Prehospital and disaster medicine
-
Prehosp Disaster Med · Apr 2014
The need for a systematic approach to disaster psychosocial response: a suggested competency framework.
Competency models attempt to define what makes expert performers "experts." Successful disaster psychosocial planning and the institutionalizing of psychosocial response within emergency management require clearly-defined skill sets. This necessitates anticipating both the short- and long-term psychosocial implications of a disaster or health emergency (ie, pandemic) by developing effective and sustained working relationships among psychosocial providers, programs, and other planning partners. The following article outlines recommended competencies for psychosocial responders to enable communities and organizations to prepare for and effectively manage a disaster response. ⋯ Using a modular approach to psychosocial planning, service providers can improve their response capacity by utilizing differences in levels of expertise and training. The competencies outlined in this paper can thus be used to standardize expectations about levels of psychosocial support interventions. In addition this approach provides an adaptable framework that can be adjusted for various contexts.
-
Note: Many of the concepts and some of the text and content provided in this paper were developed in association with Knut Ole Sundnes, MD and evolved from the Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style. * Initial and partial support for this project was provided by the Task Force for Quality Control of Disaster Management. This Project is under the auspices of the World Association for Disaster and Emergency Medicine. Abstract The goals of conducting disaster research are to obtain information to: (1) decrease the human, environmental, and economic losses; (2) decrease morbidity; (3) decrease pain and suffering; and (4) enhance the recovery of the affected population. ⋯ Birnbaum ML , Daily EK , O'Rourke AP , Loretti A. Disaster research/evaluation frameworks, part 1: an overview. Prehosp Disaster Med. 2014;29(2):1-12 .
-
Prehosp Disaster Med · Feb 2014
Multicenter StudyCharacteristics of hospitals diverting ambulances in a California EMS system.
While several reports discuss controversies regarding ambulance diversion from acute care hospitals and the mortality, financial, and resource effects, there is scant literature related to the effect of hospital characteristics. ⋯ Hospitals in this study providing specialty services were more likely to have higher diversion rates. This may result in increased difficulty getting patients requiring specialty care to centers able to provide the needed level of service. Major limitations include the retrospective nature of the study, as well as reliance on multiple data systems.
-
Prehosp Disaster Med · Feb 2014
Multicenter StudyOutcome accuracy of the Emergency Medical Dispatcher's initial selection of a diabetic problems protocol.
Diabetes mellitus, although a chronic disease, also can cause acute, sudden symptoms requiring emergency intervention. In these cases, Emergency Medical Dispatchers (EMDs) must identify true diabetic complaints in order to determine the correct care. In 911 systems utilizing the Medical Priority Dispatch System (MPDS), International Academies of Emergency Dispatch-certified EMDs determine a patient's chief complaint by matching the caller's response to an initial pre-scripted question to one of 37 possible chief complaints protocols. The ability of EMDs to identify true diabetic-triggered events reported through 911 has not been studied. ⋯ Using the MPDS to select the Diabetic Problems Chief Complaint protocol, the EMDs correctly identified a true diabetic-triggered event the majority of the time. However, many patients had other medical conditions, which complicated the initial classification of true diabetic-triggered events. Future studies should examine the associations between the five specific Diabetic Problems Chief Complaint protocol determinant codes (triage priority levels) and severity measures, eg, blood sugar level and Glasgow Coma Score.
-
Prehosp Disaster Med · Feb 2014
Waterworks, a full-scale chemical exposure exercise: interrogating pediatric critical care surge capacity in an inner-city tertiary care medical center.
Pediatric Intensive Care Unit (PICU) resources are overwhelmed in disaster as the need to accommodate influx of critically-ill children is increased. A full-scale chlorine overexposure exercise was conducted by the New York Institute for All Hazard Preparedness (NYIAHP) to assess the appropriateness of response of Kings County Hospital Center's (KCHC's) PICU surge plan to an influx of critically-ill children. The primary endpoint that was assessed was the ability of the institution to follow the PICU surge plan, while secondary endpoints include the ability to provide appropriate medical management. ⋯ During disasters, the ability to surge is paramount and each hospital addresses it differently. Hospitals and departments have written surge plans, but there is no literature available which assesses the validity of said plans through a rigorous, structured, simulated disaster drill. This study is the first to assess validity and effectiveness of a hospital's PICU surge plan. Overall, the KCHC PICU surge plan was effective; however, several deficiencies (mainly in communication and patient education in the ED) were identified, and this will improve future response.