On March 11, 2011, the Great East Japan Earthquake and Tsunami hit the northeastern part of Japan, causing 15,895 deaths and 2,539 missing persons as of March 1, 2018. Moreover, many medical facilities were destroyed, resulting in the loss of medical information stored in paper records or on servers in hospitals and clinics.

To highlight the need for a backup system for saving all clinical information during disaster preparation.

In 2012, a prefectural medical network system - the Miyagi Medical and Welfare Information Network (MMWIN) - introduced a cloud backup data storage service for disasters. This system facilitates the sharing of clinical data among hospitals, clinics, pharmacies, and other care facilities. The backup system is based on the Standardized Structured Medical Information Exchange (SS-MIX), which enables data from medical record systems, developed by different vendors, to be stored in a common format. By the end of September 2018, the total backed up clinical data, including patients’ basic information, disease names, blood tests, and prescription list, reached 370 million items from 11.2 million persons. We renewed the system last year and initiated an image data sharing service this year. The number of facilities within the MMWIN was 948, while the number of opt-in patients exceeded 80,000.

Although the project was financed by the government, a usage fee was collected from the participating facilities. To sustain this project, it is crucial to improve the balance between cost and income by increasing the number of participating facilities and decreasing maintenance cost. Thus, our clinical information backup system for disasters facilitates information sharing among medical facilities.

Some patients presenting to rural or regional hospitals may be deteriorating so rapidly that emergency procedures might be necessary before transfer to specialist facilities. Such interventions might include placement of an ICC, establishing a surgical airway, evacuation of an EDH, laparotomy, or intra-abdominal packing. The treating clinician may have had little or no experience in the procedure. Interactive telepresence technology offers further point of care support to the treating clinicians through the virtual presence of a specialist from a major trauma center.

To explore the feasibility of wearable interactive telepresence technology that can provide sub-specialist support to remote clinicians treating patients with traumatic injuries.

Thirty-seven wearable near-field display devices and annotation software applications were tested against a set of pre-specified technical and user experience requirements. A shortlist of three devices and two software applications underwent usability evaluations with a convenience sample of 24 junior clinicians and sub-specialists. The junior clinicians trialed the wearable devices and the sub-specialists trialed the annotation applications in three simulated trauma scenarios. Measures included participants’ ratings of acceptance and workload, technical issues encountered (e.g. frequency of call drop-outs), and anecdotal comments.

Participants’ subjective ratings of the solutions and anecdotal feedback were positive. However, there was no clear solution that satisfied the functionality and ease-of-use requirements for all participants. For example, the solutions that were rated more favorably by the junior clinicians were rated less favorably by the sub-specialists, and vice versa.

This work provided preliminary evidence of the feasibility and usefulness of interactive telepresence technology in healthcare. A second phase of usability testing is currently underway to explore additional device and software combinations, including those with augmented reality functionality. Future phases of the project will evaluate the solutions under higher-fidelity conditions followed by in-situ trials across selected regional centers.

Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.

This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.

This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.

42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).

Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.

Modern hospital systems are highly dependent on computerized information technology (IT) systems. The integration of laboratory and radiology ordering and resulting cannot be easily replicated with a “paper” processes. This poses challenges for no-notice events, where the rapid registration of patients is a must for effective clinical care. This weakness in hospital response has been demonstrated in events such as the Boston Marathon bombing, the Aurora Theater (to be discussed), and Las Vegas shootings.

To discuss lessons learned in configuring IT systems for disasters.

A integrated system of IT system preparation was implemented at the University of Colorado Hospital. This system has been demonstrated to be effective in multiple real-world events.

Four areas of IT preparedness are needed for hospital IT response to disasters. First is rapid disaster registration with prepared disaster medical record numbers and packets. The medical records must be active in the hospital IT environment, and a visit or case number must be preassigned or rapidly generated. The medical record number alone in the IT environment will allow the initiation of test ordering. The packet should include preprinted labels, a demographic data sheet, and downtime charting and ordering forms. The second item for response is templated order sets to allow rapid ordering of multiple studies such as laboratory, and especially radiology, without having to reenter clinical information. The third is a method of patient care charting scalable, from paper to electronic, depending on the patient volume, acuity, and workstation access. The fourth is a method for patient care in the IT downtime in a disaster setting. Simple inexpensive measures will allow rapid placement of patients in the IT environment and therefore allow rapid and accurate test ordering and resulting.

The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.

The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.

Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.

A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).

As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.

The Red Cross and Red Crescent Health Information System (RCHIS) combines the functionality of an Electronic Medical Record (EMR), Health Information System (HIS), as well as Human Resource and stock management system. Its purpose is to facilitate patient quality of care, early warning for outbreak detection, accountability/reporting, and resource management. Short-term, emergency medical teams and support staff responding to acute clinical needs in a humanitarian context are the intended end users.

To explain the functional design principles and usability testing protocol implemented in initial RCHIS design and development phases to ensure technological fit within the humanitarian medical context.

RCHIS development followed the patient-user journey, with each patient/staff interaction encapsulated by a microservice. The integration of multiple microservices enabled RCHIS to mimic various patient journeys. The functional scope of each microservice was designed by medical end-users and was further used for access management. The value and variable design, including validation rules, were led by health informaticians and existing medical standards. Intuitiveness and ease of use guided User Interface design, with targeted medical end-user feedback collected on a twice-monthly basis in addition to early design workshops, field immersion, and post-development pilot testing.

Support and implementation of RCHIS were not inherently guaranteed. As such, the process of co-designing with end users had the primary benefit of ensuring effective scope and technological fit given the humanitarian context, but also the secondary benefit of improving internal acceptability and advocacy.

The added value of digital health records as a quality assurance mechanism is well documented. However, the increased workload and reduced employment satisfaction affiliated with the rise of EMRs illustrated a need to re-evaluate current design and use within clinical settings. The design and development approach taken for RCHIS is one attempt to improve human-computer interaction in the clinical setting.

The acute care of stroke involves the administration of a clot-dissolving drug (thrombolysis) and/or its removal using endovascular clot retrieval. Earlier intervention results in significantly improved patient outcomes. Clinical assessment scores have limitations, and studies have shown that even the most robust scores have a reported false-negative rate of >20% for large vessel occlusive strokes that may be eligible for clot retrieval, while inappropriate bypass may delay delivery of thrombolysis.1 Quantitative Electroencephalography (QEEG) has been shown to have a very high sensitivity and specificity in the identification of acute stroke versus matched controls in an in-hospital setting.(2,3)

The SPIDER study commenced in Brisbane, Queensland on September 3, 2018, and is investigating the use of an EEG recorder to gather data on acute stroke patients presenting to a metropolitan ambulance service.

The data collected will guide the development of a simple numerical output reference to guide decision making. The data may aid in identifying large vessel occlusive stroke and patients eligible for endovascular intervention. The QEEG will provide a more accurate and cost-effective tool for the prehospital clinician over other imaging technologies and can guide early destination decisions. This presentation discusses the implementation of a pre-hospital research platform, integration with the clinical dispatch matrix, staff engagement, patient recruitment, and the success of the project so far.

Tracking patients through health systems is fundamental to coordinated care provision. However, it is an inconsistent element of emergency preparedness. This presentation presents findings of a study undertaken after the 2011 Christchurch Earthquake, and the resultant nationally implemented changes.

The intent was to investigate options to improve patient tracking in a mass casualty event. By looking at one scenario involving a mass casualty presentation with the central responder disabled by electricity loss, standards of practice were outlined and made scalable to meet the needs of various events.

Clinical and clerical staff involved in the event’s patient tracking were interviewed. Data were analyzed using thematic analysis and reported using the structure, process, and outcomes framework.1

Structures were material and human resources. Material resources were identification number systems, technological requirements, disaster-specific documents, minimum data for entry, digital/paper/hybrid registration systems, and digital-paper integration. Human resources were role allocation, and familiarity of plans, roles, processes, tools, and facilities. Process identified the activities to manage unidentified patients, triage, registration, and ongoing tracking processes. Outcomes were management of patient flow, patient-care provision, and patient-family reunification.

Initial implementation was local. Structures and processes were agreed upon, with varying response levels according to the incident scope, while staying as close to business as usual for familiarity. National implementation followed via a Ministry of Health working group involving different district health boards. The group developed a consensus on the minimum data to be entered and the process to merge patient identities of initially unidentified patients. Written tools were shared for standardization.

With inter-agency and inter-organization emergency response, standardized processes and information are required. Collaboration prior to events can mitigate issues when an event occurs.

The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.

Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.

A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.

It was found that the use of ePCR:

1. 1. Allowed for collection of relevant data to assist in future planning of MGEs

2. 2. Aids the overall coordination of first aid delivery at MGEs

   • - faster relaying of patient information to event commanders

   • - reduction of paperwork

   • - improved ability to locate first aid crews using GPS tracking

3. 3. Received positive feedback from first aiders, event organizers, and patrons

4. 4. Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our members

These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.

As Israel's National Emergency Medical Services (EMS) provider, Magen David Adom (MDA) is constantly looking for ways to improve the response to mass casualty incidents (MCIs). Previous research has shown that in an MCI situation, the demand for resources is disproportionate to the available resources, thus creating a dilemma of how to triage and treat the patients, as well as how to best prioritize and treat the critical patients.

Smartwatches have become an integral part of society. MDA constantly looks for ways to integrate new technologies into their emergency response protocols. Smartwatches were used in this experiment to determine if in an MCI, relaying live information to the dispatch center would improve the time it takes for emergency crews to effectively treat and transport critical patients.

A drill and scenario were designed to simulate an MCI in which there were 3 severe, 2 moderate, and 5 lightly wounded patients. There were then different colored smartwatches placed on each victim. The watches transmitted real-time blood pressure, pulse, and oxygen saturation readings to the dispatch center. The live information was transferred directly to responding teams. A second drill was conducted using the same scenario, same number of patients, but without watches to examine the differences in response times.

MDA found that the use of smartwatches directly improved the times (by 3.27 minutes) in which emergency teams were able to reach the most severely wounded patients and evacuate them to the hospital in a timely manner.

Using smartwatches to transmit live information to the dispatch center allowed for effective treatment and transport of patients in an MCI. Use of such information allows the dispatch center to direct teams to provide accurate treatment to the patients according to their needs.

Tourniquets (TQ) save lives. Although military-approved TQ are more effective than improvised TQ in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers.

The purpose of the current study was to compare the efficacy of 3 novel commercial TQ to a military-approved TQ.

A convenience sample of EM residents was utilized. Four different TQ were evaluated: Gen 7 Combat Application Tourniquet (CAT; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery occlusion was determined using a ZONARE ZS3 ultrasound. Steady-state maximal generated force was measured for 30 seconds with a thin-film force sensor (Singletract). Opinions were solicited at the conclusion of the study.

Nine residents participated in the study (7 male, 2 female). Success rates for complete arterial occlusion were 89% CAT, 67% SWAT-T, 89% RATS, and 78% TK (H 0.89, p = 0.83). Mean (± SD) times to achieve occlusion were 10.4 ± 1.7 sec CAT, 23.1 ± 9.0 sec SWAT-T, 11.1 ± 3.8 sec RATS, and 20.0 ± 7.1 sec TK (F 9.71, p < 0.001). Steady-state maximal forces were 29.9 ± 1.2 N CAT, 23.4 ± 0.8 N SWAT-T, 33.0 ± 1.3 N RATS, and 41.9 ± 1.3 N TK. Participants felt that the CAT was easiest to apply (61%), followed by the RATS (33%). Participants were most likely to select the TK (44%) for EDC, followed by the RATS (33%).

In this small convenience sampling, all novel TQ systems were non-inferior to the military-approved CAT TQ. Mean application times were less than 30 seconds. The size and unique nature of these novel TQs may make them more conducive to lay-provider EDC, thereby improving the response to high threat events.

The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.

The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.

A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.

Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.

Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.

In response to the Pulse Nightclub and Las Vegas mass shootings, staff from our Emergency Department (ED) at University Medical Center New Orleans designed a mass casualty incident (MCI) protocol aimed at preparing the entire hospital for high-volume, high-acuity incidents of unprecedented proportions. As we researched this effort, we discovered that no publically available framework currently exists to assist hospitals with creating their own comprehensive, functional MCI protocol.

To develop a framework to assist hospitals with creating MCI plans tailored to fit the needs of their individual facility.

Our hospital spent several years creating and refining an MCI protocol that is both comprehensive in addressing each service’s needs and efficient for the staff expected to use it. Upon achieving the desired outcome of a well-functioning and tested protocol, the main contributors of the project met to create a consensus document on how we would approach the task with the benefit of hindsight.

Our document is meant to serve as a framework for hospitals looking to build their own plan. It is not a template, but rather a guide on how to build an individualized plan that includes critical components that are key for success. It breaks the process down into manageable steps that are presented in an order that maximizes efficiency and includes important points to consider for each step. It encourages the user to tailor the protocol to their own unique needs.

By sharing a framework based on our own best practices and lessons learned, we hope to make it easier for other hospitals to create MCI protocols and to open a dialogue with hospitals that have additional or differing opinions to share. Most importantly, we hope to inspire hospitals to work together as we race to prepare for worst-case scenarios of increasing magnitude.

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.

On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.

A field perspective and experience feedback from the Emergency Medical Response.

The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.

Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.

Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.

Uncontrolled bleeding is a leading cause of preventable death in trauma. The “Stop the Bleed” campaign has trained over 130,000 lay people in the US to act to control bleeding. Current hemorrhage control courses, the most well-known being the American College of Surgeon’s Basic Bleeding Control (ACS B-con) course, require in-person training. Scaling this course nationwide is time and resource intensive. Furthermore, groups have advocated that young people, who are disproportionately affected by physical trauma, be universally trained in hemorrhage control.

Compare the effectiveness of teaching the ACS B-con course to high school (HS) students utilizing three different delivery mechanisms: in-person live, video-recorded, and virtual-live training.

432 students (aged 15-18) will be recruited from two HS settings: 300 from a local HS and 132 from a national online HS platform. Local HS students will be randomized into two arms: a control arm (in-person live training) and virtual training through a pre-recorded lecture. Online HS students will undergo virtual-live training. The primary outcome is correct tourniquet application following training. Secondary outcomes are the acquisition of personal resilience-associated traits using a validated instrument, motivation for further training, and perception of the importance of live training. Tourniquet application data will be assessed using a non-inferiority design using two pairwise comparisons of the intervention arms to the control (in-person). Pre- to post-training survey data will be assessed using paired univariates tests. Sub-analysis of the impact of demographic variables on these relationships will be assessed.

In addition to integration of cardiopulmonary resuscitation courses into HS curricula, there is momentum to develop effective programs to educate HS students to provide care for the injured and control bleeding before first responders arrive. This trial will help determine the most effective delivery mechanism to teach a hemorrhage control course to HS students at scale.

Homeless individuals may be dependent on social services for nutrition, shelter, and protection. These services are susceptible to disruption in disasters. Individuals are often frequent utilizers of emergency health care services, and an increase in emergency medical services utilization may be predictable. Disaster planners should anticipate and plan for the needs of these special populations.1

A review of disaster planning in US cities with high rates of homelessness was conducted. Utilizing homelessness census data, the five cities with the largest homeless population were chosen for analysis. Publicly available disaster plans specifically targeting at homeless were identified. Planning for nutritional support, shelter, protection, and emergency healthcare utilization was identified.

Planning specifically addressing the needs of the homeless was variable. Planning items surrounding nutrition and shelter were identified, but those around protection and use of emergency services were more limited.

Recent disasters in the United States have demonstrated the increased vulnerability of populations with high utilization of emergency services during a disaster.2 Homelessness is common throughout the United States, and appear to be underrepresented at the city disaster planning level.3 Resources to assist planners are available, but increased adoption is indicated.

Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The 2011 Queensland flood disaster affected central and southeast Queensland, resulting in 2.5 million people being adversely affected. Seventy-two local government areas disaster were activated under the Natural Disaster Relief and Recovery Arrangements, which was more than 99 percent of Queensland. The issues regarding the role and responsibility across governments relating to planning, setup, and management of evacuation centers will be discussed.

This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in Australia during the Queensland floods in 2011. The objective is to illuminate the challenges officials faced, and the resolutions and lessons learned in the preparation of evacuation centers through this event.

The study involved interviews with local government and relevant agencies’ officials who have been involved in establishing evacuation centers for vulnerable populations during the 2011 floods. Six officials were recruited from local government areas affected by the disaster in Queensland, Australia. Semi-structured phone interviews were audio-recorded and thematic analysis was conducted using NVivo software.

Three core themes emerged: 1) understanding of the importance of preparation, 2) challenging evacuation center environments, and 3) awareness of good governance principles.

This pilot study demonstrated that communication with stakeholders during the preparation period prior to a disaster is essential to best practice for evacuation center management. Understanding and being aware of good governance is also an important element to establish evacuation centers effectively.

Hunger is a global problem and has increased in recent years. In Latin America, hunger continues in high numbers. Although the level of hunger is relatively low compared to other regions, this increase in Latin America is mainly explained by the economic slowdown in South America. Also, climate changes are already weakening the production of the main crops in tropical and temperate regions.

Report the numbers of hunger in Latin America.

A cross-sectional study with reports of the World Health Organization’s hunger figures, September 2018.

The number of hungry people in the world has increased for the third consecutive year and affects 821 million people, according to a report released by UN agencies. This corresponds to one in nine people in the world. In Brazil, the figures indicate that more than 5.2 million people spent a day or more without consuming food by 2017, which corresponds to 2.5% of the population. In Latin America and the Caribbean, hunger has also increased and affects some 39 million people.

Hunger is a catastrophic problem in Latin America. Involving professionals in food and nutrition to try to reduce these numbers appears to be a good strategy because just as the doctor treats the disease, the involvement of other specialists to address the cause of the problem can bring long-term benefits. A social project for this purpose that mobilizes chefs and nutritionists is in progress in Brazil.

Published reports on health impacts from natural disasters causing injuries, poisonings, infectious disease, chronic illness, and NCDs continue to grow exponentially. Simultaneously, calls for the improvement in scientific rigor to improve causal links, strength of association, and efficacy of interventions are increasing. At the heart of this challenge is demonstrating mortality and morbidity risk across a time continuum, where the health effect is not detected for weeks, months, or years after the disaster event. In some circumstances, the presence and acuity of illness are not apparent until after an insidious or cumulative point has been reached. Notwithstanding medical observations or disaster-attributed morality classification matrices being available for 20 years, natural disaster mortality continues to be measured narrowly, on those confirmed dead (acute physical trauma, drowning, poisoning, or missing). There has been little effort to expand mortality assessment beyond this historical lens. For example, it fails to consider suicide in drought and was not redefined when the Indonesian fires caused the highest mortality in 2015. Tens of thousands of lives were lost from smoke exposure.

This study sought to test the progress of two decades of published medical and scientific literature on natural disaster mortality reporting.

A retrospective analysis of natural disaster impact reports for the past ten years was performed on three of the world’s largest disaster databases, including CRED, Sigma, and ADRC.

WADEM members must commence a strategic process to expand the recognition of health impacts from natural disasters. Global and domestic advocacy is required for building evidence through improved systematic collection of data and especially reporting patient continuum of care as a minimum standard. Without this leadership, disaster health impacts will continue to be underestimated and emergency health program responses and financial resources will fall short in protecting those most at risk.