Prehospital and disaster medicine
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Prehosp Disaster Med · Apr 2012
Portable handheld ultrasound in austere environments: use in the Haiti disaster.
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 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.
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Prehosp Disaster Med · Apr 2012
Leadership and use of standards by Australian disaster medical assistance teams: results of a national survey of team members.
It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters. ⋯ In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.
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Prehosp Disaster Med · Apr 2012
Principles of Emergency Department facility design for optimal management of mass-casualty incidents.
The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. ⋯ This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and staff safety.
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Prehosp Disaster Med · Apr 2012
Disaster metrics: quantification of acute medical disasters in trauma-related multiple casualty events through modeling of the Acute Medical Severity Index.
The interaction between the acute medical consequences of a Multiple Casualty Event (MCE) and the total medical capacity of the community affected determines if the event amounts to an acute medical disaster. ⋯ A novel quantitative taxonomy in MCE has been proposed by modeling the Acute Medical Severity Index (AMSI). This model accounts for both hospital and prehospital systems, and quantifies acute medical disasters. Prospective applications of various components of this model are encouraged to further verify its applicability and validity.
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Prehosp Disaster Med · Apr 2012
Disaster metrics: a proposed quantitative model for benchmarking prehospital medical response in trauma-related multiple casualty events.
Quantitative benchmarking of trauma-related prehospital response for Multiple Casualty Events (MCE) is complicated by major difficulties due to the simultaneous occurrences of multiple prehospital activities. ⋯ A new quantitative model for benchmarking prehospital response to MCE in trauma-related MCE is proposed. Prospective studies of this model are needed to validate its applicability.