Objective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.

Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.

Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).

The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.

Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

Background: Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster.

Methods: This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives.

Results: The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake.

Conclusions: This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

In 2001, a survey of Canadian emergency departments indicated significant deficiencies in disaster preparedness. Since then, there have been efforts on the part of Provincial governments to remedy this situation. This survey repeats the original study with minor modifications to determine if there has been improvement. The Hospital Emergency Readiness Overview study demonstrates that despite improvements, there remain gaps in Canadian healthcare facility readiness for disaster, specifically one involving contaminated patients. It also highlights the lack of any standardized assessment of healthcare facilities' chemical, biological, radiological, or nuclear readiness.

During large-scale, sudden-onset disasters, resscue personnel experience severe stress due to the brief window of opportunity for saving lives. Following the earthquake in Haiti, rescue personnel worked in Port-au-Prince under harsh conditions in order to save lives and extricate bodies. Reactions to this disaster among rescue personnel were examined using self-report questionnaires. Correlations between psychosocial factors and psychological trauma (dissociation and post-traumatic stress disorder (PTSD) symptoms) were examined in a sample of 20 rescue personnel who worked in Haiti. The study indicated that negative affect and crisis of meaning were associated with higher levels of dissociative and PTSD symptoms. The results suggest that rescue personnel who are overwhelmed by the destruction and number of bodies being extricated may exhibit negative affect and loss of meaning along with dissociative and PTSD symptoms.

Introduction: The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims.

Methods: A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria.

Results: The following criteria were identified as geriatric-specific criteria: (1) GCS score <14 in the presence of known or suspected traumatic brain trauma; (2) SBP <100 mmHg; (3) fall from any height with evidence of traumatic brain injury: (4) multiple body-system injuries; (5) struck by a moving vehicle; and (6) the presence of any proximal long bone fracture following motor vehicle trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center.

Conclusions: The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the overall mortality in the elderly.

Introduction: In recent years, the number of public health emergencies has increased. Improving hospital emergency management is an important challenge.

Objective: This is a pilot study intended to assess hospital emergency management in the Beijing area, make recommendations to government health authorities and hospital managers, and offer references for similar studies.

Methods: This was an observational, cross-sectional survey. Forty-five hospitals in the Beijing area were selected randomly. A self-administered questionnaire was used as a data collection tool. It comprised of three sections: (1) Section A was the introduction; (2) Section B asked for the respondent's personal information; and (3) Section C comprised the major part of the questionnaire and was intended to gather information regarding the hospital's general emergency management situation.

Results: The survey response rate was 44%, accounting for 29% of total hospitals that the study targeted. No hospital had an established emergency management department or full-time staff for emergency management. A total of 15–45% of the hospitals had established a hospital emergency management committee, performed a vulnerability analysis, or evaluated emergency management regularly. Twenty-five percent of respondents thought that the local government health authority had established an integrated hospital incident command system. A total of 40%–55% of hospitals contracted with outside institutions for supplements, backup of key functional systems and professional support.

Conclusions: After the occurrence of the 2003 severe acute respiratory syndrome (SARS) epidemic, Chinese hospital managers took many measures to improve hospital resilience. However, most of these efforts lacked the guidance of theories, concepts, principles, and methods. An integrated, standardized, operational hospital emergency management model has not been established. Although the survey response rate was relatively low, some clues for further study were discovered, and suggestions to the health authority for hospital emergency management improvement were revealed.

Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities.

Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions.

Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted.

Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters.

Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countries.

Introduction: The State University of New York at Downstate (SUNY) conducted a web-based long-distance tabletop drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals preceding the 2010 FIFA World Cup. The tabletop drill simulated a stampede and crush-type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled “Western Cape-Abilities”, was conducted between May and September 2009, and encompassed nine hospitals in the Western Cape of South Africa. The main purpose of this drill was to identify strengths and weaknesses in disaster preparedness among nine state and private hospitals in Cape Town, South Africa. These hospitals were tasked to respond to the ill and injured during the 2010 World Cup.

Methods: This LDTT utilized e-mail to conduct a 10-week, scenario-based drill. Questions focused on areas of disaster preparedness previously identified as standards from the literature. After each scenario stimulus was sent, each hospital had three days to collect answers and submit responses to drill controllers via e-mail.

Results: Data collected from the nine participating hospitals met 72% (95%CI = 69%–75%) of the overall criteria examined. The highest scores were attained in areas such as equipment, with 78% (95%CI = 66%–86%) positive responses, and development of a major incident plan with 85% (95% CI = 77%–91%) of criteria met. The lowest scores appeared in the areas of public relations/risk communications; 64% positive responses (95% CI = 56%–72%), and safety, supplies, fire and security meeting also meeting 64% of the assessed criteria (95% CI = 57%–70%). Surge capacity and surge capacity revisited both met 76% (95% CI = 68%–83% and 68%–82%, respectively).

Conclusions: This assessment of disaster preparedness indicated an overall good performance in categories such as hospital equipment and development of major incident plans, but improvement is needed in hospital security, public relations, and communications ahead of the 2010 FIFA World Cup.

Gathering essential health data to provide rapid and effective medical relief to populations devastated by the effects of a disaster-producing event involves challenges. These challenges include response to environmental hazards, security of personnel and resources, political and economic issues, cultural barriers, and difficulties in communication, particularly between aid agencies. These barriers often impede the timely collection of key health data such as morbidity and mortality, rapid health and sheltering needs assessments, key infrastructure assessments, and nutritional needs assessments. Examples of these challenges following three recent events: (1) the Indian Ocean tsunami; (2) Hurricane Katrina; and (3) the 2010 earthquake in Haiti are reviewed. Some of the innovative and cutting-edge approaches for surmounting many of these challenges include: (1) the establishment of geographical information systems (GIS) mapping disaster databases; (2) establishing internet surveillance networks and data repositories; (3) utilization of personal digital assistant-based platforms for data collection; (4) involving key community stakeholders in the data collection process; (5) use of pre-established, local, collaborative networks to coordinate disaster efforts; and (6) exploring potential civil-military collaborative efforts. The application of these and other innovative techniques shows promise for surmounting formidable challenges to disaster data collection.

Case studies can be useful in assessing and learning lessons from emergency situations. In this paper, different uses for disaster case studies, are explored with identification of potential pitfalls that should be avoided. In addition, ways to improve the rigor and significance of case studies are suggested. Case studies can be used as examples or as a research tool. If conducted properly, they can provide robust and compelling results. It is argued that sharing a common guide to conducting and writing case studies among all disaster risk reduction professionals could improve the quality of case study reports and thereby strengthen their value in advancing the prevention, preparedness, and management of disasters and emergencies.

Background: The earthquake that struck Haiti on 10 January 2010, killed 200,000 persons and injured thousands more. Working with Partners in Health, a non-governmental organization already present in Haiti, Dartmouth College, and the University of Pennsylvania sent multidisciplinary surgical teams to hospitals in the villages of Hinche and Cange. The purpose of this report is to describe the injuries seen and evolution of treatments rendered at these two outlying regional hospitals during the first month following the earthquake.

Methods: A retrospective review of the database maintained by each team was performed. In addition to a list of equipment taken to Haiti, information collected included patient age, American Society of Anesthesiology (ASA) physical status, injuries sustained, procedures performed, wound management strategy, antibiotic therapy, and early outcomes.

Results: A total of 113 surgical procedures were performed in 15 days by both teams. The average patient age was 25 years and average ASA score was 1.4. The majority of injuries involved large soft tissue wounds and closed fractures, although 21–40% of the patients at each hospital had either an open fracture or amputation wound. Initially, wound debridement was the most common procedure performed, but after two weeks, skin grafting, fracture fixation, and amputation revision were the more commonly needed operations.

Conclusions: Academic surgical teams can ameliorate the morbidity and mortality following disasters caused by natural hazards by partnering with organizations that already have a presence in the affected region. A multidisciplinary team of surgeons and nurses can improve both mortality and morbidity following a disaster.

Due to its unprecedented scale, the Pakistan flood disaster tested the limits of disaster management and coordination. Under the leadership of the World Health Organization, the Global Health Cluster system for coordinating activities improved collaboration and efficiency in conducing rapid needs assessments. However, the involvement of non-Cluster members was lacking, and information on existing service provision was not collected adequately. The present rapid health needs assessment process under the Cluster system will be discussed, using the recent floods in Pakistan as an example.

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

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

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

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

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

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

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

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

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

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

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

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