Event planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.

A retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.

Medical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.

These two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.

BurtonJO , CorrySJ , LewisG , PriestmanWS . Differences in Medical Care Usage between Two Mass-Gathering Sporting Events. Prehosp Disaster Med.2012;27(4):1-5.

The objective of this study was to determine whether Emergency Medical Services (EMS) records can identify bars that serve a disproportionate number of minors, and if government officials will use this data to direct underage drinker enforcement efforts.

Emergency Medical Services call logs to all bars in the study area were cross-referenced with a local hospital's records. The records of patients with alcohol-related complaints were analyzed. Outlier bars were identified, and presented to government officials who completed a survey to assess if this information would prompt new enforcement efforts.

Emergency Medical Services responded to 149 establishments during the study period. Eighty-four responses were distributed across six bars, and 78 were matched with the hospital's records. Fifty-one patients, 18 (35%) of whom were underage, were treated for alcohol intoxication, with 46% of the cases originating from four bars. Government officials found the information useful, and planned to initiate new operations based on the information.

Alcohol consumption by minors can lead to life-long abuse, with high personal, financial, and societal costs. Emergency Medical Services response data and hospital records can be used to identify bars that allow underage drinking, which is useful in directing law enforcement efforts.

Lemkin DL, Bond MC, Alves DW, Bissell RA. A public health enforcement initiative to combat underage drinking using emergency medical services call data. Prehosp Disaster Med. 2012;27(2):1-5.

The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.

The hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.

This was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.

Forty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients with abnormal breathing and clammy conditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and the difficulty speaking between breaths (DSBB) condition was the most prevalent (50.3%). Ineffective breathing and not alert conditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had the not alert condition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher in DSBB plus not alert; DSBB plus not alert plus changing color; and DSBB plus not alert plus clammy conditions cases, compared to asthmatic abnormal breathing cases.

The study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.

Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity. Prehosp Disaster Med. 2012;27(4):1-6.

The first decade of the 21st century has witnessed three major influenza public health emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009 H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health emergency planning.

A systemic literature review of relevant, peer-reviewed, quantitative, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic.

Thirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family.

Understanding the factors that contribute to the willingness of HCP to report to work during an influenza public health emergency is critical to emergency planning and preparedness. Information from this review can guide emergency policy makers, planners, and implementers in both understanding and influencing the willingness of HCP to work during an influenza public health emergency.

DevnaniM. Factors Associated with the Willingness of Health Care Personnel to Work During an Influenza Public Health Emergency: An Integrative Review. Prehosp Disaster Med. 2012;27(6):1-16.

Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.

To describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.

Retrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011.

Clinical presentation, medical interventions and discharge destination.

Sixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.

The deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.

DutchMJ , AustinKB . Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams. Prehosp Disaster Med. 2012;27(4):1-5.

The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone.

This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes.

A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs.

The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.

Dhar SA, Dar TA, Wani SA, Hussain S, Wani ZA, Aazad S, Yaqoob S, Mansoor I, Ali MF, Ahmed M, Mumtaz I, Azhar I. In the line of duty: a study of ambulance drivers during the 2010 conflict in Kashmir. Prehosp Disaster Med. 2012;27(4):1-4.

A 7.0 magnitude earthquake struck Haiti on January 12, 2010, resulting in 222,000 deaths and 300,000 injuries. Three weeks after the initial quake, the New Mexico Disaster Medical Assistance Team (NM DMAT-1) was deployed to Haiti for ongoing medical relief. During this deployment, a portable handheld ultrasound machine was tested for usefulness in aiding with patient care decisions.

The utility of portable ultrasound to help with triage and patient management decisions in a major disaster setting was evaluated.

Retrospective observational non-blinded images were obtained on 51 patients voluntarily presenting to the Gheskio Field clinic at Port-au-Prince. Ultrasound was used for evaluation of undifferentiated hypotension, torso trauma, pregnancy, non-traumatic abdominal pain, deep venous thrombosis and pulmonary embolism, and dyspnea-chest pain, as well as for assisting with procedures. Scans were obtained using a Signos personal handheld ultrasound machine with images stored on a microSD card. Qualitative data were reviewed to identify whether ultrasound influenced management decisions, and results were categorized in terms of percent of scans that influenced management.

Fifty-one ultrasound scans on 50 patients were performed, with 35% interpreted as positive, 41% as negative, and 24% as equivocal. The highest yields of information were for abdominal ultrasound and ultrasound related to pregnancy. Ultrasound influenced decisions on patient care in 70% of scans. Most of these decisions were reflected in the clinician's confidence in discharging a patient with or without non-emergent follow-up.

The use of a handheld portable ultrasound machine was effective for patient management decisions in resource-poor settings, and decreased the need to triage selected patients to higher levels of care. Ultrasound was very useful for evaluation of non-traumatic abdominal pain. Dynamic capability is necessary for ultrasound evaluation of undifferentiated hypotension and cardiac and lung examinations. Ultrasound also was useful for guidance during procedural applications, and for aiding in the diagnosis of parasitic diseases.

Shorter M, Macias D. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehosp Disaster Med. 2012;27(2):1-6.

Japan has a long history of disaster due to its location on the “Pacific Ring of Fire.” The frequency of earthquakes experienced in recent years has had significant influence on disaster health research in Japan. This paper describes disaster health research trends in Japan, with an emphasis on disaster nursing research.

A systematic literature review of disaster health research in Japan from 2001 through 2007 was conducted for this study. The most commonly used database in Japan, Ichushi (version 4.0), was used for this literature review. The keywords and sub-keywords used were: disaster, disaster nursing, practice, education, ability, response, emergency, licensure, capability, function, prevention, planning and research. These keywords were sometimes used in combination to identify relevant literature.

A total of 222 articles were reviewed. The number of research papers available increased gradually from 2001 through 2007. The most common articles used were found using the search category of “disaster nursing and research.” Among the search categories, “disaster nursing and education” also had a high number of publications. This category also peaked in 2007.

The recent experiences of natural disaster in Japan accelerated the impetus to explore and implement a disaster nursing concept into practice and nursing curricula. Further evidence-based studies to develop methodology and other areas of studies in disaster nursing, including other language databases are to be expected in the future.

Kako M, Mitani S, Arbon P. Literature review of disaster health research in Japan: focusing on disaster nursing education. Prehosp Disaster Med. 2012;27(2):1-6.

Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.

Review the literature regarding the use of intraosseous (IO) devices in the prehospital setting.

Selected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.

The search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients’ vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.

While manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.

OlaussenA , WilliamsB . Intraosseous Access in the Prehospital Setting: Literature Review. Prehosp Disaster Med.2012;27(5):1-5.

Humanitarian surgery is often organized and delivered with short notice and limited time for developing unique strategies for providing care. While some surgical pathologies can be anticipated by the nature of the crisis, the role of foreign medical teams in treating the existing and unmet burden of surgical disease during crises is unclear. The purpose of this study was to examine published data from crises during the years 1990 through 2011 to understand the role of foreign medical teams in providing surgical care in these settings.

A literature search was completed using PubMed, MEDLINE, and EMBASE databases to locate relevant manuscripts published in peer-reviewed journals. A qualitative review of the surgical activities reported in the studies was performed.

Of 185 papers where humanitarian surgical care was provided by a foreign medical team, only 11 articles met inclusion criteria. The reporting of surgical activities varied significantly, and pooled statistical analysis was not possible. The quality of reporting was notably poor, and produced neither reliable estimates of the pattern of surgical consultations nor data on the epidemiology of the burden of surgical diseases. The qualitative trend analysis revealed that the most frequent procedures were related to soft tissue or orthopedic surgery. Procedures such as caesarean sections, hernia repairs, and appendectomies also were common. As length of deployment increased, the surgical caseload became more reflective of the existing, unmet burden of surgical disease.

This review suggests that where foreign medical teams are indicated and requested, multidisciplinary surgical teams capable of providing a range of emergency and essential surgical, and rehabilitation services are required. Standardization of data collection and reporting tools for surgical care are needed to improve the reporting of surgical epidemiology in crisis-affected populations.

Nickerson JW, Chackungal S, Knowlton L, McQueen K, Burkle FM Jr. Surgical care during humanitarian crises: a systematic review of published surgical caseload data from foreign medical teams. Prehosp Disaster Med. 2012;27(2):1-6.