Kumbh Mela 2013: Healthcare for the millions

Mass gatherings pose challenges to healthcare systems anywhere in the world. The Kumbh Mela 2013 at Allahabad, India was the largest gathering of humanity in the history of mankind, and posed an exciting challenge to the provision of healthcare services. At the finale of the Mela, it was estimated that about 120 million pilgrims had visited the site.Equitable geospatial distribution of adhoc health care facilities were created on a standardised template with integrated planning of evacuation modalities. Innovative and low cost response measures for disaster mitigation were implemented. Emergency patient management kits were prepared and stocked across the health care facilities for crisis response. Dynamic resource allocation (in terms of manpower and supplies) based on patient volumes was done on a daily basis, in response to feedback.An adhoc mega township created on the banks of a perennial river (Ganga) in the Indian subcontinent for accommodating millions of Hindu pilgrims. Conventional mindset of merely providing limited and static healthcare through adhoc facilities was done away with. Innovative concepts such as riverine ambulances and disaster kits were introduced. Managing the medical aspects of a mass gathering mega event requires allocation of adequate funds, proactive and integrated medical planning and preparedness.     

灾害所致大量伤员的入院前处理问题

回顾1986年-1995年中资料较全的5次灾害所致大五伤员的入院前处理，从灾害急救医学观点讨论灾害发生后入院前与大量伤员处理密切相关的急救通讯、检伤分类、现场急救、伤员运送等重要环节，提出存在的问题，吸取经验教训，以利提高救灾医疗水平．     

与灾害相关的身心健康中家庭医生的角色

每年,自然灾害、技术灾害和大型暴力冲击了美国数百万人。灾害后,提供初级保健服务的时间要增至12个月或更长。帮助受害者的概念框架包括,理解灾害后影响身心健康的个体和环境风险因素。灾害的受害者呈现给家庭医生的典型问题包括急性躯体健康问题,如胃肠炎或病毒综合征。慢性问题常需要药物治疗和提供初级保健服务。有些受害者可存在急性或者慢性身心问题的风险性,如创伤后应激障碍、抑郁症或者酒精依赖。灾害后出现身心健康问题的风险因素包括,灾害前的心理健康问题和高水平暴露于灾害相关的应激源（如对死亡或者严重创伤的担心、暴露于严重创伤或者死亡、与家庭分离,长时间迁居）。对灾害有效的行动计划需要做好充分的准备工作。针对灾害对身心健康的威胁性,家庭医生应该做好自我教育,并且与地方和国家相关组织机构进行配合;保证诊所或办公场所有充足的药品、缝合和打石膏用品等医疗资源。医生也应该对其家庭安全做出应有的计划。     

National medical response to mass disasters in the United States. Are we prepared?

Preparing for a resuscitation response to mass disasters, such as major earthquakes or industrial disasters, requires revisions of present local, regional, and national disaster plans. These should include the following: (1) life-supporting first aid and basic rescue capability of the lay public; (2) advanced trauma life support and advanced (heavy) rescue capability brought quickly to the scene from local and surrounding (regional) emergency medical services systems; and (3) trauma hospitals sending medical resuscitation teams to, and receiving casualties from, the disaster scene for resuscitative surgery and definitive care. Local and regional everyday emergency medical services systems would respond first. The armed forces should help, at least for transport and security. We propose that the National Disaster Medical System replace its civil defense model with an emergency medical services model, designed to mobilize rapid support for local emergency medical services systems from regional, state, and national resources. Coordination should be by one federal agency, such as the Federal Emergency Management Agency, which, however, needs to focus more on resuscitation through physician input.     

Medical services for outdoor rock music festivals.

This paper describes the medical services provided at an outdoor rock music festival near Toronto and reviews similar services at other outdoor concerts as reported in the literature. Between 0.5% and 1.5% of concertgoers were reported to have used medical services, proportions that may be useful in planning for future festivals. Most of the medical problems encountered were minor, although life-threatening problems occasionally occurred. Alcohol and drug abuse were common but led to major medical problems in only small proportions of patients. Guidelines for planning are suggested that include recommendations about facilities, supplies and equipment, transportation and communications, staffing and procedures. The need for liaison with the concert promoters, the police, ambulance officials and local hospital personnel is noted, and the use of the nonmedical ancillary staff is encouraged.     

Role of medical teams in a community disaster plan.

In London, Ont. two mock disaster exercises have indicated the need for re-evaluating the role of medical disaster teams. To coordinate and direct these teams a medical on-site coordinating team, composed of three emergency physicians with an expanded and more clearly defined role, was formed. The role of the triage teams deployed from the hospital to assess and resuscitate casualties is reviewed in detail. In addition, the communication systems, availability and deployment of medical supplies, identification of medical personnel and tagging of casualties are discussed. Because a mass casualty episode is possible in any community, disaster planning and clear outlining of the role of medical disaster teams are needed.     

重大化学灾害事件医学应急救援预案的准备

在各类灾害事件处置和救援过程中,应急救援预案是一切行动的核心,是各种具体行动有序、高效展开,以及减少事故影响和损失最为有效的保证。本文拟以“天津港8·12特大爆炸事故”为背景,分析重大化学灾害事件医学应急救援预案准备过程中应关注的重要因素,并对预案内容提出具体建议。     

军队医学院校开展灾难医学教育的思考

灾难医学教育是医学教育的重要内容,近年来我国频发的公共安全事件和自然灾害对我国医学院校进行灾难医学教育提出了迫切要求。在军事医学院校开展灾难医学教育有其特殊优势。在全国性的灾难医学教育必修课设立之前,可以采取短期培训、选修课和隐形课程等方式进行综合性的灾难医学教育。     

某综合医院灾害易损性现状研究

目的对医院各种潜在风险进行顺位,确定该院需要重点应对的风险事件,并分析其形成的原因以及对该院可能造成的影响,提出加强风险管理的策略,把医院灾害易损性降低。方法通过问卷调查方式,对于每一风险事件,均从发生可能性、严重性（损伤-防范）方面建立评价因子的分级标准,选择综合指标法进行灾害易损性调查,根据计算结果对风险事件进行排位。结果该院高风险危害依次为医疗纠纷风险（R=129.28）、网络舆论事件（R=101.46）、电梯意外事件（R=90.01）、网络信息系统瘫痪（R=89.47）和医院感染（R=84.81）。结论该院需要重点防范的风险事件主要为医疗纠纷风险、网络舆论事件、电梯意外事件、网络信息系统瘫痪和医院感染。应对风险事件,医院可通过加强机制、体制建设,建立预警体系,有针对性的制定或完善相应预案,组织开展培训及演练,储备相应的应急物资,减小灾害对医院运行和医疗工作造成的影响。     

Supporting whistleblowers in academic medicine: training and respecting the courage of professional conscience

Conflicts between the ethical values of an organisation and the ethical values of the employees of that organisation can often lead to conflict. When the ethical values of the employee are considerably higher than those of the organisation the potential for catastrophic results is enormous. In recent years several high profile cases have exposed organisations with ethical weaknesses. Academic medical institutions have exhibited such weaknesses and when exposed their employees have almost invariably been vindicated by objective inquiry. The mechanisms that work to produce such low ethical standards in what should be exemplary organisations are well documented and have been highlighted recently. The contribution of elements of medical training in eroding ethical standards of medical students have also been emphasised recently and strategies proposed to reduce or reverse this process. The ability to rapidly change the ethical and professional culture of graduate medical trainees may help to deal with some of the perceived problems of declining ethical standards in academic medicine.     

实现灾难应急医学救援数据资源智能化管理的思考

科学应对灾难救援已成为全球关注的热点和当今社会的普遍共识。人工智能技术有助于人类未来预防灾难、抵御灾难,可最大限度地减少灾难损失的影响,是最具前景的发展领域。目前,中国政府从科技研发、应用推广和产业发展等层面提出了一系列措施,也为智能化灾难应急医学救援的发展指出了方向。通过灾难数据信息智能化管理可优化整合各种资源,减少不必要浪费,也能获得更好的综合判断结论和更合理的应对决策。采用智能大数据技术与灾难救援产业结合作为创新研发突破点,并应用于灾难救援实践中,可以大幅度提升我国灾害应急救援水平。结合灾难前、灾难中、灾难后的复杂性、特殊性的实情,积极开拓灾难预防应急智能技术,使之成为有助公众防灾避险的智能工具。     

Hurricane preparedness among healthcare workers in St James

OBJECTIVE: To assess the preparedness of health workers in St James, Jamaica, to respond to natural disasters. METHODS: A cross-sectional survey was conducted on a 25% quota sample of hospital and health department staff in St James in 2005 (n = 307). Awareness of and attitudes to disaster management policies, plans and training and how these influenced their response in Hurricane Ivan were evaluated Statistical package for the Social Science 11.5 was used to summarize quantitative data, while qualitative data were analyzed manually. RESULTS: Most respondents (67%) knew of the disaster plan but only 40% had been trained in disaster management. More nurses (68%) and paramedicals (51%) reported being trained than ancillary/ auxilliary (33%), medical (21%) or administrative/clerical (18%) staff Most (96%) had participated in at least one disaster preparedness drill, usually a fire drill, but not in the previous two years. Attitudes towards disaster management were positive (99% insisted training should be compulsory, 95% agreed they should help in a hurricane). The majority (86%) reported being available to work at any time and 77% had worked as scheduled during Hurricane Ivan. Transportation and personal responsibility (to children, elderly or property) were the main limiting factors. Provisions for staff welfare (eg transportation, protective gear, media updates) were perceived as inadequate. Having defined disaster response roles was positively correlated with age, years of service and occupation (p < 0.01) CONCLUSION: Health workers in St James have positive attitudes to disaster management but require routine training to compensate for staff turnover. More attention must be given to staff welfare during disasters.     

The "Sherman effect": decreased ambulatory care volumes in Atlanta during the 1996 Summer Olympic Games

OBJECTIVE: To estimate the effect of the 1996 Atlanta Summer Olympic Games on visits to local ambulatory healthcare facilities. DESIGN: Comparison of median visit rates by time period, obtained from retrospective review of administrative data. SETTING: The emergency department of the designated athletes' hospital, the public hospital's adult emergency department and adult walk-in clinics, and the adult and paediatric outpatient facilities of a large health maintenance organisation. PATIENTS: All 132,826 visitors to the designated facilities during the study interval. MAIN OUTCOME MEASURE: Daily visit frequencies at each facility. Our informal observations had suggested that volumes were not as high as expected. RESULTS: In all but the athletes' designated hospital, there was a decrease in average volumes the week before the opening ceremonies, ranging from zero to 8.4% of baseline. Average daily volumes in these non-venue facilities varied from 3.2% above to 16.1% below baseline during the two weeks of the Games, but all experienced an increase in volumes the week after the closing ceremonies, ranging from 3.0% to 13.7% of baseline. CONCLUSION: Unlike the venue-related facility, community ambulatory care sites did not encounter a significant rise in volumes until after the closing ceremonies. Although confirmation from other events is needed, our data suggest that, in addition to increased preparedness for sudden volume surges, overtime staffing of local facilities during planned mass gatherings should occur not during, but immediately after, the event.     

Health Emergencies in Large Populations: The Orissa Experience

Natural disasters occur frequently in the country and civic authorities requisition medical aid from the Armed Forces for the succour of populations, with increasing regularity. The recent Orissa floods (2001) saw deployment of a Medical Team and the experiences of the team are discussed. Over a nine day period, 7450 cases were treated on site in medical aid posts established in flood affected areas. Of these patients, 4038 (54.20%) were affected by gastrointestinal illnesses (diarrhoea/acute gastroenteritis); 976 (13.10%) had suffered injuries and were treated accordingly; 2007 (26.94%) cases of respiratory infection were managed. 210 (2.82%) cases of undiagnosed fever were treated, and 18 (0.24%) cases of clinical malaria were diagnosed additionally. Skin and other infections comprised 186 (2.50%) cases of the total. Thus, this study provides a brief outline of the spectrum of illnesses that may be encountered in dealing with flood affected populations, for the benefit of planning for future humanitarian operations. The various stages of a disaster have been brought out, for an insight into the morbidity pattern in such deployments. The concept of “Health Emergencies in Large Populations” is introduced in the discussion, for policy to be evolved. Public health is closely interlinked with disaster management, and the Army with its resource of trained specialists is geared for response in the face of disaster in a professional manner. Recommendations on dealing with future situations under such conditions of deployment have also been made.Key Words: Disasters, Floods, Health problems, Populations, Public health     

药灾界定研究

目的是界定药灾。通过对灾害相关理论和药灾主要表现的研究，课题组提出药灾应具备的特征、药灾起因、药灾转折、药灾定义和衡量药灾严重程度的评估指标。     

Forensic Investigation of mass disasters in Nigeria: A review

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner''s system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.     

Design and evaluation of a wireless electronic health records system for field care in mass casualty settings

Background

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).

Materials and methods

WIISARD combined advanced networking technology with electronic triage tags that reported victims'' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds.

Results

WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22).

Conclusion

Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters.     

Disaster epidemiology and disease monitoring

Better epidemiologic knowledge of the mechanisms of death and of the types of injuries and illnesses caused by disasters is clearly essential to determining the appropriate, relief medications, supplies, equipment, and personnel needed to effectively respond to such emergencies. The overall objective of disaster epidemiology is to measure scientifically and describe the health effects of disasters and the factors contributing to these effects. The results of such investigations allow disaster epidemiologists to assess the needs of disaster-affected populations, efficiently match resources to needs, prevent further adverse health effects, evaluate relief effectiveness, and plan for future disasters.     

Mass casualty incidents and disasters in Nigeria: The need for better management strategies

AIMS AND OBJECTIVES: The aim of this article is to discuss principles involved in disaster management, disasters in Nigeria, examine the current level of preparedness in the country and make recommendations for improvement. METHODS: An overview of various disaster events in the country coupled with review of the literature. RESULT: Fatality figures for disaster in Nigeria are high. CONCLUSION: There is need for a strong political will from government at all levels regarding disaster management in order to mitigate its occurrence and impact.