With the development of the economy and the expansion of the hazardous chemicals industry in one city, it is necessary for the city to establish an evaluation model of emergency medical rescue capability for hazardous chemicals production, storage, and exposure risk.

Establish an emergency medical rescue capacity evaluation model for secondary and higher hospitals in a city to deal with exposure risks of hazardous chemicals.

1. 1. Develop an expert consultation form

2. 2. Develop a survey on the status quo of emergency medical rescue capacity of hospitals in secondary and above hospitals in response to exposure and risk of hazardous chemicals production and storage.

3. 3. Calculate the weights of the first, second, and third-grade indicators, and establish a comprehensive evaluation model for the rescue capacity assessment of Chengdu hospitals.

Five levels of first-level indicators were obtained, namely, the weights of the five indicators of “centralized admission ability,” “hospital comprehensive ability,” “emergency management ability,” “material equipment capability,” and “health emergency team” were 0.2884, 0.2219, 0.1938, 0.1507, and 0.1453, respectively.

The establishment of an emergency medical rescue capacity evaluation model for the risk of exposure and storage of hazardous chemicals in secondary and higher hospitals in a city is related to five capabilities, the most important of which is the ability to focus on admission.

Many triage algorithms exist for use in mass-casualty incidents (MCIs) involving pediatric patients. Most of these algorithms have not been validated for reliability across users.

Investigators sought to compare inter-rater reliability (IRR) and agreement among five MCI algorithms used in the pediatric population.

A dataset of 253 pediatric (<14 years of age) trauma activations from a Level I trauma center was used to obtain prehospital information and demographics. Three raters were trained on five MCI triage algorithms: Simple Triage and Rapid Treatment (START) and JumpSTART, as appropriate for age (combined as J-START); Sort Assess Life-Saving Intervention Treatment (SALT); Pediatric Triage Tape (PTT); CareFlight (CF); and Sacco Triage Method (STM). Patient outcomes were collected but not available to raters. Each rater triaged the full set of patients into Green, Yellow, Red, or Black categories with each of the five MCI algorithms. The IRR was reported as weighted kappa scores with 95% confidence intervals (CI). Descriptive statistics were used to describe inter-rater and inter-MCI algorithm agreement.

Of the 253 patients, 247 had complete triage assignments among the five algorithms and were included in the study. The IRR was excellent for a majority of the algorithms; however, J-START and CF had the highest reliability with a kappa 0.94 or higher (0.9-1.0, 95% CI for overall weighted kappa). The greatest variability was in SALT among Green and Yellow patients. Overall, J-START and CF had the highest inter-rater and inter-MCI algorithm agreements.

The IRR was excellent for a majority of the algorithms. The SALT algorithm, which contains subjective components, had the lowest IRR when applied to this dataset of pediatric trauma patients. Both J-START and CF demonstrated the best overall reliability and agreement.

It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims.

The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm.

Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools.

A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]).

Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.

In Australia, aeromedical retrieval provides a vital link for rural communities with limited health services to definitive care in urban centers. Yet, there are few studies of aeromedical patient experiences and outcomes, or clear measures of the service quality provided to these patients.

This study explores whether a previously developed quality framework could usefully be applied to existing air ambulance patient journeys (ie, the sequences of care that span multiple settings; prehospital and hospital-based pre-flight, flight transport, after-flight hospital in-patient, and disposition). The study aimed to use linked data from aeromedical, emergency department (ED), and hospital sources, and from death registries, to document and analyze patient journeys.

A previously developed air ambulance quality framework was used to place patient, prehospital, and in-hospital service outcomes in relevant quality domains identified from the Institutes of Medicine (IOM) and Dr. Donabedian models. To understand the aeromedical patients’ journeys, data from all relevant data sources were linked by unique patient identifiers and the outcomes of the resulting analyses were applied to the air ambulance quality framework.

Overall, air ambulance referral pathways could be classified into three categories: Intraregional (those retrievals which stayed within the region), Out of Region, and Into Region. Patient journeys and service outcomes varied markedly between referral pathways. Prehospital and in-hospital service variables and patient outcomes showed that the framework could be used to explore air ambulance service quality.

The air ambulance quality framework can usefully be applied to air ambulance patient experiences and outcomes using linked data analysis. The framework can help guide prehospital and in-hospital performance reporting. With variations between regional referral pathways, this knowledge will aid with planning within the local service. The study successfully linked data from aeromedical, ED, in-hospital, and death sources and explored the aeromedical patients’ journeys.

The preparedness for mass casualty is needed in political event. We have the experience to build up the disaster medical system in G8 summit in Okinawa and Hokkaido. But these two areas were resort area which had little population. This time Japan hosted APEC JAPAN 2010 which held in Yokohama City. We reported disaster medical system for this event in big city.

We mobilized DMAT from 21 hospitals whole Japan. We set 11 teams in Yokohama city, 10 teams in 2 Airports. DMAT inspected rerated disaster base hospitals. These hospitals made the plan for receive mass casualty included the victims by CBRNE event and had the exercise. They set up the decontamination system during APEC leader's week. We also have the contingency plan to coordinate with fire department. This contingency plan included transportation plan for hospitals and coordination plan in site. In transportation plan, sever casualty transported dispersal for hospital in Yokohama within 25. For over 25, sever casualty transported intensive for 4 hospitals in Yokohama. After stabilization treatment in these hospitals, the casualty transported dispersal from these hospitals to outside of Yokohama. In coordinate plan in site included job description in command and control, decontamination and medical relief post.

We established disaster medical system for APEC JAPAN 2010. This event hold in Yokohama City had the big population. Compare with former G8 summit, medical system put importance in mass casualty event. As a result, non mass casualty event happened. But this preparedness will contribute not only future same kind events but also accidental mass casualty event such as train accident.

The possibility of natural disasters and public health emergencies coupled with the possibility of terrorism clearly support the need to incorporate emergency preparedness and response material into the curricula for every health professional school in the nation.

To date, the focus has been on the education of the existing healthcare workforce. Students' needs differ from those of practitioners in that there is a fundamental difference between educational competencies and occupational competencies. It is also important to recognize that to assure proper preparedness there must be a clear connection between departments of public health and all other healthcare entities. To this end we included public health students in the creation of competencies and have shown that non-clinical practitioners can, and indeed must, be included in this process.

We describe a process and present a list of emergency preparedness core competencies for health care professions and their applicability to Medical, Dental, Nursing and Public Health students. While we have designed this set of competencies using these disciplines, they may be easily adapted to other healthcare disciplines. The only variations would be in the assignment of proficiency levels and the decision of whether or not clinical competencies are appropriate. The core competencies have been divided into the following four categories which represent broad subject areas and the separation of the competencies related to direct patient care:

• – Emergency Management Principles

• – Terrorism and Public Health Emergency Preparedness

• – Public Health Surveillance and Response

• – Patient Care for Disasters, Terrorism and Public Heath Emergencies.

Recordings of heatwaves date back to the early 1900s and usually are associated with high mortality. In Australia, heatwaves have been the major cause of natural hazard-related deaths. Heatwaves usually do not carry the global media coverage associated with other disasters, and frequently, are referred to as silent disasters. The main impact of heatwaves is on health and human life.

Preliminary results are presented for the 2009 heatwave, investigating the emergency department patient presentations from three public hospitals in Adelaide, a city in the central southern area of Australia.

Demographic and syndromic data were obtained from emergency department records. Ethics permission was obtained prior to data collection. Heatwave conditions occurred from 26 January–07 February 2009. Two non-heatwave periods were day-matched approximately two weeks before and after the heatwave. Data were analyzed by age groups, gender, and ICD codes for chronic conditions.

The two largest groups of people presenting were between 15 and 64 years of age and > 75 years of age during the heatwave and non-heatwave periods. During the heatwave period, both groups had significant increases in patient presentation related to renal problems (ICD 10: N000-N3999) and dehydration and hyperthermia (ICD10: E86, T67). The latter syndrome was far more accentuated during the heatwave, with emergency department patient presentations rising from 2 (non heatwave) to 62 presentations for the 15 and 64 years cohort and from 4 (non heatwave) to 91 for the > 75 years cohort. Cardiovascular- and respiratory-related presentations showed slight increases during the heatwave, while mental health had high presentations for the 15–64 year cohort throughout heatwave and non heatwave periods.

Both young and older people were affected by heatwave, and precautionary warning should be used throughout the community to alert people of the dangers underlying extreme heat conditions.