The incidence and mortality of traumatic brain injury (TBI) has increased rapidly in the last decade in China. Appropriate ambulance service can reduce case-fatality rates of TBI significantly. This study aimed to explore the factors (age, gender, education level, clinical experience, professional title, organization, specialty before prehospital care, and training frequency) that could influence prehospital doctors’ knowledge level and practices in TBI management in China, Hubei Province.

A cross-sectional questionnaire survey was conducted in two cities in Hubei Province. The self-administered questionnaire consisted of demographic information and questions about prehospital TBI management. Independent samples t-test and one-way ANOVA were used to analyze group differences in the average scores in terms of demographic character. General linear regression was used to explore associated factors in prehospital TBI management.

A total of 56 questionnaires were handed out and 52 (93%) were returned. Participants received the lowest scores in TBI treatment (0.64; SD=0.08) and the highest scores in TBI assessment (0.80; SD=0.14). According to the regression model, the education level was associated positively with the score of TBI identification (P=.019); participants who worked in the emergency department (ED; P=.011) or formerly practiced internal medicine (P=.009) tended to get lower scores in TBI assessment; participants’ scores in TBI treatment were associated positively with the training frequency (P=.011); and no statistically significant associated factor was found in the overall TBI management.

This study described the current situation of prehospital TBI management. The prehospital doctors’ knowledge level and practices in TBI management were quantified and the influential factors hidden underneath were explored. The results indicated that an appropriate continuing medical education (CME) program enables improvement of the quality of ambulance service in China.

KouK , HouXY , SunJD , ChuK . Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings. Prehosp Disaster Med. 2015;30(6):560–568.

Dogs left behind in the restricted area by the Great East Japan Earthquakes of 2011 (Fukushima Prefecture, Japan) were initially rescued at a temporary first response shelter under chaotic conditions: poor housing and husbandry was maintained by unfamiliar/untrained staff, and lack of exercise was associated with deterioration of the mental and physical health of the impounded dogs. The objectives of this study were to report characteristics, disposition, and health status of dogs rescued in the Fukushima Prefecture, and to perform a retrospective epidemiological evaluation of factors associated with disposition and disease incidence at shelters.

The problems addressed in this study were shelter-related health issues at the first response shelter and reasons for retained adoption at the secondary shelter that caused delayed closure of the shelter.

A retrospective cohort study was performed with all dogs that were rescued from the restricted area in the Fukushima Prefecture. Kaplan-Meier time-to-event analysis was performed to estimate the median days to outcomes. A chi-square test of homogeneity was used to determine whether ownership status was associated with breed. Cox proportional hazards regression models were used to assess the association between time-to-adoption with ownership status, age, sex, and breed, the association between time to onset of diarrhea with age and breed, and between duration of diarrheic symptoms with the number of antibiotics and the number of medications.

Five-hundred and twenty-nine dogs were admitted to the Ihno and Miharu shelters (Fukushima Prefecture), including 179 that had detailed medical records. Seventy-six percent of dogs were mixed breed. Twenty-six percent of dogs had verified ownership, and almost 16% of dogs were reclaimed by their owners. Sixty-six percent of dogs developed diarrhea, and 17 different antibiotics were used to treat it. Using three or more different antibiotics was associated with prolonged signs of diarrhea. Dogs with verified ownership took longer for adoption than those without verified ownership. Breed and sex were not significantly associated with time to adoption. Age was associated with prolonged time to adoption.

To improve the welfare of dogs in disasters, responsible owner education, a well-organized registered volunteer training program for care of animals at shelters, proper disease management protocols, and enrichment strategies to prevent stress and disease in shelter setting are essential.

TanakaA, Martinez-LopezB, KassP.Epidemiological Evaluation of Dogs Rescued in the Fukushima Prefecture Following the Great East Japan Earthquakes of 2011. Prehosp Disaster Med. 2018;33(5):478–583.

India is one of the most flood prone countries in the world, flooding annually about 9 million hectares and accounting for one-fifth of global flood deaths. Approximately 56.5 % of flood-affected Indians live in Bihar. Out of 38 districts in Bihar, 22 are flood prone, including Begusarai. The life line to the community is the Primary Health Center (PHC) which is at stake during a disaster such as floods.

To study the status of primary health care in rural parts of Begusarai during recurring floods, a survey was undertaken to analyze the preparedness and response mechanism at various hospital levels. The status of rural hospitals during a flood was represented by a case study on the PHC of Bakhri block of Begusarai district. To determine the prevailing situation during floods, the chief medical officers of each level of health care centers were interviewed.

The PHC of Bakhri caters to a population of about 408,896, which is four times the normal load for a PHC. In 2007, it was affected severely by flooding from the Baghmati River. The PHCs that were studied perennially face a shortage of human resource and infrastructural support. This is compounded by unsafe locations and structural hazards associated with the hospital building, rendering the working conditions unsafe for the medical team during disasters.

This paper envisages the functionality and challenges of healthcare providers during floods despite their limited available resources. The prevailing case scenario demonstrates the challenges in rural India, and the best practices for safe rural hospitals in coping with disasters in a resource-poor setting will be discussed.

An activity or situation that produces conditions which are not real, but have the appearance of being real, used especially for testing something. Longman Dictionary of Contemporary English. Simulation has evolved over the centuries but has not been applied to medicine until the 20th century with the introduction of virtual reality and computers. Prior to the 20th century simulation took the forms of physical models and cadavers. With the introduction of flight simulation there was an effort to move similar approaches into medicine. This was pushed by the demands of minimally invasive surgery and the introduction of robotics in surgery. In the 21st century in addition to cognitive task analysis tools we are beginning to see the migration of advanced intelligence tools to simulation. We are just at the beginning of how we will use adversarial reasoning in the medical environment and in high risk time constrained situations like Emergency Medicine. The practitioner of emergency medicine is at high risk for errors because of multiple factors including high decision density, high levels of diagnostic uncertainty, high patient acuity, and frequent distractions. Some authors have suggested that instructing physicians in “cognitive forcing strategies” or “metacognition” will help reduce the amount of cognitive error in medical practice. It has been said ‘‘[There is an] ethical obligation to make all efforts to expose health professionals to clinical challenges that can be reasonably well simulated prior to allowing them to encounter and be responsible for similar real-life challenges.’' TYPES OF SIMULATION • Verbal • Tactile • Visual • Situational • Environmental TYPES OF SIMULATION TRAINING • Standardized patients (role play) • Basic models (partial task trainers) • Simple level • Higher level • Mannequins • Low fidelity • High fidelity • Virtual patients • Screen-based; computer-based • COMBINATIONS • Augmented sp encounters with technology • Crises management HUMAN PATIENT SIMULATION • Realistic • Suitable for all levels • Safe • Wide variety of training programs • Expensive ADVANTAGES OF SIMULATION • Patients are never at risk • Serious but infrequent events, in predictable times and places • Errors can be allowed to occur, and play-out • Rehearsal, repetition, mastery • Crisis management simulation, planning • Reduces institutional liability • Increases operational confidence • Produces rapid results • Allows team training • Increases institutional prestige The use of high fidelity simulations to train multidisciplinary teams in critical environments is well established.

Poisoning is a public health problem that effects all ages, genders, and ethnicities, but certain populations are at increased risk. Unintentional poisoning disproportionately affects lower- and middle-income countries. The epidemiological pattern of poisoning can differ significantly within countries. In Thailand, national poisoning data is collected by voluntary reporting to a poison control center in the capital, Bangkok. Limited poisonings are reported from Chiang Mai, a province in Northern Thailand, though it has the highest suicide rate in the country.

The aim of this study is to describe poisoning epidemiology, examine differences between intentional and unintentional poisonings and, to develop a multivariate predictive model of intentional poisonings in Northern Thailand.

A total of 550 poisoning admissions were identified at Chiang Mai's University Hospital from 01 January 2005 to 31 December 2005. Demographic data were collected retrospectively by manual chart review. Chi-square and t-tests were used to examine differences in poisoning by intent. A step-wise logistic regression analysis was performed to develop a predictive model of intentional poisonings. Factors significantly associated with intentional poisoning were used in a logistic progression model to identify predictors of intentional poisoning.

Younger age was significantly associated with intentional poisoning. There was no demonstrated difference in gender and poisoning intent. Predictors of intentional poisonings were use of chemical agents, high-risk medications (analgesics and psychiatric), unemployment, and younger age.

Interventions should focus on factors that put young adults and the unemployed at greater risk for intentional poisonings. Further interventions are also needed to limit access to potentially lethal doses of chemical agents and high risk medications.

In the southern Philippines, human-induced disasters, such as terrorist attacks, have caused unprecedented damage to the economic, social, and political life of the attacked and nearby areas. More gruesome is the direct impacts to human life and wellbeing. This study focuses on the 2017 Marawi armed siege, the longest urban battle in the Philippines. The 154-day siege took a heavy toll, including 1,132 deaths among militants, soldiers, police, and civilians, and caused the displacement of some 400,000 local inhabitants. The city is in total ruins leaving its economic center as “Ground 0.” The aftermath of the siege demands major interventions to address physical and economic damages, but more importantly, to ameliorate the human impacts caused by the brutalities of war. The displaced peoples need to recover from health impacts – psychological trauma, as well as social, environmental, and cultural. The Sendai Framework for Disaster Risk Reduction (DRR) 2015-2030 states that DRR requires society-wide engagement. Everyone, regardless of their age, gender, ethnicity, religion, or socio-economic position, should be involved in thinking, planning, and deciding about DRR. Studies on youth participation in disaster recovery are still scarce.

This current research aims to help fill this gap and to contribute to providing the much-needed evidence base for the formulation and implementation of future policies to enable and improve youth participation in post-disaster initiatives in the Philippines.

Initial findings reveal that the following are crucial factors for youth mobilization: (1.) avenues for volunteering, (2.) access to adequate resources and support including information, funds, manpower, and social capital, (3.) opportunities for the youth to participate in the form of events or activities, (4.) legal mandate for youth participation in local, national, and international policies and frameworks. The study also looked at barriers or challenges to youth participation and their motivations.