Determinants of Response in a Longitudinal Health Study Following the Firework-disaster in Enschede,The Netherlands

Very few longitudinal health studies after disasters published data on the determinants of loss to follow up. However, these determinants provide important information for future disaster studies to improve their response and reduce selection bias. For this purpose we analyzed the data of a longitudinal health survey which was performed among residents and emergency workers, at 3 weeks (n = 3662) and at 18 months (n = 2769) after a major firework disaster in The Netherlands (Enschede, May 13, 2000). The response was lower among immigrants (54%) than among native Dutch (81%). Severe damage to the house due to the disaster (OR: 1.8; 95% CI: 1.1–3.0) and being involved as an emergency workers (OR: 2.1; 95% CI: 1.2–3.4) were associated with higher response among native Dutch, while this was not the case among immigrants. Non-western immigrants with health problems in the first study were more likely to participate in the second study (for example physical symptoms OR: 2.5: 95% CI: 1.4–4.4), while the native Dutch with these symptoms were less likely to participate (OR: 0.7; 95% CI: 0.5–0.9). In conclusion, disaster-related characteristics were associated with higher response in native Dutch. Health problems were associated with higher response among non-western immigrants and with lower response among the native Dutch.     

灾后吸烟与创伤暴露及创伤后应激障碍的关系研究

目的 了解吸烟与创伤暴露及创伤后应激障碍(Post-traumatic stress disorders,PTSD)之间的关系.方法 对1056名参加汶川抗震救灾的一线救援军人PTSD的患病率及吸烟情况进行调查.结果 创伤暴露后,吸烟人数和吸烟量未有明显改变.PTSD组中吸烟率为76.8%,显著高于非PTSD组(60%).多元Logistic回归分析显示,服役满意度低、创伤暴露后患PTSD、军龄长是地震现场救援军人创伤暴露后吸烟行为增加的危险因素.结论 创伤暴露对吸烟无明显影响,吸烟主要与PTSD有关,吸烟会增加创伤暴露后患PTSD的危险,而患PTSD后又会增加吸烟的危险.     

日本灾害护理学的发展对我国灾害护理教育的启示

日本作为自然灾害多发的国家,对灾害护理的研究处于领先地位。本文通过借鉴日本灾害护理学建立和发展的经验,反思我国灾害护理教育的现状,为我国灾害护理学的构建和灾害护理教育的发展提供理论依据。     

Barriers and facilitators to provide continuity of care to dischargeable patients in disasters: A qualitative study

ObjectiveEarly discharge of some in-patients is the effective measure to create hospital surge capacity in disasters. However, some of these patients may need to post-discharge continuity of care. The aim of the current study then is to explore the barriers of continuity of care, and to provide suitable solutions for potentially dischargeable patients during disasters.MethodsThis qualitative study was conducted in Iran in 2017. The data was collected via unstructured interviews with 24 disaster professionals; and analyzed by content analysis method.ResultsIdentified barriers to the continuity of care were classified into seven categories, ‘lack of disaster paradigm’; ‘challenges of pre-hospital system’; ‘insufficient coordination and cooperation’; ‘inadequate hospital preparedness’; ‘lack of using available resources and capacities’; ‘poor patients' knowledge’ and ‘poor planning’. The suggested solutions for post-discharge continuity of care were: creation of registry and follow-up system; removing pre-hospital challenges; including disaster management courses in medical school curriculum; promoting hospital preparedness by All-Hazard Approach; and effective use of available resources.ConclusionUnderstanding the barriers to continuity of care for discharged patients for adopting policies based on experiences of health care providers can help planners to design and implement effective programs, which will enhance patients' access to necessary care.     

灾害管理中护士角色及灾害备灾的课程设置

本文分别从灾害的定义及其相关概念、灾害管理阶段中护士角色定位、灾害护理的核心能力、我国灾害培训课程的设置进行介绍,旨在为护理灾害救援和灾害培训课程的设置提供借鉴。     

高等医学院校医学生灾难医学教育课程的设计开发

目的 为本教研室的医学生提供结构化的教育指导和资源,开发和设计灾难医学课程。方法 采用医学教育课程开发六步法作为组织流程,急诊及灾难医学专家的专业知识、文献检索灾害医师培训计划、科学证据,作为内容开发的基础。结果 最后课程由14个模块组成,每个模块教学事件2 小时。介绍灾难医学概念,包括灾难的响应、医疗救助、法律条款、指挥、协调、沟通和大规模灾难的管理。综述全球灾难援助的医院预案和经验。讨论灾难发生条件下挽救生命的急诊治疗与有限的个人治疗。介绍爆炸、战争、辐射/核事件、化学和生物事件尤其是传染病和恐怖袭击初始处理的特殊性。灾难疏散的演习,大规模灾难分诊分流与当地救灾机构合作的模拟。当地消防部门合作演练个人去污与净化。人体模型复苏练习,个人防护设备应用练习。职业道德、应激疾病、社会心理干预措施和质量改进的培训。结论 该课程设计提供了合理的时间框架、多学科、多实践的灾难医学教育模式,可以作为医学生灾难医学教育的基本模板。因其具有全面灵活的组织结构,其进一步深化,也有利于急救或灾难专业医疗学生的灾难医学教育课程     

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

BackgroundEmergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city.MethodsThis cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government''s public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity.ResultsIn the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity.ConclusionIf the hospital''s emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.     

建立适应我国国情的灾害医学救援队伍

我国灾害频发,但灾害医学救援力量仍较落后。基于自身的实践经验,笔者提出若干建议。应建立涉及不同层次的权威性卫生行政体系,建立人才储备库,包括医生,护士,流行病学家,疾病控制专家,消毒、杀菌专家,卫生监督人员,警察,司机等等。中国医学救援协会定期举办短期培训。各级卫生行政部门建立储备物品的动态信息管理系统,涉及药品、医疗设备,以及救援队必需的日用品,应指定经销商。必须保证医学救援队员一个星期的生活用品。要建立覆盖全国的医疗救援信息网络,救援队应具备通讯工具。