There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes that add value in a medical disaster situation. Some studies suggest that not only technical skills are needed, but also non-technical skills. However, little is known about the actual demands and skills needed to manage a medical disaster situation. Therefore, this scoping review aimed to identify core competencies required for the disaster medicine response.

A scoping review using the Arksey & O´Malley framework (1) was used. Structured searchers in the databases PuBMed, CINAHL full plus, Web of Science, PsychInfo and Scopus was conducted. Thereafter, data was structured and analyzed. Inclusion criteria were (1) original papers published in English during the last ten years, (2) covering any aspect of competence or skills needed to respond to a disaster situation. (3) Both qualitative and quantitative studies were included. Exclusion criteria were (1) reviews, editorial texts or similar, (2) papers focusing on the care of single patients.

(1) Arksey H, O’Malley L. Scoping Studies: Towards a methodological framework. Int. J. Social Research Methodology. 2005;8(1):19-32.

To be presented at the congress.

To be presented at the congress.

Disasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.

Using a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.

A total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.

Given that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.

Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.

To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.

The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel

Disaster response programs should ensure:

• Collection of data to identify vulnerable populations

• Establishment of procedures for monitoring and reporting

• Inclusion of female staff at all levels of planning and response

• Implementation of holistic services including physical and psychosocial care and legal response

• Safety in designing accommodations and distribution centers

Pre-Deployment training should include:

• Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence

• Familiarity with behaviors and conditions associated with gender-based violence

• Non-judgmental, supportive, and validating approach to inquiry and response

• Familiarity with risk assessment tools

• Mobilization of social supports

• Knowledge of resources, including medical and legal services

Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.

According to the Belgian Hospital Disaster Planning Act, all hospitals are required to have written disaster plans and to routinely conduct annual disaster drills. In 2010, three neighboring hospitals organized independently from each other an evacuation exercise of a critical care department (CCD): two university hospitals of a Dialysis Center and a One-day Surgery Clinic respectively and the military hospital of a Burn Unit.

To compare these CCD's evacuation plans and drills and the overall hospital emergency incident response and command system.

Conducting an evacuation exercise in a CCD, moving vulnerable highly dependent people towards an alternative shelter site is challenging, causing an important burden to ongoing medical specialist care, working staff and critical infrastructure. In all three CCD, it was decided to conduct a simulated evacuation exercise following an internal fire, thereby deploying fashioned simulated patients and visitors but bringing into action the regular attending medical, nursing and logistic staff. In each hospital a multidisciplinary design team was launched, consisting of the hospitals disaster preparedness coordinator, the EMS-staff, external emergency incident management and operational engineering experts. The appointed objectives for evaluation were the knowledge of the regular evacuation drills, especially the clearance of an intensive care or an operating room; access to evacuation routes; visibility of safety guidelines; need of specific evacuation equipment for the movement of patients; mission and tasks of the hospital's first response team and the medical incident manager; communication and information flow and the establishment of the hospital's coordination committee.

1. Simulated hospital evacuation exercises increased the hospital emergency preparedness, awareness and response to disasters within the hospital, in particular in a CCD, otherwise difficult to assess. 2. All three CCD experienced the same challenges and identified similar flaws. 3. A hospital disaster exercise manual might be of valuable help.

Standardization of data collection and reporting within EMTs is challenging. In past deployments, the Red Cross Red Crescent Type 1 and Type 2 facilities have collected data by hand using paper-based form and Excel spreadsheets. This process can be laborious, time-consuming, and often inaccurate.

To combat this issue with reporting, RCHIS (Red Cross Red Crescent Health Information System) has been designed to ensure that reporting is accurate and also very easy to complete, increasing compliance with the EMT-MDS reporting.

RCHIS is both an electronic medical record (EMR) and health information system (HIS). RCHIS has been designed to produce pre-made reports including the MDS in seconds, extracting data from the patient records. Through significant testing and pilot deployments in a domestic Type 1 fixed clinic, the rapid production of reports such as the MDS has increased compliance and accuracy with reporting.

Overall, the utilization of an electronic medical system for increasing compliance and accuracy with the MDS has been hugely successful. An in-depth analysis of the export data was done to confirm the 100% accuracy within the MDS report.

The utilization of RCHIS within a domestic ERU (equivalent to an EMT Type 1 or Type 2) has been hugely successful. The next steps will involve the deployment of RCHIS within an international deployment.

Use of Point-of-Care Ultrasound (US) has grown considerably in resource-limited and wilderness environments because of a combination of features, including portability, durability, and safety. However, the optimal method of powering US devices in such environments is not well established.

This project has the following aims:

1. 1. Develop a solar power generation and storage system that maximizes power capacity and minimizes weight while being easily transportable by a single person.

2. 2. Test the system in a real-world environment to evaluate actual performance relative to stated performance.

3. 3. Determine the approximate US scan-time where solar systems would outperform pre-charged batteries with respect to weight.

We developed multiple solar collecting systems using a combination of polycrystalline, monocrystalline, and thin-film solar arrays paired with different powerbanks and tested them using a variety of US systems. From this, the duration of usage was calculated, which makes the solar power generation system a superior option to pre-charged batteries.

Lithium-ion energy storage was found to be superior to lead-acid batteries for multiple reasons, most prominently, weight. Several models of US systems were tested revealing that portable US systems consume between 30 to 50 watts. Tri-fold monocrystalline solar panels coupled with lithium-ion powerbanks provided the best combination of weight and transportability. Total weight of the combined solar array, powerbank, and US system is 10 kilograms and easily packs into a backpack carrier. It was found that systems using solar generating capacity become superior to pre-charged powerbanks in regard to weight at approximately 14 hours of scanning time.

While these results are not fully generalizable due to seasonal and geographic variability as well as the type of US system used, use of solar generating capacity to power US systems is optimal for extended durations of use in resource-limited environments.

Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS).

This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1.

There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers.

Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

According to the Federal Bureau of Investigation (FBI), there were fifty active shooter incidents in 2016 and 2017. In the first five months of 2018, there have been 23 school shootings where someone was injured or killed. Hemorrhage-control tourniquets have proven their life-saving capability in the military and civilian EMS. Now, they are being advocated for use by civilians – the true “first responders.” Since Combat Application Tourniquets (CATs) are strap-and-windlass devices, the question remains whether a naïve population can intuitively apply them efficaciously.

To determine the efficacy (speed, correct placement) of a CAT by an interprofessional group of healthcare students naïve to tourniquet hemorrhage control.

Consenting students attempted to apply a CAT to a standardized patient with a simulated hemorrhaging brachial artery. No instruction was given except for the directions included in the package. Timing began upon removal of the tourniquet from the package and ended when the participants stated they completed their attempt. Errors in application were documented. Afterward, students received education and an opportunity to properly re-apply the tourniquet. The completion times of the students were compared to ten emergency medical technicians (EMT-P), serving as subject matter experts. Errors in application were categorized.

50 students from the following professions participated: Medicine, Nursing, Public Health, and Respiratory Therapy. The mean time of tourniquet application was 96.16 seconds (range: 25.12-226.31). This was statistically different from the EMT-Ps’ time of 42.83 seconds (range: 23.89-82.94). Additionally, only five (10%) placed the tourniquet correctly. Errors included improper location and windlass misuse or non-use. The instructions were frequently critiqued for being difficult to read and containing confusing graphics.

Provision of commercial tourniquets in public access areas must be accompanied by civilian education and the creation of CAT instructions that are simplistic, comprehensible, and suitably graphic.

Trauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.

The ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.

Participants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value < 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value < 0.001), with all groups reaching statistical significance.

This course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.

In 2007, several atoll islands in the Federated States of Micronesia (FSM) were inexplicably flooded by sea water.

To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations.

Households of Lukunoch and Oneop islands, FSM were assessed for demographics, asset damage, food availability, and water quantity and quality. Every fourth household on Lukunoch, (n = 40), was randomly selected and surveyed. All Oneop households were surveyed (n = 72). Prevalence data were analyzed.

A total of 112 total households were surveyed representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%–30%) reported a complete loss of taro and four (10%) of the 40 households (95% Cl. 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11(28%) of 40 households, (95% Cl. 15%–43%) reported damage from well salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well.

These findings suggest that FSM populations experienced disastrous losses due to a sea level rise event damaging crop productivity and freshwater sources.