Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process.

This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis.

The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community.

Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.

KhankehH, NakhaeiM, MasoumiG, HosseiniM, Parsa-YektaZ, KurlandL, CastrenM. Life Recovery After Disasters: A Qualitative Study in the Iranian Context. Prehosp Disaster Med. 2013;28(6):573-579.

Health care institutions constantly must be prepared for disaster response. However, there are deficiencies in the current level of preparedness. The aim of this study was to investigate the factors affecting the perception of health care workers (HCWs) towards individual and institutional preparedness for a disaster.

A survey on disaster incident preparedness was conducted among doctors, nurses, and allied health workers over a period of two months in 2010. The survey investigated perceptions of disaster preparedness at the individual and institutional level. Responses were measured using a five-point Likert scale. The primary outcomes were factors affecting HCWs’ perception of institution and individual preparedness. Secondary outcomes were the proportions of staff willing to participate and to place importance on disaster response training and their knowledge of access to such training. Data was analyzed using descriptive statistics. Logistic regression was performed to determine the factors that influenced the HCWs’ perception of their individual and institutional readiness. Odd ratios (ORs) of such factors were reported with their 95% confidence intervals (CIs).

Of 1700 HCWs, 1534 (90.2%) completed the survey. 75.3% (1155/1534) felt that the institution was ready for a disaster incident, but only 36.4% (558/1534) felt that they (as individuals) were prepared. Some important factors associated with a positive perception of institution preparedness were leadership preparedness (OR = 13.19; 95% CI, 9.93-17.51), peer preparedness (OR = 6.11; 95% CI, 4.27-8.73) and availability of training opportunities (OR = 4.76; 95% CI, 3.65-6.22). Some important factors associated with a positive perception of individual preparedness were prior experience in disaster response (OR = 2.80; 95% CI, 1.99-3.93), institution preparedness (OR = 3.71; 95% CI, 2.68-5.14), peer preparedness (OR = 3.49; 95% CI, 2.75-4.26), previous training in disaster response (OR = 3.48; 95% CI, 2.76-4.39) and family support (OR = 3.22; 95% CI, 2.54-4.07). Most (80.7%, 1238/1534) were willing to participate in future disaster incident response training, while 74.5% (1143/1534) felt that being able to respond to a disaster incident constitutes part of their professional competency. However, only 27.8% (426/1534) knew how to access these training opportunities.

This study demonstrated that HCWs fare poorly in their perception of their individual preparedness. Important factors that might contribute to improving this perception at the individual and institution level have been identified. These factors could guide the review and implementation of future disaster incident response training in health care institutions.

LimGH, LimBL, VasuA. Survey of Factors Affecting Health Care Workers’ Perception Towards Institutional and Individual Disaster Preparedness. Prehosp Disaster Med. 2013;28(4):1-6.

The number of civilians killed in Iraq following the 2003 invasion has proven difficult to measure and contentious in recent years. The release of the Wikileaks War Logs (WL) has created the potential to conduct a sensitivity analysis of the commonly-cited Iraq Body Count's (IBC's) tally, which is based on press, government, and other public sources.

The 66,000 deaths reported in the Wikileaks War Logs are mostly the same events as those previously reported in the press and elsewhere as tallied by iraqbodycount.org.

A systematic random sample of 2500 violent fatal War Log incidents was selected and evaluated to determine whether these incidents were also found in IBC's press-based listing. Each selected event was ranked on a scale of 0 (no match present) to 3 (almost certainly matched) with regard to the likelihood it was listed in the IBC database.

Of the two thousand four hundred and nine War Log records, 488 (23.8%) were found to have likely matches in IBC records. Events that killed more people were far more likely to appear in both datasets, with 94.1% of events in which ≥20 people were killed being likely matches, as compared with 17.4% of singleton killings. Because of this skew towards the recording of large events in both datasets, it is estimated that 2035 (46.3%) of the 4394 deaths reported in the Wikileaks War Logs had been previously reported in IBC.

Passive surveillance systems, widely seen as incomplete, may also be selective in the types of events detected in times of armed conflict. Bombings and other events during which many people are killed, and events in less violent areas, appear to be detected far more often, creating a skewed image of the mortality profile in Iraq. Members of the press and researchers should be hesitant to draw conclusions about the nature or extent of violence from passive surveillance systems of low or unknown sensitivity.

CarpenterD, FullerT, RobertsL. WikiLeaks and Iraq Body Count: the Sum of Parts May Not Add Up to the Whole—A Comparison of Two Tallies of Iraqi Civilian Deaths. Prehosp Disaster Med. 2013;28(3):1-7.

Dealing with major incidents requires an immediate and coordinated response by multiple organizations. Communicating and coordinating over multiple geographical locations and organizations is a complex process. One of the greatest challenges is patient tracking and tracing. Often, data about the number of victims, their condition, location and transport is lacking. This hinders an effective response and causes public distress. To address this problem, a Victim Tracing and Tracking system (ViTTS) was developed.

An online ViTTS was developed based on a wireless network with routers on ambulances, and direct online registration of victims and their triage data through barcode injury cards. The system was tested for feasibility and usability during disaster drills.

The formation of a local radio network of hotspots with mobile routers and connection over General Packet Radio Service (GPRS) to the central database worked well. ViTTS produced accurately stored data, real-time availability, and a real-time overview of the patients (number, seriousness of injury, and location).

The ViTTS provides a system for early, unique registration of victims close to the impact site. Online application and connection of the various systems used by the different chains in disaster relief promotes interoperability and enables patient tracking and tracing. It offers a real-time overview of victims to all involved disaster relief partners, which is necessary to generate an adequate disaster response.

MarresGMH, TaalL, BemelmanM, BoumanJ, LeenenLPH. Online Victim Tracking and Tracing System (ViTTS) for Major Incident Casualties. Prehosp Disaster Med. 2013;28(4):1-9.

Timely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.

This retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.

The mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).

Prehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.

OhwakiK, WatanabeT, ShinoharaT, NakagomiT, YanoE. Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients. Prehosp Disaster Med. 2012;28(1):1-4.

United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.

A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.

Of the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant.

Without rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.

LicinaD. Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012. Prehosp Disaster Med.2013;28(3):1–10..

Research has shown that partnerships between public health agencies, service providers, and other key stakeholders can expand resources and facilitate focus on community health issues more effectively than can any agency or organization acting alone. There is, however, little empirical evidence drawn from actual public health emergency responses to support this claim. The US response to novel influenza A (H1N1) virus provided the Centers for Disease Control and Prevention (CDC) the opportunity to explore whether, and the extent to which, state, local and territorial health departments strengthened partnerships with key partner agencies and sectors.

Participants included the CDC Public Health Emergency Response (PHER) grantees comprised of 62 state, territorial and local health departments. PHER grantees completed an assessment instrument in May 2011, including questions asking them to rate their partnership strength (on a four-point ordinal scale) with six types of partners before and after the H1N1 response. Grantees additionally reported if and how PHER funding contributed to enhancing the strength of these partnerships.

Sixty-one PHER grantees (61/62, 98%) completed the assessment instrument's partnerships section. PHER grantees reported that their partnerships with retail pharmacies were most strengthened (mean increase = 1.11 (on a four-point ordinal scale), SD = .82). This was followed by schools (K-12) (mean increase = .90, SD = .58); private medical providers (mean increase = .81, SD = .68); immunization authorities (mean increase = .80, SD = .61); main education authorities (mean increase = .75, SD = .68); and businesses (mean increase = .74, SD = .61). Mean PHER grantee increases in the strength of each partner type were statistically significant for all partner types (P < .01). Grantees reported that PHER funding contributed to enhancing the strength of their partnerships with schools most frequently (46/46, 100%), and businesses least frequently (31/37, 83.8%).

This inquiry provides evidence that state, territorial, and local health department partnerships with key sectors, agencies, and programs were strengthened after the H1N1 response. It further demonstrates that the CDC's PHER funding contributed to the health departments’ reports of increased partnership strength.

KunK, ZimmermanJ, RoseD, RubelS. State, Territorial, and Local Health Departments’ Reporting of Partnership Strength Before and After the H1N1 Response. Prehosp Disaster Med. 2013;28(6):1-6.

In December 2007, civil disruption and violence erupted in Kenya following national elections, displacing 350,000 people and affecting supply chains and services. The Kenyan government and partners were interested in assessing the extent of disruption in essential health services, especially HIV treatment.

A two-stage cluster sampling for patients taking antiretroviral therapy (ART) was implemented ten weeks after elections, March 10-21, 2008, at twelve health facilities providing ART randomly selected in each of the three provinces most affected by post-election disruption—Rift Valley, Nyanza, and Central Provinces. Convenience samples of patients with tuberculosis, hypertension, or diabetes were also interviewed from the same facilities. Finally, a convenience sampling of internally displaced persons (IDPs) in the three provinces was conducted.

Three hundred thirty-six IDPs in nine camps and 1,294 patients in 35 health facilities were interviewed. Overall, nine percent of patients reported having not returned to their routine health care facility; 9%-25% (overall 16%) reported a temporary inability for themselves or their children to access care at some point during January-February 2008. Less than 15% of patients on long-term therapies for HIV, tuberculosis, diabetes, or hypertension had treatment interruptions compared with 2007. The proportion of tuberculosis patients receiving a ≥45-day supply of medication increased from five percent in November 2007 to 69% in December 2007. HIV testing decreased in January 2008 compared with November 2007 among women in labor wards and among persons tested through voluntary counseling and testing services in Nyanza and Rift Valley Provinces. Patients and their family members witnessed violence, especially in Nyanza and Rift Valley Provinces (54%-59%), but few patients (2.5%-14%, 10% overall) personally experienced violence. More IDPs reported witnessing (80%) or personally experiencing (38%) violence than did patients. About half of patients and three-quarters of IDPs interviewed had anxiety or depression symptoms during the four weeks before the assessment. There was no association among patients between the presence of HIV, tuberculosis, diabetes, and hypertension and the prevalence of anxiety or depression symptoms.

More than 85% of patients in highly affected provinces avoided treatment interruptions; this may be in part related to practitioners anticipating potential disruption and providing patients with medications for an extended period. During periods of similar crisis, anticipating potential limitations on medication access and increased mental health needs could potentially prevent negative health impacts.

BamrahS, MbithiA, MerminJH, BooT, BunnellRE, SharifSK, CooksonST. The Impact of Post-Election Violence on HIV and Other Clinical Services and on Mental Health—Kenya, 2008. Prehosp Disaster Med. 2013;28(1):1-9.

The health of people with chronic medical conditions is particularly vulnerable to the disruptions caused by public health disasters, especially when there is massive damage to the medical infrastructure. Government agencies and national organizations recommend that people with chronic illness prepare for disasters by stockpiling extra supplies of medications.

A wide range of chronic illnesses has long been documented among veterans of the US armed forces. Veterans with chronic illness could be at great risk of complications due to disaster-related medication disruptions; however, the prevalence of personal medication preparedness among chronically ill veterans is not currently known.

Data was used from the 2009 California Health Interview Survey on 28,167 respondents who reported taking daily medications. After adjusting for differences in age, health status, and other characteristics, calculations were made of the percentage of respondents who had a two-week supply of emergency medications and, among respondents without a supply, the percentage who said they could obtain one. Veteran men, veteran women, nonveteran men, and nonveteran women were compared.

Medication supplies among veteran men (81.9%) were higher than among nonveteran women (74.8%; P < .0001) and veteran women (81.1%; P = 0.014). Among respondents without medication supplies, 67.2% of nonveteran men said that they could obtain a two-week supply, compared with 60.1% of nonveteran women (P = .012).

Among adults in California with chronic illness, veteran men are more likely to have personal emergency medication supplies than are veteran and nonveteran women. Veteran men may be more likely to be prepared because of their training to work in combat zones and other emergency situations, which perhaps engenders in them a culture of preparedness or self-reliance. It is also possible that people who choose to enlist in the military are different from the general population in ways that make them more likely to be better prepared for emergencies.

Veterans in California have a relatively high level of emergency medication preparedness. Given the health complications that can result from disaster-related medication disruptions, this is a promising finding. Disasters are a national concern, however, and the personal preparedness of veterans in all parts of the nation should be assessed; these findings could serve as a useful reference point for such work in the future.

HeslinK, GinJ, AfableM, RicciK, DobalianA. Personal Medication Preparedness Among Veteran and Nonveteran Men and Women in the California Population. Prehosp Disaster Med. 2013; 28(4):1-8.

The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.

Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period.

Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe.

Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients.

PetinauxB, YadavK. Patient-Driven Resource Planning of a Health Care Facility Evacuation. Prehosp Disaster Med. 2013;28(2):1-7.

Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.

Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.

The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.

The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.

DjalaliA, CastrenM, KhankehH, GrythD, RadestadM, OhlenG, KurlandL. Hospital Disaster Preparedness as Measured by Functional Capacity: a Comparison between Iran and Sweden. Prehosp Disaster Med.2013;28(5):1-8.

Heart failure poses a significant burden of disease, resulting in 2,658 Australian deaths in 2008, and listed as an associated cause of death in a further 14,466 cases. Common in the hospital setting, continuous positive airway pressure (CPAP) therapy is a non-invasive ventilation technique used to prevent airway collapse and manage acute pulmonary edema (APO). In the hospital setting, CPAP has been known to decrease the need for endotracheal intubation in patients with APO. Therefore the objective of this literature review was to identify the effectiveness of CPAP therapy in the prehospital environment.

A review of selected electronic medical databases (Cochrane, Medline, EMBASE, and CINAHL) was conducted from their commencement date through the end of May 2012. Inclusion criterion was any study type reporting the use of CPAP therapy in the prehospital environment, specifically in the treatment of heart failure and acute pulmonary edema. References of relevant articles were also reviewed.

The literature search located 1,253 articles, 12 of which met the inclusion criteria. The majority of studies found that the use of CPAP therapy in the prehospital environment is associated with reduced short-term mortality as well as reduced rates of endotracheal intubation. Continuous positive airway pressure therapy was also shown to improve patient vital signs during prehospital transport and reduce myocardial damage.

The studies conducted of prehospital use of CPAP to manage APO have all demonstrated improvement in patient outcomes in the short term.

Available evidence suggests that the use of CPAP therapy in the prehospital environment may be beneficial to patients with acute pulmonary edema as it can potentially decrease the need for endotracheal intubation, improve vital signs during transport to hospital, and improve short-term mortality.

WilliamsB, BoyleM, RobertsonN, GiddingsC. When Pressure is Positive: A Literature Review of the Prehospital Use of Continuous Positive Airway Pressure. Prehosp Disaster Med.2013;28(1):1-10.

Mass-gathering events require varying types and amounts of medical resources to deal with patient presentations as well as careful planning for environmental health management. The Holy Shroud Exhibition was hosted in Torino, Italy, between April and May 2010. The venue was a unique mass-gathering event which lasted several weeks. It was held in a limited area in the center of the city and it was attended by a large and heterogeneous population. A dedicated Health Care Service was created for the event.

This study is a retrospective analysis of clinical presentations of patients who were managed by the Medical Services during the event. The main study outcomes included Patient Presentation Rate (PPR), type of injuries and illnesses, and the Transport to Hospital Rate (TTHR).

The PPR and TTHR were both low (0.27 and 0.039 respectively). The majority of patients presented with low severity codes and no sudden cardiac death (SCD) or cardiac arrest occurred. Cardiac and trauma emergencies were most frequent categories of presentation. A number of pediatric patients (19.37%) were treated by the event Medical Service. Approximately two million persons participated in the 40-day event.

The experience for this 40-day event supported having an on-site, organized, dedicated Medical Service that decreased overcrowding of the local Emergency Medical System and hospitals. It is recommended that, for such events, there be recruitment of emergency physicians with experience in mass-gathering events, recruitment of pediatricians, and training for professionals during the planning process.

BortolinM, UllaM, BonoA, FerreriE, TomatisM, SgambetterraS. Holy Shroud Exhibition 2010: Health Services During a 40-Day Mass-Gathering Event. Prehosp Disaster Med. 2013;28(3):1-6.

Patients with possible spinal injury must be immobilized properly during transport to medical facilities. The aim of this research was comparing spinal immobilization using a long backboard (LBB) with using a vacuum mattress splint (VMS) in trauma victims transported by an Emergency Medical Services (EMS) system.

In this randomized clinical trial, 60 trauma victims with possible spinal trauma were divided to two groups, each group immobilized with one of the two instruments. Speed and ease of application, immobilization rate, and the patients’ comfort were recorded.

In this survey, LBB was faster to apply: 211.66 (SD = 28.53) seconds vs 654.00 (SD = 16.61) seconds. Various measures of immobilization were better by LBB. Also, LBB offered a significant improvement in comfort over a VMS for the patient with possible spinal injury. All of the results were statistically significant.

The results of this study showed that immobilization using LBB was easier, faster, and more comfortable for the patient, and provided additional decrease in spinal movement when compared with a VMS.

MahshidfarB, MofidiM, YariA, MehrsoroshS. Long Backboard versus Vacuum Mattress Splint to Immobilize Whole Spine in Trauma Victims in the Field: a Randomized Clinical Trial. Prehosp Disaster Med. 2013;28(5):1-4.

The newer cyanide antidote, hydroxocobalamin, due to its pigmentation, has been found to cause interferences in some laboratory assays. Co-oximetry may also be affected by hydroxocobalamin, leading to false elevations in hemoglobin concentration, methemoglobin, carboxyhemoglobin, and false decreases in oxyhemoglobin. The Masimo Radical-7 is a medical device that performs noninvasive oximetry and estimates hemoglobin (Hb) concentration and percent carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin saturation (O2Hb).

The study sought to determine the effect of hydroxocobalamin on noninvasive measurement of hemoglobin indices using the Masimo Radical-7 monitor.

Seven asymptomatic volunteers who were unexposed to cyanide had baseline heart rate (HR), blood pressure (BP), and oximeter measurements recorded followed by an infusion of five grams of hydroxocobalamin over 15 minutes. The above parameters were subsequently recorded at: 5, 10, 15, 30 and 60 minutes post infusion. Data were analyzed by calculating the area under the curve (AUC) for each variable and comparing the results to expected values by paired t tests. Expected AUC values were calculated by extrapolating baseline values across the entire time period.

The mean differences from baseline values with 95% confidence intervals and t tests of mean difference were: SBP: 11 mm Hg (95% CI, 0-22; P = .051); HR: -9 (95% CI, -15 to -3; P = .01); Hb: -0.1 (95% CI, -0.7 to 0.4; P = .57); O2Hb: 0 g/dL (95% CI, -1 to 1; P = .41); COHb: -1 (95% CI, -3 to 1; P = .25); MetHb: -0.2 (95% CI, -0.3 to 0; P = .03).

After infusion of hydroxocobalamin there was a significant elevation of systolic blood pressure and decrease in heart rate. There were no significant differences in Hb, O2Hb, and COHb. Although percent methemoglobin concentrations were statistically lower, the authors feel this difference is of trivial clinical significance.

The administration of hydroxocobalamin does not significantly impact noninvasive oximetry.

CashinB, MatlockA, KangC, ReynoldsP, WillsB. Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans. Prehosp Disaster Med. 2013;28(4):1-3.

Patients seeking care in public hospitals are often resource-limited populations who have in past disasters become the most vulnerable. The objective of this study was to determine the personal disaster preparedness of emergency department (ED) patients and to identify predictors of low levels of preparedness. It was hypothesized that vulnerable populations would be better prepared for disasters.

A prospective cross-sectional survey was conducted over a one-year period of patients seeking care in a public university hospital ED (census 65,000). Exclusion criteria were mentally impaired, institutionalized, or non-English speaking subjects. Subjects completed an anonymous survey detailing the 15 personal preparedness items from the Federal Emergency Management Agency's disaster preparedness checklist as well as demographic characteristics. Summary statistics were used to describe general preparedness. Chi-square tests were used to compare preparedness by demographics.

During the study period, 857/1000 subjects completed the survey. Participants were predominantly male (57%), Caucasian (65%), middle-aged (mean 45 years), and high school graduates (83%). Seventeen percent (n = 146) reported having special needs and 8% were single parents. Most participants were not prepared: 451 (53%) had >75% of checklist items, 393 (46%) had food and water for 3 days, and 318 (37%) had food, water, and >75% of items. Level of preparedness was associated with age and parenting. Those aged 44 and older were more likely to be prepared for a disaster compared to younger respondents. (43.3% vs 31.1%, P = .0002). Similarly, single parents were more likely to be prepared than dual parenting households (47.1 vs 32.9%, P = .03).

This study and others have found that only the minority of any group is actually prepared for disaster. Future research should focus on ways to implement disaster preparedness education, specifically targeting vulnerable populations, then measuring the effects of educational programs to demonstrate that preparedness has increased as a result.

TrueNA, AdedoyinJD, ShoferFS, HastyEK, BriceJH. Level of Disaster Preparedness in Patients Visiting the Emergency Department: Results of the Civilian Assessment of Readiness for Disaster (CARD) Survey. Prehosp Disaster Med.2013;28(2):1-5.

Major adverse climatic events (MACEs) in heavily-populated areas can inflict severe damage to infrastructure, disrupting essential municipal and commercial services. Compromised health care delivery systems and limited utilities such as electricity, heating, potable water, sanitation, and housing, place populations in disaster areas at risk of toxic exposures. Hurricane Sandy made landfall on October 29, 2012 and caused severe infrastructure damage in heavily-populated areas. The prolonged electrical outage and damage to oil refineries caused a gasoline shortage and rationing unseen in the USA since the 1970s. This study explored gasoline exposures and clinical outcomes in the aftermath of Hurricane Sandy.

Prospectively collected, regional poison control center (PCC) data regarding gasoline exposure cases from October 29, 2012 (hurricane landfall) through November 28, 2012 were reviewed and compared to the previous four years. The trends of gasoline exposures, exposure type, severity of clinical outcome, and hospital referral rates were assessed.

Two-hundred and eighty-three gasoline exposures were identified, representing an 18 to 283-fold increase over the previous four years. The leading exposure route was siphoning (53.4%). Men comprised 83.0% of exposures; 91.9% were older than 20 years of age. Of 273 home-based calls, 88.7% were managed on site. Asymptomatic exposures occurred in 61.5% of the cases. However, minor and moderate toxic effects occurred in 12.4% and 3.5% of cases, respectively. Gastrointestinal (24.4%) and pulmonary (8.4%) symptoms predominated. No major outcomes or deaths were reported.

Hurricane Sandy significantly increased gasoline exposures. While the majority of exposures were managed at home with minimum clinical toxicity, some patients experienced more severe symptoms. Disaster plans should incorporate public health messaging and regional PCCs for public health promotion and toxicological surveillance.

KimH, TakematsuM, BiaryR, WilliamsN, HoffmanR, SmithS. Epidemic Gasoline Exposures Following Hurricane Sandy. Prehosp Disaster Med. 2013;28(6):1-6.

On September 4, 2010 a major earthquake caused widespread damage, but no loss of life, to Christchurch city and surrounding areas. There were numerous aftershocks, including on February 22, 2011 which, in contrast, caused substantial loss of life and major damage to the city. The research aim was to assess how these two earthquakes affected the staff in the General Medicine Department at Christchurch Hospital.

To date there have been no published data assessing the impact of this type of natural disaster on hospital staff in Australasia.

A questionnaire that examined seven domains (demographics, personal impact, psychological impact, emotional impact, impact on care for patients, work impact, and coping strategies) was handed out to General Medicine staff and students nine days after the September 2010 earthquake and 14 days after the February 2011 earthquake.

Response rates were ≥ 99%. Sixty percent of responders were <30 years of age, and approximately 60% were female. Families of eight percent and 35% had to move to another place due to the September and February earthquakes, respectively. A fifth to a third of people had to find an alternative route of transport to get to work but only eight percent to 18% took time off work. Financial impact was more severe following the February earthquake, with 46% reporting damage of >NZ $1,000, compared with 15% following the September earthquake (P < .001). Significantly more people felt upset about the situation following the February earthquake than the September earthquake (42% vs 69%, P < .001). Almost a quarter thought that quality of patient care was affected in some way following the September earthquake but this rose to 53% after the February earthquake (12/53 vs 45/85, P < .001). Half believed that discharges were delayed following the September earthquake but this dropped significantly to 15% following the February earthquake (27/53 vs 13/62, P < .001).

This survey provides a measure of the result of two major but contrasting Christchurch earthquakes upon General Medicine hospital staff. The effect was widespread with minor financial impact during the first but much more during the second earthquake. Moderate psychological impact was experienced in both earthquakes. This data may be useful to help prepare plans for future natural disasters.

TovaranonteP, CawoodTJ. Impact of the Christchurch Earthquakes on Hospital Staff. Prehosp Disaster Med. 2013;28(3):1-6.

According to US military data, airway obstruction is the third leading cause of possibly preventable death in combat. In the absence of law enforcement-specific medical training, military experience has been translated to the law enforcement sector. The purpose of this study was to determine whether airway obstruction represents a significant cause of possibly preventable death in police officers, and whether current military combat lifesaver training programs might have prevented these fatalities.

De-identified, open-source US Federal Bureau of Investigation (FBI) Uniform Crime Report Law Enforcement Officers Killed and Assaulted (LEOKA) data for the years 1998-2007 were reviewed. Cases were included if officers were on duty at the time of fatal injury and died within one hour from time of wounding from penetrating face or neck trauma. After case identification, letters requesting autopsy reports were sent to the departments of victim officers. Reports were abstracted into a Microsoft Excel database.

During the study period, 42 of 533 victim officers met inclusion criteria. Departmental response rate was 85.7%. Autopsy reports were provided for 29 officers; 23 (54.8%) cases remained in the final analysis. All officers died from gunshot wounds. No coroner specifically identified airway obstruction as either a direct cause of death or contributing factor. Based upon autopsy findings, three of 341 officers possibly succumbed to airway trauma (0.9%; 95% CI, 0.0%-1.9%). Endotracheal intubation was the most common advanced airway management technique utilized during attempted resuscitation.

The limited LEOKA data suggests that acute airway obstruction secondary to penetrating trauma appears to be a rare cause of possibly preventable death in police officers. Based upon the nature of airway trauma, nasopharyngeal airways would not be expected to be an effective lifesaving intervention. This study highlights the requirement for a comprehensive mortality and “near miss” database for law enforcement officers.

FisherL, CallawayD, SztajnkrycerM. Incidence of Fatal Airway Obstruction in Police Officers Feloniously Killed in the Line of Duty: A 10-Year Retrospective Analysis. Prehosp Disaster Med.2013;28(5):1-5.

US Navy hospital ships are used as a foreign policy instrument to achieve various objectives that include building partnerships. Despite substantial resource investment by the Department of Defense (DoD) in these missions, their impact is unclear. The purpose of this study was to understand how and why hospital ship missions influence partnerships among the different participants.

An embedded case study was used and included the hospital ship Mercy's mission to Timor-Leste in 2008 and 2010 with four units of analysis: the US government, partner nation, host nation, and nongovernmental organizations. Key stakeholders representing each unit were interviewed using open-ended questions that explored the experiences of each participant and their organization. Findings were analyzed using a priori domains from a proposed partnership theoretical framework. A documentary review of key policy, guidance, and planning documents was also conducted.

Fifteen themes related to how and why hospital ship missions influence partnerships emerged from the 37 interviews and documentary review. The five most prominent included: developing relationships, developing new perspectives, sharing resources, understanding partner constraints, and developing credibility. Facilitators to joining the mission included partner nations seeking a regional presence and senior executive relationships. Enablers included historical relationships and host nation receptivity. The primary barrier to joining was the military leading the mission. Internal constraints included the short mission duration, participant resentment, and lack of personnel continuity. External constraints included low host nation and United States Agency for International Development (USAID) capacity.

The research finds the idea of building partnerships exists among most units of analysis. However, the results show a delay in downstream effects of generating action and impact among the participants. Without a common partnership definition and policy, guidance, and planning documents reinforcing these constructs, achieving the partnership goal will remain challenging. Efforts should be made to magnify the facilitators and enablers while developing mitigation strategies for the barriers and constraints. This is the first study to scientifically assess the partnership impact of hospital ship missions and could support the DoD's effort to establish, enable, and sustain meaningful partnerships. Application of the findings to improve partnerships in contexts beyond hospital ship missions may be warranted and require further analysis. This unique opportunity could bridge the rift with humanitarian actors and establish, enable, and sustain meaningful partnerships with the DoD.

LicinaD, MookherjiS, MigliaccioG, RingerC. Hospital Ships Adrift? Part 2: The Role of US Navy Hospital Ship Humanitarian Assistance Missions in Building Partnerships. Prehosp Disaster Med.2013;28(6):592-604.