The general public's association with livestock (cattle, sheep and horses) raises a need for public safety. During emergency/disasters, animals are accidentally/intentionally released from containment structures. Loose livestock become agitated with unpredictable behavior which is a risk to both humans and animals. Specific training/protocols for responders are necessary for dealing with livestock.

Livestock running loose in populated areas raises risks to people, especially during capture attempts. Untrained personnel subject themselves to undue danger when assisting with livestock capture. Capture plans should be in place in advance and training should be provided to first responders on safety issues regarding animals.

A review of a loose livestock event brought forth the following considerations: (1) Evaluate the risks of a loose livestock/public event; (2) Inspect containment facility and identify secondary containment barriers, including fencing, buildings, rivers, etc.; (3) Develop plan for capture and containment within the immediate facility and surrounding area; (4) Provide training: training exercises, animal capture, basic animal behavior, and Incident Command System for first responders; (5) Arrange for emergency care or humane euthanasia for injured animals; (6) Coordinate capture and transport activities with local livestock experts.

Production of a comprehensive loose livestock plan can prevent injury and/or death to both people/animals. Agencies involved in safety and emergency response should have a well written plan that can be used by all appropriate local agencies involved in loose livestock response. The utilization of a loose livestock worksheet (template) with professional training is essential for emergency response agencies.

Disaster managers should develop a comprehensive plan and training program with other local agencies in advance of an event to respond effectively to capture loose livestock.

Every year, the City of Zurich hosts the “Street Parade”. This is one of the biggest European “techno parade” dance parties attracting way over a half a million mostly young people who party on a 2 km route along the lakeside of the City. Many of these guests drink alcohol and some eventually consume other drugs (e.g., GHB, Ecstasy, LSD). Combinations of these drugs may affect conscience eventually leading to a critical medical condition. Until recently the emergency-posts at the scene, as well as the emergency rooms of the local hospitals have been “flooded” with such patients, leading to obvious logistical problems.

Over the last years the Ambulance Service of the City of Zurich utilized an unused shelter close to the event scene, where these “intoxicated” mostly young patients were medically supervised and taken care of. The shelter has room for 108 patients. Every patient is first triaged; if a patient suffers from something else than just “intoxication” (e.g., cuts from broken glass) he is sent directly to the hospital for adequate treatment. The patients are then numbered, if needed showered, and receive a bed where they are regularly assessed for pulse, oxygen saturation, blood pressure and GCS by professional personnel. In parallel, if their clothes are dirty, they are washed and dried so the patient will have something clean to dress at the moment of dismissal. The average time of the patients in this shelter is 3 hours 7 minute and the charge is 600 CHF (approx 620 USD). This system has been so helpful for the hospitals, they now supply medical personnel for no cost.

This system of triage and separate medical supervision of “simply” intoxicated patients has been successful in the management of a large number these kind of patients.

In the past decade, India has witnessed many lapses in crowd safety during mass gatherings. The high casualty rate in stampedes during traditional mass gatherings has prompted the study of these events. Wide variations exist in casualty rates for similar events, and key issues in healthcare services in these special situations were addressed in the Indian context.

From 2001–2010, Mass gathering data were collected from news items reported in the archives of newspapers, “The Times of India”, “The Hindu” and “The Indian Express”. The keywords used were: “stampede”, “mass gathering”, “mass-gathering events”, “mass-gathering incidents”, “crowd”, and “crowd management”. The study included triggers for the incident and the number of casualties (dead and injured) in each incident.

In 27 separate mass gatherings in India, there were 936 dead and 540 injured casualties. The unique characteristics of mass gatherings in India included a predominance of old and vulnerable people in traditional mass gatherings, in contrast to the young and middle-aged groups who gather for music and sporting events elsewhere. Further, alcohol/substance abuse, brawls, and violent behavior were absent at traditional Indian mass gatherings. Non-traditional mass gatherings accounted for a lesser number of incidents in India, and were located in movie theatres and railway stations.

In a populous country like India, traditional mass gatherings predominate, and ensuring the health, safety, and security of the public at such events will require an understanding of crowd behavior, critical crowd densities, and crowd capacities in the Indian context. However, planning for mass gatherings can be developed using the existing body of knowledge of mass-casualty preparedness, food safety, and health promotion.

Unpredictable environmental conditions, crowd dynamics, and a variety of medical emergencies create logistical and clinical obstacles when planning emergency medical response coverage for mass-gathering events. In a collaborative endeavor between a university athletics program and an academic division of Emergency Medicine, a stadium emergency medical response system was created consisting of hospital-based healthcare providers and pre-hospital healthcare providers.

Provide descriptive statistics relevant to the nature and frequency of injury/illness, location of treatment within stadium confines, and resources used in the care of students, event staff, and spectators during collegiate football operations, to assist in future planning of mass-gathering events.

A continuously updated, quality assurance database of de-identified, aggregate statistics was utilized to analyze trends regarding aspects of medical operations.

During a 7-game home football season, there were a total of 399 patients encounters, including 1 cardiac arrest (0.25%), 12 “life-threatening” (3.01%), 121 urgent (30.33%), and 266 routine (66.67%). Total season attendance was 201,248 attendees (28,749/game and 19.83 patients encounters per 10,000 in attendance). Twenty-eight patients were transported (1.39 per 10,000), with eight resultant hospital admissions. Encounters varied by complaint, with skin (42%) comprising the largest number of encounters. Other categories included: (1) heat-related (23.5%); (2) allergic (15%); (3) neurologic (10.3%); (4) cardiopulmonary (3.5%); (5) gastrointestinal (3.6%); (6) musculoskeletal (5%); and (7) other (5%). Encounters increased noticeably when the heat index was greater than 80 °F– (29.4 vs. 10.5 per 10,000 attendees).

The collaborative effort by a multi-level provider model adequately covered presenting medical conditions. Consistent with previously literature, a strong correlation existed between heat index and number of patient encounters deemed urgent and routine. Interestingly, the number of “life-threatening” encounters did not appear to vary much with the heat index. Further studies of medical presentations and provider/resource utilization could provide for predictive modeling of future staffing and supply models.

Mass gatherings pose a significant risk on health and safety. The mass gathering in the subway systems in Beijing represents a daily risk. An average of 4.52 million passengers rode the subway each day between 15 November and 30 November 2010, with the highest daily passenger number totaling 5.14 million. The purpose of this study is to identify the health and safety aspects of mass gatherings in Beijing subways, and proposes strategies that may mitigate these risks.

The methods included a literature review, field visitation of the subway systems, and interviews of 20 passengers and 10 management personnel from the subway system.

Many safety and health measures has been taken by the Beijing Subway System, including emergency exit signs and other safety signs, prohibition of smoking, firefighting equipment and explosion-proof tanks, safety inspection of bags, and safety education in the subways. However, additional key health and safety aspects were indentified, including: (1) lack of strict flow control of passengers in interchange subway stations; (2) lack of platform safety gates in Line 1, Line 2, Line 13; (3) lack of passenger control during peak hours; (4) lack of biomedical monitoring systems in the subways; and (5) lack of health facilities and rescue equipments in the subways.

Mass gatherings pose great risks on subway passengers in Beijing, including psychosocial risks, biomedical risks, and environmental risks. Additional safety measures need to be taken to ensure the safety and health of passengers in subways in Beijing.

The Pacific Arts Festival is a mass-gathering event occurring every four years in Oceania. The 10th festival in American Samoa, July 20 to August 2, 2008, brought 2200 performers and 2500 tourists (a 15% population increase) from 27 Pacific nations to the island. Anticipated healthcare concerns included hospital surge (175% in 2004), HIV/STI transmission, imported/communicable diseases, food/water/sanitation-borne illness, interpersonal violence, and healthcare resource utilization.

To describe the preparedness and response efforts for this mass gathering event by emergency medical services, the hospital, and the department of health.

A retrospective review of after-action reports, public health and emergency department surveillance records, and key-informant interviews was conducted. Descriptive statistics were used to evaluate data.

A Unified Command structure was utilized for pre-/post-event response. Patient surveillance data was collected daily. During the festival 217 participants (42% female, 58% male, Average age 36) sought medical care. Acute illness (n = 166), injury (n = 39), other (n = 15), routine follow up (n = 9), chronic conditions (n = 6), mental health (n = 1), OB/GYN (n = 1) were complaints addressed. Predominant acute illnesses included headache (n = 49, 23%), respiratory illness (n = 30, 14%), musculoskeletal pain (n = 26, 12%), and gastroenteritis (n = 17, 8%). One fatality occurred among delegates. No public health outbreaks were reported. Visits per healthcare venue demonstrated a decentralization of patient surge from the hospital setting (37.4% venue aid stations, 28.1% delegation medical staff, 24% DOH clinic, 10.6% hospital).

A unified health command structure was effective in responding to this mass gathering event. Surveillance data was rapidly gathered and utilized to direct healthcare resources. Efforts to decentralize healthcare from the hospital were successful. Public health emergencies were avoided.

Human-stampede events are emerging epidemics with large unplanned or impromptu mass gatherings. They are increasing in frequency worldwide, yet little is known of the epidemiology and other characteristics that would allow for communities to prepare, prevent and properly manage medical outcomes. We report a non-traditional methodology to identify a stampede's epidemiological characteristics using news reports, social networking, and systematic search of the internet. This hitherto unused technological dimension is a useful adjunct to obtain crucial data on mortality and morbidity, improve immediate understanding of the pathophysiology of the event, and provides opportunities to develop public education to remove potential bottlenecks and improve crowd control of these preventable tragedies.

A LexisNexis search was followed by sequential searches of multiple internet-based English-language news agencies and the few research reports available in the scientific literature. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Descriptive analysis was performed for deaths, injuries and location for this abstract.

Following an extensive search of media accounts and research reports, a total of 263 human stampede events were identified worldwide between 1980 and 2011 resulting in 8,268 deaths and over 16,707 injuries. Major Religious assemblages, particularly in India and the Middle East, accounted for the highest number of fatalities. Precipitants of stampedes follow a geographical pattern; In Africa, sporting and political events and in Europe, entertainment venues sparked stampedes. This case series reports 7 incidents in China. All cases occurred in the recess hour of schools, when students formed a bottleneck at narrow staircases, resulting in 27 deaths and 168 injured.

Understanding the triggers in mass gatherings for a human stampede have been greatly aided by advances in social networking, internet and video mobile phones. Particularly in difficult environments which were previously difficult to document. The patterns identified in this study can appreciably add to community level preparedness, prevention and improved clinical understanding and management at prehospital and hospital levels.

The purpose of this study was to find the change in knowledge regarding disaster management among nurses after educational intervention.

One group pretest and post test design was adopted for the study. The study was carried out in B.P. Koirala Institute of Health Sciences, Nepal. Forty Nurses were selected from emergency, orthopedics, medicine, and surgical ward by using non-probability convenience sampling technique. A self-administered semi-structured questionnaire was used to collect the data. Data was collected before and after the educational intervention. The collected data were analyzed using descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Chi-square and Z test) were used to identify the difference in knowledge between pre-test and post-test, at 0.05 level of significance.

Study findings revealed that in the pre-test, grand mean of the means of the nurses' knowledge on different aspects of disaster management as a whole was 2.39 with the standard deviation of 0.87. Similarly the grand mean of means of knowledge on different aspects of disaster management was 3.2 with the standard deviation of 0.47 in the post-test. The difference between pre-test and post-test in respondents' knowledge in different aspects of disaster management as a whole was calculated by using “Z” test (p < 0.05) The result showed that the educational intervention was effective in bringing changes in knowledge in all aspects of disaster management.

Study findings revealed that there was significant increase in knowledge in the post-test after the educational intervention. Therefore, it can be concluded that education plays an important role in increasing awareness. It is recommended that awareness programs on disaster management should be carried out periodically as in-service education.

Disaster response is an emergency nursing responsibility. Responding to disasters, however, is hazardous as terrorism, pandemics and chemical industrial accidents challenge the safety of nurses and their families. International experience has shown that nurses can become victims of disasters and that fear of contaminating family and friends may prevent nurses from attending work or returning home during a disaster response. An understanding of the factors that enable or disable their disaster preparedness will underpin future disaster policy and planning for Australian and international health care organizations.

This study examines the willingness of Australian emergency nurses to attend work to respond to a health care disaster, using a 3-phase mixed-method design. Phase 1 was a national online survey, with 451 responses. Phase 2 involved 6 focus groups at 4 hospital sites, with 41 participants and Phase 3 involved in-depth interviews with emergency nurses at different sites, with 11 participants. This presentation will highlight results from the study on the willingness of Australian emergency nurses to respond to a health care disaster.

Preliminary findings indicate that emergency nurses' willingness to respond to health care disasters was dependent on a number of factors, including their out-of-work responsibilities, the changes to their roles and responsibilities at work, their confidence in management and their work team, the information they are given about the disaster, the type of disaster and the degree of risk involved.

The contribution the findings this study will make to disaster planning and preparedness for nursing staff, health planners and administrators will be outlined.

Nurses have pivotal roles before, during, and after disasters. Enhancing their professional skills to help the injured is one the basic principles in health management in disasters. The aim of this study is to investigate the effectiveness of training disaster nursing preparedness on improving the preparedness of nurses.

Using a quasi-experimental method, 113 nurses were selected randomly. The preparedness program, which consisted of a one-day workshop on disaster management, a tabletop exercise, and an operational maneuver, was executed for the participants. The preparedness of all participating nurses was measured by disaster preparedness questionnaire, one week and also one month after the program. Data analysis was performed by using the ANOVA test.

The mean scores of knowledge, attitude, and performance improved from 5.55 to 19.88, from 66.18 to 72.41, and from 3.36 to 12.48, respectively (p < 0.001). In addition, the mean of total preparedness score was increased from 75.14 in pretest to 104.77 in the follow up (p < 0.001).

Preparedness plan training improves participants' preparedness for responding disasters, because preparedness and reliability for responding to disasters is influenced directly by the training courses and previous experiments. Therefore, based on the results obtained in this project, in order to improve the preparedness of nursing staff, including a disaster preparedness plan in academic, educational curriculum and as a continuing educational program is recommended.

The objective of this study was to identify the daily lives and health conditions of survivors of the Sichuan Earthquake after two years.

The study was conducted for the survivors ≥ 18 years of age who experienced the earthquake. The questionnaire included the survivors' socio-demographics, impact of the disaster, and their health status after the disaster.

Approximately 65% of respondents said that their conditions were healthy in the second year after the earthquake. The changes of daily lives among the survivors were increased from 1st year to 2nd year, as follows: diet (1st year; 24.5%–2nd year; 14.1%), sleep (29.4%–23.6%), entertainments (9.6%–15.1%). As health conditions, the following symptoms were increased; diabetes (2.8%–3.5%), cardiac disease (2.9%–5.0%), functional disturbances of body's joints and muscles (18%–21%). In contrast, the following symptoms were decreased; obesity/skinny (5%–3.5%), kidney disease (4.4%–1.6%), asthma and allergy (7.2%–5.6%). The current health conditions of the survivors included: headache, eyestrain, hand, foot, and/or joint's ache, sleep disorder. With regard to the psychological condition, the mean value of IES-R score was 22.2 ± 11.8. Compared with the 1st year results, the mean value IES-R score significantly decreased (1st year; 30.8 ± 16.8, p < 0.001, by paired t-test).

The survivors' physical and psychological conditions have improved compared to 1st year results. However most of the survivors still had some health problems in their health.

Previous disaster studies mainly focused on analyzing the experience from a psychological or psychiatric perspective. The occurrence of post-traumatic stress disorder also has been the central issue when studying survivors of train crashes. Research concerning being involved in train crashes is scarce.

The aim of this study was to explore the experience of surviving a severe train crash.

In 2004, a severe train crash occurred in the south of Sweden. Approximately 78 passengers were on the train. All of them were injured, and two of the passengers died. Fourteen of the survivors agreed to be interviewed five years after the crash. The interviews were narrative, transcribed verbatim, and analyzed using a phenomenological-hermeneutical method. First, a naive reading of the text, later, a structural analysis, and finally a comprehensive understanding in which the other phases were considered and discussed with relevant literature.

The preliminary results show a naive understanding of being in the pre-crash, crash and post-crash phases. Four themes were recognized: (1) life is going on like being on a railway track; (2) the train derails, so do I; (3) back on track again; and (4) life goes on in a new track. The results will be elaborated and discussed together with the comprehensive understanding.

Surviving a severe train crash changes life immediately as well as five years later.

Prehospital patients, irrespective of diseases or trauma, might experience discomfort due to a cold environment and are at risk for decreasing body temperature which can increase morbidity and mortality. Research concerning experiences of being injured in a cold environment is scarce.

The aim of this study was to explore the patients' descriptions of being injured in a cold environment.

Twenty persons who have been injured in a cold environment during wintertime in the north of Sweden were interviewed; 14 of them were treated with active heat supply. They waited on snow or ice for an ambulance between 8 minutes and 4 hours and 10 minutes. The interviews were performed face-to-face and telephone interviews were used when the participants lived far away. The interviews had a storytelling run-up and the participants were asked to narrate the injury event, from just before the event until arrival at the emergency department. The interviews were transcribed verbatim and analyzed by content.

In the preliminary results three themes were formulated: (1) waiting for an ambulance; (2) being cared for; and (3) reflecting on changes in life after the traumatic event. The cold environment influenced the experience of being injured in a negative way. More suffering from the cold than from pain of the injury was described. Those who were treated with active heat experienced it in a positive way.

Discomfort from cold became the largest problem independent of their injury classification. Active heat should be used in prehospital care to reduce the negative experiences from cold.

The number of victims in various refugee camps who experience anxiety after the Mount Merapi eruption. Various factors that cause this condition include a lack of concern for the early treatment of psychological casualties. Support from health professionals, particularly nurses, is needed to prevent the onset of mild anxiety.

The study was carried out in order to help understand the meaning of nurses' experiences of trauma healing to prevent anxiety among the victims of the Mount Merapi eruption.

This was a qualitative research study with a phenomenological approach. In-depth interviews were used to explore participants' experiences conducting trauma healing therapy to the Mount Merapi eruption victims.

The result showed the implementation of trauma healing therapy includes: (1) assessment of emotional responses; (2) physical examination; and (3) psychological assistance. The therapy being implemented includes: (1) five-finger hypnosis therapy; (2) stopped thinking therapy; and (3) progressive relaxation. The impacts of trauma healing included: (1) spirit returning; (2) increased of relaxation; (3) calmness; (4) normal vital signs; and (5) the ability to interact with other refugees. Problems experienced included the large number of refugees, the noisy environment, and a lack of concentration from the nurse when providing therapy.

To solve the problem, nurses are expected to recognize the response required for the victim and apply interventions based on the assessment, data analysis, planning, implementation, and evaluation. Victims of the Mount Merapi eruption are expected to attempt to apply the self-trauma healing.