The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.

The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.

Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.

Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.

Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.

After a major earthquake, the assignment of scarce mental health emergency personnel to different geographic areas is crucial to the effective management of the crisis. The scarce information that is available in the aftermath of a disaster may be valuable in helping predict where are the populations that are in most need.

The objectives of this study were to derive algorithms to predict posttraumatic stress (PTS) symptom prevalence and local distribution after an earthquake and to test whether there are algorithms that require few input data and are still reasonably predictive.

A rich database of PTS symptoms, informed after Chile’s 2010 earthquake and tsunami, was used. Several model specifications for the mean and centiles of the distribution of PTS symptoms, together with posttraumatic stress disorder (PTSD) prevalence, were estimated via linear and quantile regressions. The models varied in the set of covariates included.

Adjusted R2 for the most liberal specifications (in terms of numbers of covariates included) ranged from 0.62 to 0.74, depending on the outcome. When only including peak ground acceleration (PGA), poverty rate, and household damage in linear and quadratic form, predictive capacity was still good (adjusted R2 from 0.59 to 0.67 were obtained).

Information about local poverty, household damage, and PGA can be used as an aid to predict PTS symptom prevalence and local distribution after an earthquake. This can be of help to improve the assignment of mental health personnel to the affected localities.

DussaillantF, ApablazaM. Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data. Prehosp Disaster Med. 2017;32(4):357–367.

Electronic waste (e-waste) is increasing worldwide and is often shipped from developed to developing countries. Many of these products contain toxic levels of metals, organics, etc. When unsafe recycling approaches or methods are used (e.g., burning wire to reclaim copper), the resulting occupational exposures can adversely affect the health of e-waste recyclers.

To identify which polybrominated and which polychlorinated dibenzo-p-dioxins/furans are higher in electronic waste recyclers when compared to non-recyclers.

This study focused on female e-waste recyclers and non-recyclers that live in rural northern Vietnam. Whole blood, urine, and serum of forty e-waste recyclers and twenty Vietnamese comparisons and were evaluated for metals, organics, and dioxin-like exposure by the Center for Disease Control. This paper will be reporting on serum organohalogens. The Vietnamese cohorts were compared to the U.S. general population, using the National Health And Nutrition Examination Survey. TEQ’s were calculated and statistical significance was determined using Wilcoxon Rank Sum Test. The IRB of the University of Texas Health Science Center Houston and the Ethics Board of the Hanoi School of Public Health oversee this study.

12378-PeCDF, 123678-HxCDD, 123678-HxCDF, and 1234678-HpCDF were significantly different between recyclers and Vietnamese comparisons. Total dioxin TEQ was higher in e-waste recyclers than comparisons. Of the polybrominated dioxins and furans, 12378-PeBDD and 2378-TeBDF were significantly different between recyclers and comparisons.

This is the only study with data on polybrominated dibenzo-p-dioxins/furans in female electronic waste recyclers from rural Northern Vietnam, and the first to describe serum levels of both polychlorinated and polybrominated dibenzo-p-dioxins/furans in Vietnamese female e-waste recyclers. Improved occupational protocols may reduce potential adverse health effects such as cancer, endocrine, reproductive, developmental, and other disorders.

Asia is one of the regions most affected by natural disasters such as major typhoons. In Japan, recovery from natural disasters is said to take more than 10 years, and local government officials are primarily responsible for this recovery. In this study, we investigated the effectiveness of the me-fullness® smartphone application in maintaining the well-being of local government employees involved in recovery efforts.

We conducted a survey of 35 employees of the town of Shichigahama, one of the areas affected by the 2011 Great East Japan Earthquake. The Chalder Fatigue Scale (CFS), Athens Insomnia Scale (AIS), and Depression, Anxiety and Stress Scale–21 Items (DASS-21) were used as survey instruments. 22 of the 35 employees used the me-fullness application on their smartphones for one month. During the month the application was in use, there was a heavy rain warning and an election for the House of Counselors, which the Shichigahama town employees had to cope with in parallel with the recovery from the Great East Japan Earthquake.

The percentage of insomnia indicated by an AIS score of four or higher was 53.5% (7/13) before and 30.8% (4/13) after the use of the me-fullness application. The percentage of stress was 38.5% (5/13) before and 7.7% (1/13) after the use of the me-fullness application.

This study showed that the me-fullness® application could improve the sleep and stress of local government employees and maintain their well-being for a long time during the recovery efforts.

In a disaster or mass casualty incident, the Emergency Department (ED) charge nurse is thrust into an expanded leadership role, expected to not only manage the department but also organize a disaster response. Hospital emergency preparedness training programs typically focus on high-level leadership, while frontline decision-making staff get experience only through online training and infrequent full-scale exercises. Financial and time limitations of full-scale exercises have been identified as major barriers to frontline training.

To discuss a cost-effective approach to training ED charge nurses and informal leaders in disaster response.

A formal training program was implemented in the ED. All permanent and relief charge nurses are required to attend one four-hour Hospital ICS course within their first year in their position, as well as participate in a minimum of one two-hour ED-based tabletop exercise per year. The tabletop exercises are offered bimonthly, covering various mass casualty scenarios such as apartment complex fires, riots, and a tornado strike. Full-scale exercises involving the ED occur annually.

ED permanent and relief charge nurses expressed increased skills and knowledge in areas such as initiation of disaster processes, implementation of hospital incident command, and familiarization with protocols and available resources. Furthermore, ED charge nurses have demonstrated strong leadership, decision-making, and improved response to actual mass casualty incidents since implementing ICS training and tabletop exercises.

Limitations of relying on full-scale disaster exercises to provide experience to frontline leaders can be overcome by the inclusion of ICS training and tabletop exercises for ED charge nurses in a hospital training and exercise plan. Implementing a structured training program for ED charge nurses focusing on leadership in mass casualty incidents is one step to building a more resilient and prepared ED, hospital, and community.

Heat stress is an occupational hazard for all personnel requiring Personal Protective Equipment (PPE). Even “breathable PPE” increases measurable heat stress in active troops and surgical personnel. A novel negative-pressure, semipermeable surgical cooling vests for use in the operating theater was jointly developed by Mountain Laurel Biomedical, Hamilton Sundstrand, and Hartford Hospital.

Surgical personnel alternated between wearing cooling garment vs no cooling under their surgical gowns (PPE) during surgical procedures lasting up to several hours. Tympanic temperatures were monitored for safety. A questionnaire was completed after the conclusion of surgery to assess perception of comfort. Trials began at ∼18 deg C, but ambient temperature was increased to 24 deg C (40–50% RH) for the third series of trials. Results: The study was terminated prematurely. After wearing the cooling vest, surgeons refused to complete additional control trials due to the heat. They demanded to use the cooling device for all surgery, even outside the protocol! Vest wearers remained dry and reported a statistically significant (p < 0.0001) greater level of comfort compared to control subjects. The weight, fit, and mobility restriction of the vest was not clinically significant.

Active cooling and drying using a negative pressure cooling vest improves subjective thermal comfort with minimal perceived impact on mobility during surgical procedures. This technology may have utility in other fields that utilize PPE. The Chemical Biological Warfare (CBW) ensemble, in particular, is a promising candidate. Heat stress from PPE ensemble even if “breathable” -Cooling at ∼100 watts with 18 deg C water -Semipermeable membrane allows condensation removal. Wearer stays cool and dry. -Negative pressure prevents coolant loss if punctured -Minimal perceived restriction of shoulder, neck, and waist range of motion - Light weight ∼1.5 lbs. (0.68 kg) - Quick disconnects allow options for cooling source.

As Hurricane Katrina bore down on New Orleans in August 2005, the city's mandatory evacuation prompted the exodus of an estimated 80% of its 485,000 residents. According to estimates from the US Centers for Disease Control and Prevention (CDC), at least 18 states subsequently hosted >200,000 evacuees.

In this case study, “Operation Helping Hands” (OHH), the Massachusetts health and medical response in assisting Hurricane Katrina evacuees is described. Operation Helping Hands represents the largest medical response to evacuees in recent Massachusetts history.

The data describing OHH were derived from a series of structured interviews conducted with two leading public health officials directing planning efforts, and a sample of first responders with oversight ofoperations at the evacuation site. Also, a literature review was conducted to identify similar experiences, common challenges, and lessons learned.

Activities and services were provided in the following areas: (1) administration and management;(2) medical and mental health; (3) public health; and (4) social support. This study adds to the knowledge base for future evacuation and shelter planning, and presents a conceptual framework that could be used by other researchers and practitioners to describe the process and out comes of similar operations.

This study provides a description of the planning and implementation efforts of the largest medical evacuee experience in recent Massachusetts history, an effort that involved multiple agencies and partners. The conceptual framework can inform future evacuation and shelter initiatives at the state and national levels, and promotes the overarching public health goal of the highest attainable standard of health for all.

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.