The assessment of hospital disaster preparedness and response performance is a way to find and remove possible gaps and weaknesses in hospital disaster management effectiveness. The aim of this pilot study was to test the association between the level of preparedness and the level of response performance during a full-scale hospital exercise.

This pilot study was conducted in a hospital during a full-scale exercise in the Piedmont region of Italy. The preparedness evaluation was conducted by a group of three experts, three days before the exercise, and the response evaluation was conducted during the exercise. The functional capacity module was used for preparedness evaluation, and the response performance of the “command and control” function of the hospital was evaluated by nine semiquantitative performance indicators.

The preparedness of the chosen hospital was 59%, while the response performance was evaluated as 70%. The hospital staff conducted Simple Triage and Rapid Transport (START) triage while they received 61 casualties, which was 90% correct for the yellow group and 100% correct for the green group.

This pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures. An experimental study including a group of hospitals, also using more comprehensive evaluation tools, should be done to evaluate the correlation between the level of preparedness and the response performance of a hospital, and the impact of hospital disaster planning, on the outcome of disasters victims.

DjalaliA, CarenzoL, RagazzoniL, AzzarettoM, PetrinoR, Della CorteF, IngrassiaPL. Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study. Prehosp Disaster Med. 2014;29(4):1-7.

Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.

The aim of this research was to determine the international research priorities for disaster nursing.

This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.

Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.

Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.

RanseJ, HuttonA, JeeawodyB, WilsonR. What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study. Prehosp Disaster Med. 2014;29(5):1-7.

Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting.

This study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test.

One hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).

JohnsonEM, DiekemaDS, Lewis-NewbyM, KingMA. Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion. Prehosp Disaster Med. 2014;29(5):1-6.

No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact.

Group consensus methods can be used to develop measures of effectiveness detailing the major functions of post natural disaster acute phase medical response.

A review of peer-reviewed disaster response publications (2001-2011) identified potential measures describing domestic and international medical response. A steering committee comprised of six persons with publications pertaining to disaster response, and those serving in leadership capacity for a disaster response organization, was assembled. The committee determined which measures identified in the literature review had the best potential to gauge effectiveness during post-disaster acute-phase medical response. Using a modified Delphi technique, a second, larger group (Expert Panel) evaluated these measures and novel measures suggested (or “free-texted”) by participants for importance, validity, usability, and feasibility. After three iterations, the highest rated measures were selected.

The literature review identified 397 measures. The steering committee approved 116 (29.2%) of these measures for advancement to the Delphi process. In Round 1, 25 (22%) measures attained >75% approval and, accompanied by 77 free-text measures, graduated to Round 2. There, 56 (50%) measures achieved >75% approval. In Round 3, 37 (66%) measures achieved median scores of 4 or higher (on a 5-point ordinal scale). These selected measures describe major aspects of disaster response, including: Evaluation, Treatment, Disposition, Public Health, and Team Logistics. Of participants from the Expert Panel, 24/39 (63%) completed all rounds. Thirty-three percent of these experts represented international agencies; 42% represented US government agencies.

Experts identified response measures that reflect major functions of an acute medical response. Measures of effectiveness facilitate real-time assessment of performance and can signal where practices should be improved to better aid community preparedness and response. These measures can promote unification of medical assistance, allow for comparison of responses, and bring accountability to post-disaster acute-phase medical care. This is the first consensus-developed reporting tool constructed using objective measures to describe the functions of acute phase disaster medical response. It should be evaluated by agencies providing medical response during the next major natural disaster.

DaftaryRK, CruzAT, ReavesEJ, BurkleFMJr, ChristianMD, FagbuyiDB, GarrettAL, KapurGB, SirbaughPE. Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response. Prehosp Disaster Med. 2014;29(5):1-7.

Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.

This study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness.

Deidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone.

The primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business.

All three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions.

SeamanEL, LevyMJ, JenkinsJL, GodarCC, SeamanKG. Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data. Prehosp Disaster Med. 2014;29(4):1-6.

The aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.

This study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.

Two thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).

In-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.

HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital Care and In-hospital Mortality of Trauma Patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

This study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia.

A phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings.

Emergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training.

Emergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.

LeggioWJJr. The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study. Prehosp Disaster Med. 2014;29(5):1-6.

Shortening response time to an emergency call leads to the success of resuscitation by chest compression and defibrillation. However, response by ambulance or fire truck is not fast enough for resuscitation in Japan. In rural areas, response times can be more than 10 minutes. One possible way to shorten the response time is to establish a system of first responders (eg, police officers or firefighters) who are trained appropriately to perform resuscitation. Another possible way is to use a system of Community First Responders (CFRs) who are trained neighbors. At present, there are no call triage protocols to decide if dispatchers should activate CFRs.

The aim of this study was to determine the predictability to detect if dispatchers should activate CFRs.

Two CFR call triage protocols (CFR protocol Ver.0 and Ver.1) were established. The predictability of CFR protocols was examined by comparing the paramedic field reports. From the results of sensitivity of CFR protocol, the numbers of annual CFR activations were calculated. All data were collected, prospectively, for four months from October 1, 2012 through January 31, 2013.

The ROC-AUC values appear slightly higher in CFR protocol Ver.1 (0.857; 95% CI, 79.8-91.7) than in CFR protocol Ver.0 (0.847; 95% CI, 79.0-90.3). The number of annual CFR activations is higher in CFR protocol Ver.0 (7.47) than in CFR protocol Ver.1 (5.45).

Two call triage protocols have almost the same predictability as the Medical Priority Dispatch System (MPDS). The study indicates that CFR protocol Ver.1 is better than CFR protocol Ver.0 because of the higher predictability and low number of activations. Also, it indicates that CFRs who are not medical professionals can respond to a patient with cardiac arrest.

NarikawaK, SakamotoT, KubotaK, SuzukawaM, YonekawaC, YamashitaK, ToyokuniY, YasudaY, KobayashiA, IijimaK. Predictability of the Call Triage Protocol to Detect if Dispatchers Should Activate Community First Responders. Prehosp Disaster Med. 2014;29(5):1-5.

Every mass gathering presents its unique characteristics that influence medical resource utilization. Medical planning for mass gatherings involves both use of predictive models and analysis of data from similar past events. This study aimed to describe the medical presentations and the unique challenges influencing medical planning at the Formula One Singtel Singapore Grand Prix, the inaugural Formula One night race. Patient presentation characteristics, rates of patient presentation, and transportation to hospitals in association with attendance and heat index were evaluated over a 4-year period from 2009 through 2012. This will facilitate medical planning for similar events.

A database containing patient presentations from the 3-day Singapore Grand Prix in 2009, 2010, 2011, and 2012 was analyzed. Patient presentations were categorized by time of day and presenting complaints. Patient presentation rates (PPRs) were analyzed to determine correlation with attendance numbers and heat index.

The average annual attendance at the Singapore Grand Prix was 81,992 from 2009 through 2012. The average PPR was 2.17 (SD=0.63)/1,000 attendees. The average transport to hospital rate (TTHR) was 0.033 (SD=0.026)/1,000 attendees. While medical coverage was provided at the circuit park between 2:00 pm to 1:00 am daily, most attendees presented from 5:00 pm to 10:00 pm. The most common presenting complaints included: musculoskeletal conditions (59%) and heat related illnesses (19%). There was no correlation between attendance numbers and PPR and the heat index and PPR.

Musculoskeletal conditions and heat-related illnesses were the most common presenting complaints at the Singapore Grand Prix from 2009-2012. The lack of correlation between heat index and PPR is a new finding compared with prior studies. This could be due to the minimal heat variation that occurred during the night event. Further study is required to refine models that can be used in specialized events.

HoWH, KoenigKL, QuekLS. Formula One Night Race in Singapore: A 4-Year Analysis of a Planned Mass Gathering. Prehosp Disaster Med. 2014;29(5):1-5.

Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed.

Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target.

This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts.

From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration.

While there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission.

Redwood-CampbellLJ, SekharSN, PersaudCR. Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment. Prehosp Disaster Med. 2014;29(5):1-5.

On March 4, 2012, an arms dump exploded in a densely populated area in Brazzaville, Republic of the Congo. At least 250 people were killed, 2,500 wounded, and 13,800 left homeless, of which 5,000 were relocated to a newly constructed internally displaced person (IDP) camp.

To describe the medical complaints of persons presenting to the IDP camp for medical evaluation.

All patients seen and treated by the Belgian First Aid and Support Team (B-FAST) in the IDP camp on March 10 and 11, 2012 were included. A unique number, age, gender, and inventory of complaints were registered on standard World Health Organization (WHO) forms.

Out of 245 presenting patients, 242 files were processed. One in two patients were minors (<18 years-old), the male/female ratio was 50/50 in minors and 28/72 in adults; median (range) age in minors was three years (0-17) and for adults was 32.5 years (18-68). Twenty percent of the children were determined to be malnourished. Signs and symptoms related to infectious diseases were present in 75% of minors and 53% of adults. Trauma was present in 12% of minors and 21% of adults.

One week following the disaster event, after people had relocated to IDP camps, infectious diseases became the predominate reason for seeking medical evaluation. Less than one in five people presenting to the medical post had injuries directly related to the event. Demographic data showed that around 50% of people in the IDP camp presenting for medical care were children, of which one in five was malnourished.

RoggenI, van BerlaerG, GijsG, HubloueI. Clinical Characteristics of the Inhabitants of an Internally Displaced Persons Camp in Brazzaville, Republic of Congo After the Arms Dump Blast on March 4, 2012. Prehosp Disaster Med. 2014;29(5):1-5.

Red Bull Stratos was a commercial program that brought a test parachutist, protected by a full-pressure suit, in a stratospheric balloon with pressurized capsule to over 127,582 ft (38,969 m), from which he free fell and subsequently parachuted to the ground. Given that the major risks to the parachutist included ebullism, negative Gz (toe-to-head) acceleration exposure from an uncontrolled flat spin, and trauma, a comprehensive plan was developed to recover the parachutist under nominal conditions and to respond to any medical contingencies that might have arisen. In this report, the project medical team describes the experience of providing emergency medical support and crew recovery for the manned balloon flights of the program.

The phases of flight, associated risks, and available resources were systematically evaluated.

Six distinct phases of flight from an Emergency Medical Services (EMS) standpoint were identified. A Medical Support Plan was developed to address the risks associated with each phase, encompassing personnel, equipment, procedures, and communications.

Despite geographical, communications, and resource limitations, the medical team was able to implement the Medical Support Plan, enabling multiple successful manned balloon flights to 71,615 ft (21,828 m), 97,221 ft (29,610 m), and 127,582 ft (38,969 m). The experience allowed refinement of the EMS and crew recovery procedures for each successive flight and could be applied to other high altitude or commercial space ventures.

BlueRS, NortonSC, LawJ, PattariniJM, AntonsenEL, GarbinoA, ClarkJB, TurneyMW. Emergency Medical Support for a Manned Stratospheric Balloon Test Program. Prehosp Disaster Med. 2014;29(5):1-6.