The Ministry of Health of Panama (MINSA) received several reports of ill persons who had clinical presentations of acute renal insufficiency or failure during September and October 2006. On 01 October 2006, the MINSA formally asked the Pan-American Health Organization (PAHO) and the US Centers for Disease Control and Prevention (CDC) to assist with the investigation. Additional agencies involved in the response included the US Food and Drug Administration (FDA), the Gorgas Institute for Health Studies (GIHS), and the Social Security Health System (SSHS) of Panama. Through a joint effort, the MINSA, CDC, FDA, GIHS, SSHS, and PAHO were able to characterize the illness, identify the etiological agent, identify the population-at-risk, and launch an unprecedented media and social mobilization effort to prevent additional cases.

International outbreak responses may require familiarity with basic emergency management principles beyond technical or scientific considerations. The management, logistical capabilities, team interaction, and efficiency of outbreak investigations can be enhanced substantially by having staff already familiar with common operational frameworks for incident responses. This report describes the inter-agency coordination and organizational structure implemented during an international response to identify the cause of an outbreak of acute renal failure in Panama.

Background: The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or canceling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity.

Methods: This is a pilot study. A categorization methodology was devised and applied retrospectively to all scheduled procedures during four one-week periods chosen by convenience. The categorization scheme grouped procedures into four categories: (A) procedures with no impact on inpatient capacity; (B) procedures that could be delayed indefinitely; (C) procedures that could be delayed by one week; and (D) procedures that could not be delayed. The categorization scheme was applied by two research assistants and an emergency medicine resident. All three raters categorized the first 100 cases to allow for calculation of inter-rater reliability. Maximal hospital bed capacity was defined as the 95th percentile weekday occupancy, as this is more representative of functional bed capacity than is the number of licensed beds. The main outcome was the number of hospital beds that could be created by postponing procedures in categories B and C.

Results: Maximal hospital bed capacity was 816 beds. Mean occupancy during weekdays was 759 versus 694 on weekends. By postponing Group B and C procedures, a mean of 60 beds (51 general medical/surgical and nine intensive care unit (ICU)) could be created on weekdays, and four beds (three general medical/surgical and one ICU) on weekends. This represents 7.3% and 0.49% of maximal hospital bed capacity and ICU capacity, respectively. In the event that sustained surge is needed, delaying all category B and C procedures for one week would lead to the generation of 1,235 hospital-bed days. Inter-rater reliability was high (kappa = 0.74) indicating good agreement between all three raters.

Conclusions: For the institution studied, the strategy of delaying scheduled procedures could generate inpatient capacity with maximal impact during weekdays and little impact on weekends. Future research is needed to validate the categorization scheme and increase the ability to predict inpatient surge capacity across various hospital types and sizes.

Landmines and improvised explosive device (IED) explosions induce bodily injuries through the primary, secondary, tertiary, and quaternary mechanisms of blast among civilians, mostly children which results in a complicated, multidimensional injury pattern. If > 80 percent of countries can ensure the security of their borders without using anti-personnel mines, surely India can too. A change in mindset and a change in defense doctrine are needed, as well as an UN-backed world body campaigning against the use of landmines to urge the Indian government to sign a global treaty to ban the weapons. An estimated four to five million anti-personnel mines exist in India, which is the sixth-largest stockpile in the world. Non-state armed groups in the central, southern, northern, and northeastern regions frequently have used anti-personnel mines and improvised explosive devices to target convoys of soldiers and civilians. Using historical, current research and related literature reviews, this study provides description about the types of explosion, the device, pattern of injury, prehospital and emergency department care, and challenges for the disaster plan. Hand amputation is the most common type of upper limb amputation (more common among the 7–18-year age group) and below-knee amputation is the most common type of lower limb amputation. Using these data, a focused disaster response for future attacks has been created. It includes the planning, monitoring, and coordination of all aspects by hospitals and the regional disaster system's plan—“upside-down” triage—the most severely injured arrive after the less injured, which bypass emergency medical services (EMS) and go directly to the nearest hospitals. Details about the nature of the explosion, potential toxic exposures and environmental hazards, and casualty location from police, fire, EMS, health department, and reliable news sources must be recorded.

Introduction: Emergency preparedness experts generally are based at academic or governmental institutions. A mechanism for experts to remotely facilitate a distant hospital’s disaster readiness is lacking.

Objective: The objective of this study was to develop and examine the feasibility of an Internet-based software tool to assess disaster preparedness for remote hospitals using a long-distance, virtual, tabletop drill.

Methods: An Internet-based system that remotely acquires information and analyzes disaster preparedness for hospitals at a distance in a virtual, tabletop drill model was piloted. Nine hospitals in Cape Town, South Africa designated as receiving institutions for the 2010 FIFA World Cup Games and its organizers, utilized the system over a 10-week period. At one-week intervals, the system e-mailed each hospital’s leadership a description of a stadium disaster and instructed them to login to the system and answer questions relating to their hospital’s state of readiness. A total of 169 questions were posed relating to operational and surge capacities, communication, equipment, major incident planning, public relations, staff safety, hospital supplies, and security in each hospital. The system was used to analyze answers and generate a real-time grid that reflectied readiness as a percent for each hospital in each of the above categories. It also created individualized recommendations of how to improve preparedness for each hospital. To assess feasibility of such a system, the end users’ compliance and response times were examined.

Results: Overall, compliance was excellent with an aggregate response rate of 98%. The mean response interval, defined as the time elapsed between sending a stimuli and receiving a response, was eight days (95% CI = 8–9 days).

Conclusions: A web-based data acquisition system using a virtual, tabletop drill to remotely facilitate assessment of disaster preparedness is efficient and feasible. Weekly reinforcement for disaster preparedness resulted in strong compliance.

Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.

After disasters, the individual health and well-being of first responders and affected population are affected for years. Therefore, psychosocial help is needed. Although most victims recover on their own, a minority of survivors, members of rescue teams, or relatives develop long-term, disaster-related psychic disorders, such as post-traumatic stress disorder (PTSD). This subgroup especially should receive timely and appropriate psychosocial help. Many European countries offer post-disaster psychosocial care from a variety of caregivers (i.e., professionals and volunteers, non-governmental organizations, church or commercial organizations). Therefore, European standards for providing post-disaster psychosocial support currently is required. This article describes the project European Guideline for Target Group-Oriented Psychosocial Aftercare—Implementation, supported by the European Commission.