Prehospital and disaster medicine
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Prehosp Disaster Med · Mar 2008
Twenty-five years of violence: the epidemiology of terrorism in South America.
Terrorism is a global public health burden. South Americans have been victims of terrorism for many decades. While the causes vary, the results are the same: death, disability, and suffering. The objective of this study was to perform a comprehensive, epidemiological, descriptive study of terrorist incidents in South America. ⋯ Terrorist incidents in South America have accounted for nearly 2,000 deaths, with conventional explosive devices as the predominant method of choice. Understanding the nature of terrorist attacks and the medical consequences assist emergency preparedness and disaster management officials in allocating resources and preparing for potential future events.
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Prehosp Disaster Med · Mar 2008
Foreign field hospitals in the recent sudden-onset disasters in Iran, Haiti, Indonesia, and Pakistan.
Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters. ⋯ A striking finding was the lack of detailed information on FFH activities. None of the 43 FFHs arrived early enough to provide emergency medical trauma care. The deployment of FFHs following sudden-onset disasters should be better adapted to the main needs and the context and more oriented toward substituting for pre-existing hospitals, rather than on providing immediate trauma care.
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Prehosp Disaster Med · Mar 2008
Ability of regional hospitals to meet projected avian flu pandemic surge capacity requirements.
Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities. The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks. ⋯ The GDAHA hospitals should test their regional distributors' ability to resupply PPE for multiple facilities simultaneously. Facilities should retrofit current air exchange systems to increase the number of potential negative pressure rooms and include such designs in all future construction. Neuraminidase inhibitor supplies should be increased to provide treatment for healthcare workers exposed in the course of their duties. Each hospital should have a complete set of policies to address the special considerations for a prolonged surge. Additional capacity is required to meet the predicted demands of a threat similar to the 1918 pandemic.
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Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event ofbioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction. ⋯ The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.
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Prehosp Disaster Med · Mar 2008
Why the closest ambulance cannot be dispatched in an urban emergency medical services system.
Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety. ⋯ The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixed-deployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.