deficient in written emergency plans, 2.1% in staff training, 1.2% in written evacuation plans, and 7.9% in fire drills.Conclusions. Some nursing homes need more specific evacuation plans. Water supply was the most and evacuation routes were the least well-addressed areas.The US Department of Health and Human Services recently reported that administrators from 5 of 13 nursing homes evacuated as part of Hurricane Katrina described negative effects on residents’ health, such as dehydration, depression, and skin tears. The report further stated that “problems can be tied to a lack of effective emergency planning.”1^(pii)In nursing homes, an important tool used as part of emergency planning is the evacuation plan. Federal law requires that Medicare-and Medicaid-certified nursing homes have written plans for evacuation. Nursing homes are subject to deficiency citations (and fines) if the Medicare or Medicaid survey and certification process determines that they do not have adequate written evacuation plans.State Medicaid programs are responsible for approximately 50% of all nursing home expenditures, and Medicaid recipients consume 70% of all bed days. Because the federal government is such a dominant purchaser of nursing home care, it is also the dominant overseer of care quality. This oversight primarily occurs via the certification process. Titles XVIII and XIX of the Social Security Act require that all nursing homes accepting Medicare or Medicaid residents must be certified. Specific minimum standards were established for this certification, and surveyors inspect facilities for compliance.2 The standards require facilities to have “detailed written plans and procedures to meet all potential emergencies and disasters.”3^(p19) In addition, facilities must “train employees in emergency procedures when they begin work in the facility, periodically review procedures, and carry out unannounced staff drills.”3^(p19)The intent of the survey and certification process is to monitor and ensure quality of care. Several mechanisms are available to the government when facilities fail to meet certification minimum standards. These include varying levels of fines (≤ $10000/day) and termination from the Medicare and Medicaid programs. In all cases, however, when a facility does not meet government standards, a deficiency citation is issued. The deficiency citations (commonly called F-tags) for evacuation planning are F-517 and F-518. F-517 states, “The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather and missing residents.”4^(p32) F-518 states,

The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.4^(p32)

In addition, incorporated into survey and certification regulations are Life Safety Code requirements (commonly called K-tags). These regulations focus mainly on fire safety but also include evacuation planning procedures, such as K-48 and K-50. K-48 states, “There is a written plan for the protection of all patients and for their evacuation in the event of an emergency.”5^(p42) K-50 states,

Fire drills are held at unexpected times under varying conditions, at least quarterly on each shift. Staff are familiar with procedures and aware that drills are an established routine. Responsibility for planning/conducting drills is assigned only to competent persons who are qualified to exercise leadership.5^(p42)

To my knowledge, the report from the Department of Health and Human Services is the only published document addressing evacuation plans used by nursing homes.1 The authors of the report interviewed 20 nursing home top managers involved with facility evacuation and examined deficiency citations given nationally in 2004 for having no plans or deficient plans for evacuation (codes F-517, F-518, K-48, and K-50). They found that nationwide, 94% of nursing homes met federal standards for emergency plans and 80% had sufficient emergency training. They also found substantial variation in the content of evaluation plans used by the 20 nursing homes examined.I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes (such as for-profit or nonprofit) that received deficiency citations for inadequate plans. My analysis extends the previous research by (1) examining evacuation plans from a large sample (n = 2134) of nursing homes and (2) analyzing longitudinal panel data (1997–2005) from nursing homes (n = 121 779) to determine the types of nursing homes that received deficiency citations for inadequate evacuation plans.     

Epidemiological intelligence as a model of organization in health

The concept of epidemiological intelligence, as a construction of information societies, goes beyond monitoring a list of diseases and the ability to elicit rapid responses. The concept should consider the complexity of the definition of epidemiology in the identification of this object of study without being limited to a set of actions in a single government sector. The activities of epidemiological intelligence include risk assessment, strategies for prevention and protection, subsystems of information, crisis management rooms, geographical analysis, etc. This concept contributes to the understanding of policies in health, in multisectorial and geopolitical dimensions, as regards the organization of services around public health emergencies, primary healthcare, as well as disasters. The activities of epidemiological intelligence should not be restricted to scientific research, but the researchers must beware of threats to public health. Lalonde's model enabled consideration of epidemiological intelligence as a way to restructure policies and share resources by creating communities of intelligence, whose purpose is primarily to deal with public health emergencies and disasters.     

Communication, perception and behaviour during a natural disaster involving a 'Do Not Drink' and a subsequent 'Boil Water' notice: a postal questionnaire study

Background  

During times of public health emergencies, effective communication between the emergency response agencies and the affected public is important to ensure that people protect themselves from injury or disease. In order to investigate compliance with public health advice during natural disasters, we examined consumer behaviour during two water notices that were issued as a result of serious flooding. During the summer of 2007, 140,000 homes in Gloucestershire, United Kingdom, that are supplied water from Mythe treatment works, lost their drinking water for up to 17 days. Consumers were issued a 'Do Not Drink' notice when the water was restored, which was subsequently replaced with a 'Boil Water' notice. The rare occurrence of two water notices provided a unique opportunity to compare compliance with public health advice. Information source use and other factors that may affect consumer perception and behaviour were also explored.     

Characteristics of radio medical advice to fishing vessels in Scottish coastal waters

We examined the emergencies arising on fishing vessels in Scottish Coastal Waters which required ship-to-shore radio medical advice. All calls to the service were identified for the 12-month period from August 2005. A total of 186 calls were received; 38% of calls were from fishing vessels. During the study period 53% of the calls were trauma-related, while 47% were medical emergencies. Our data suggest that there are many fishermen working offshore with chronic medical conditions. Overall, 85% of calls from fishing vessels resulted in evacuation as the outcome. Improved occupational health screening, compliance with health and safety legislation, and an evidence-based approach to remote medical care may improve seafarer self-care and reduce emergency evacuations.     

Risk management of international trade: emergency preparedness

Emergency preparedness and management are among the most important and critical issues facing animal health in the world today. The goals of a country for an animal health emergency management (AHEM) system should include the following: --being prepared to detect and manage an outbreak of a foreign animal disease --preventing the introduction of foreign and emerging animal pathogens --having an appropriate response system for control and eradication of the disease --having a system for recovery from animal health emergencies, including natural disasters. An AHEM system can no longer be limited to a single organisation within a country. In the event of a serious threat to the animal agriculture of a country, broader and more comprehensive participation is required. If not properly planned for, animal health emergencies can rapidly become national disasters. Therefore, it is essential that the central government of a country work towards these goals through partnerships with other Federal and State/Provincial/District organisations, academic institutions and national animal industries.     

高层医院建筑火灾人员营救与疏散

阐述了高层医院发生火灾后人员营救及疏散的难点和对策,并结合消防实战演练经验,有针对性的提出了必须即时修订火灾应急疏散预案,开展常态应急疏散演练,坚持＂救人第一＂原则,选择正确疏散方法等以确保人员安全的管理对策。