Preparedness and response to a mass casualty event resulting from terrorist use of explosives

"The purpose of this interim planning guidance is to provide valuable information and insight to help public policy and health system leaders at all levels prepare for and respond to a mass casualty event (MCE) caused by terrorist use of explosives (TUE). Medical preparations for an MCE have traditionally focused on the scene and prehospital sectors. Comprehensive mass casualty care, from a health systems perspective, has received far less attention and has evolved separately from the rest of the emergency response community. This document provides practical information to promote comprehensive mass casualty care in the event of a TUE. It is not intended to reflect U.S. Department of Health and Human Services (DHHS) policy but, rather, to provide public policy and health systems leaders with options to consider when planning their response to an MCE. This document is a collaboration between the Centers for Disease Control and Prevention (CDC) and the National Preparedness Leadership Initiative of Harvard University. CDC provides additional specific mass casualty and blast-injury related material that complements this document. These materials include "Blast Injuries: Fact Sheets for Professionals," "In a Moment's Notice: Surge Capacity for Terrorist Bombings: Challenges and Proposed Solutions," and the "Bombings: Injury Patterns and Care" course." - p. 4Executive summary -- 1. Introduction -- 2. Principles for health systems' preparedness in emergencies -- 3. Prehospital care -- 4. Patient distribution -- 5. Surge capacities and capabilities for hospitals -- Conclusion -- References -- AcknowledgementsTitle from PDF title screen (viewed on Mar. 19, 2010).Authors: Isaac Ashkenazi, MD, MPA, MSC, MNS, Richard C. Hunt, MD, FACEP, Scott M. Sasser, MD, FACEP, Sridhar V. Basavaraju, MD, Ernest E. Sullivent, MD, MPH, FACEP, Vikas Kapil, DO, MPH, FACOEM, Lisa C. McGuire, PhD, Lisa T. Garbarino, and Paula S. Peters, MPH, CHES.Mode of access: World Wide Web as an Arobat .pdf file (1.24 MB, 36 p.).Includes bibliographical references (p. 30).National Center for Injury Prevention and Control. Interim planning guidance for preparedness and response to a mass casualty event resulting from terrorist use of explosives. Atlanta, GA: Centers for Disease Control and Prevention; 2010

Preparedness and Response to a Mass Casualty Event Resulting from Terrorist Use of Explosives

No DescriptionInjury Prevention and ControlPublic Health Preparedness and ResponseCurren

Community-based perceptions of emergency care in communities lacking formalised emergency medicine systems

Kenya and Zambia face an increasing burden of emergent disease, with a high incidence of communicable diseases, increasing prevalence of non-communicable diseases and traumatic injuries. However, neither country has an integrated emergency care system that provides community access to high-quality emergency services. There has been recent interest in strengthening the emergency care systems in these countries, but before any interventions are implemented, an assessment of the current need for emergency care must be conducted, as the burden of acute disease and barriers to accessing emergency care in Zambia and Kenya remain largely undocumented. Aims and Objectives: The aim of this project was to ascertain community-based perceptions of the critical interventions necessary to improve access to emergency care in Zambia and Kenya, with the following objectives: 1. Determine the current pattern of out-of-hospital emergency care delivery at the community level. 2. Identify the communities’ experiences with emergency conditions and the barriers they face when trying to access care. 3. Discover community-generated solutions to the paucity of emergency care in urban and rural settings. Methods: Semi-structured focus groups were piloted in Zambia with 200 participants. Results were analysed with subsequent tool refinement for Kenya. Data were collected via focus groups with 600 urban and rural community members in cities and rural villages in the 8 Kenyan provinces. Thematic analysis of community member focus groups identified frequency of emergencies, perceptions of emergency care, perceived barriers to emergency care, and ideas for potential interventions. Results: Analysis of the focus group data identified several common themes. Community members in Zambia and Kenya experience a wide range of medical emergencies, and they rely on family members, neighbours, and Good Samaritans for assistance. These community members frequently provide assistance with transportation to medical facilities, and also attempt some basic first aid. These communities are already assisting one another during emergencies, and are willing to help in the future. Participants in this study also identified several barriers to emergency care : a lack of community education, absent or non-functional communication systems, insufficient transportation, no triage system, a lack of healthcare providers trained in emergency care, and inadequate equipment and supplies. Conclusions: Community members in Zambia and Kenya experience a wide range of medical emergencies. There is substantial reliance on family members and neighbours for assistance, commonly with transportation. Creating community education initiatives, identifying novel transportation solutions, implementing triage in healthcare facilities, and improving receiving facility care were community-identified solutions to barriers to emergency care

What factors are associated with the use of teletrauma in northern British Columbia?

Despite the existence of universal health care for Canadians, health inequalities persist. Those residing in rural regions of Canada may be at a disadvantage for accessing appropriate services. To enhance access, a teletrauma program was implemented in the Robson Valley, connecting rural clinicians during emergency cases. This study was undertaken to better understand the experiences of teletrauma users and why teletrauma is utilized. Data were gathered from 14 interviews with clinicians, health administrators, a researcher, and a health executive. Guided by interpretive description methodology, four major themes emerged, including: teletrauma affects the entire system of care; teletrauma enables a network of care built on interprofessional relationships; reasons clinicians use teletrauma are multifaceted and interrelated; and, interconnectedness of the healthcare system. Information from this study provides insight into the role and function of teletrauma in northern British Columbia and how it may better serve the needs of rural clinicians

Report to Congress on traumatic brain injury in the United States : epidemiology and rehabilitation

The Traumatic Brain Injury Act of 2008 authorized research and public health activities related to traumatic brain injury (TBI). The goal of public health related to injury prevention is to reduce the burden of injury at the population level by preventing injuries and ensuring care and rehabilitation that maximizes the health and quality of life for injured persons. The purpose of this report is to review what is known about TBI in three areas:TBI BURDEN\u2022 Describe the incidence of TBI, including trends over time;\u2022 Describe data on the prevalence of TBI-related disability;TBI OUTCOMES\u2022 Review the adequacy of TBI outcome measures;\u2022 Describe factors that influence differential TBI outcomes;TBI REHABILITATION\u2022 Assess the current status and effectiveness of TBI rehabilitation services.Suggested citation: Centers for Disease Control and Prevention. (2014). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.CS253199-AExecutive Summary. -- Background -- Section I: Epidemiology and Consequences of TBI in the United States -- Section II: Effectiveness of TBI Outcome Measures. -- Section III: TBI Rehabilitation -- Conclusion. -- Appendix A: Authors, Panel Members, Consultants, and Subject Matter Experts \u2013 References

The regionalization of emergency medical services : a strategy for planning and intervention

Thesis. 1975. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning.Bibliography: leaves 186-189.by Shelley F. Bernstein, E. Michael Paul Thomas.M.C.P

Understanding the public health problem among current and former military personnel

The Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel is a publication of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) in collaboration with the Department of Defense (DOD) and the Department of Veterans Affairs (VA).Since the beginning of Operation Enduring Freedom (OEF) (Afghanistan) and Operation Iraqi Freedom (OIF), public health and health care-communities have become aware of the increased rates of traumatic brain injury (TBI) among active duty U.S. military personnel. Epidemiologic and clinical studies suggest that many of these military service-related injuries have serious long-term health and socioeconomic consequences.In response to these public health and medical concerns, Congress passed the Traumatic Brain Injury Act of 2008 (TBI Act of 2008), which requires the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), in consultation with the Department of Defense (DoD) and Department of Veterans Affairs (VA), to determine how best to improve the collection and dissemination of information on the incidence and prevalence of TBI among persons who were formerly in the military; and to make recommendations on the manner in which CDC, NIH, DoD, and VA can collaborate further on the development and improvement of TBI diagnostic tools and treatments. To that end, the CDC, NIH, DoD, and VA formed a Leadership Panel of experts with extensive experience in epidemiologic and clinical research, and in treating and managing TBI and its consequences.This report presents the major findings and recommendations of the Leadership Panel and a review of relevant scientific literature and a thorough examination of current TBI-related activities and programs conducted by the four agencies/departments. It describes the public health importance of military service- related TBI, recommends how to measure the magnitude of the health and socioeconomic impact of TBI and suggests ways in which the four agencies/departments can collaborate further on the development and improvement of TBI diagnostic tools and treatments.Suggested Citation: The CDC, NIH, DoD, and VA Leadership Panel. Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel. Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Department of Defense (DoD), and the Department of Veterans Affairs (VA). 2013.Preface -- Goals of the Report -- Members of the Leadership Panel -- Executive Summary -- I. Introduction -- II. Pathophysiology and Mechanisms -- III. Diagnosis -- IV. Treatment -- V. Prognosis and Recovery -- VI. Surveillance -- VII. Epidemiology -- VIII. Prevention -- IX. Recommendation

A trauma system for KwaZulu-Natal : local development for local need.

Ph. D. University of KwaZulu-Natal, Durban 2013.Introduction: The need for Trauma Care in South Africa is without question one of the four major health issues facing the country and indeed the African continent today. First-world developed systems focus on the care of trauma from prevention to rehabilitation, yet in Africa the issue of access to even resuscitation is often the challenge faced by communities in poverty. The philosophical concepts which underpin the main thrust of the thesis are summarised as the introductory chapter. “The 11 P’s of an Afrocentric trauma system for South Africa” and “Guideline for the assessment of trauma centres for South Africa” were the result of this literature review. “Trauma care in South Africa: From humble beginnings to an afrocentric outreach” examines the history of trauma care in South Africa and the current desire to be relevant to the greater African Continent, highlighting the realities of practicing trauma care in this country. Local development is essential with regionally specific injury profiles, especially in a country like South Africa with very high trauma rates when compared to the rest of the world. Aim: This PhD submission aims to review the practical problems and the ethical issues facing trauma in South Africa. This submission examines the current burden of disease of live-injured patients entering the existing informal system in KwaZulu-Natal, both at a prehospital and in-hospital level of care. This submission also examines the current facilities and transfer processes within the government hospital sector, including specifically the utilization of the Level 1 Trauma Centre at Albert Luthuli Central Hospital. The submission aims to provide a solid provincial dataset on which to design a proposal for a practical system of trauma care across the province, and that may be potentially exportable to the rest of the country, and to Africa. Methods: This PhD proposal provides the evidence for the achievement of the stated aims through the submission of linked papers published in peer-reviewed medical journals relevant to the field of study covering an overview of the literature, examination of the ethical challenges in trauma facing South Africa, and the need for trauma systems. The current prehospital and hospital disease burden is examined and facility structure and staff skill-sets reviewed. A review of utilisation of and need for a major trauma centre is undertaken. Finally the thesis proposes an appropriate regionalised trauma system, emphasising the need for more such facilities across the province. The methods were described in the approved protocol and these are presented in the overview chapters. Results: The three papers that form the thrust of the scientific contribution of this work were all published in July 2013 in World Journal of Surgery and are as follows: 1. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. 2. An Assessment of the Hospital Disease Burden and the Facilities for the In-hospital Care of Trauma in KwaZulu-Natal,South Africa. 3. Utilisation of a Level 1 Trauma Centre in KwaZulu-Natal: Appropriateness of Referral Determines Trauma Patient Access All three studies received BREC approval (BE011/010). The essential methodology, findings and conclusions derived from these three papers are outlined here: Paper 1: Methods: Using a convenience data set all Emergency Medical Service (EMS) call data for the months of March and September 2010 were reviewed for the three main EMS providers in KZN. Data were extrapolated to annual data and placed in the context of population, ambulance service, and facility. The data were then mapped for area distribution and prehospital workload relative to the entire province. Questionnaire-based assessments of knowledge and deficiencies of the current system were completed by senior officers of the provincial system as part of the analysis of the current system. Results: The total annual call burden for trauma ranges between 94,840 and 101,420, or around 11.6 trauma calls per thousand of the population per year. Almost 70 % of calls were either for interpersonal intentional violence or vehicular collisions. Only 0.25 % of calls involved aeromedical resources. Some 80 % of patients were considered to be moderately to seriously injured, yet only 41 % of the patients were transported to a suitable level of care immediately, with many going to inappropriate lower level care facilities. Many rural calls are not attended within the time norms accepted nationally. Deficiencies noted by the questionnaire survey are the general lack of a bypass mechanism and the feeling among staff that most EMS bases do not have a bypass option or feel part of a system of care, despite large numbers of staff having been recently trained in triage and Conclusions: The prehospital trauma burden in KZN is significant and consumes vital resources and gridlocks facilities. A prehospital trauma system that is financially sustainable and meets the needs of the trauma burden is proposed to enable Afrocentric emergency care planning for low and middle income regions. Paper 2: Methods: Hospital administrators in KZN were requested to submit trauma caseloads for the months of March and September 2010. Caseloads were reviewed to determine the trauma load for the province per category using two extrapolation methods to determine the predicted range of annual incidence of trauma, intentional versus non-intentional trauma ratios and population-related incidence of trauma. The results were GIS mapped to demonstrate variations across districts. Hospital data were obtained from assessments of structure, process, and personnel undertaken prior to a major sporting event. These were compared to the ideal facilities required for accreditation of trauma care facilities of the Trauma Society of South Africa and other established documents. Results: Data were obtained from 36 of the 47 public hospitals in KZN that manage acute emergency cases. The predicted annual trauma incidence in KZN ranges from 124,000 to 125,000, or 12.9 per 1,000 population. This would imply a national public hospital trauma load on the order of at least 750,000 cases per year. Most hospitals are required to treat trauma; however, within KZN many hospitals do not have adequate personnel, medical equipment, or structural integrity to be formally accredited as trauma care facilities in terms of existing criteria. Conclusions: There is a significant trauma load that consumes vital emergency center resources. Most hospitals will need extensive upgrading to provide appropriate care for trauma. An inclusive trauma system needs to be formalized and funded, especially in light of the planned National Health Insurance for South Africa. Paper 3: Methods: An audit was performed of the referral proformas used in the unit to record admission decisions and of the computerised trauma database. The audit examined referral source (scene vs. interhospital), regional distribution, and final decision regarding admission of the injured patients. The study was approved by the UKZN Ethics Committee (BE207/09 and 011/010). Results: Of the 1,212 external consults, 540 were accepted for admission while the rest were not accepted for various reasons. These included 206 cases where no bed was available, 233 did not meet admission criteria (minor injury or futile situation), and 115 were for subspecialty management of a single-system injury. Finally, 115 were initially refused pending stabilisation for transfer at a regional facility. Twenty-six percent of the cases were referrals from the scene, with an acceptance rate of 96 %. Most patients (59 %) were from the local eThekwini region. Conclusion: Major multiorgan system trauma remains a significant public health burden in KwaZulu-Natal. A Level 1 Trauma Service is used appropriately in most circumstances. However, the additional need for more hospital facilities that provide such services across the whole province to enable effective geographical coverage for those trauma patients requiring such specialised trauma care is essential. After evaluation of the submitted papers a summative chapter is provided as to how they provide a framework to design a Trauma System relevant to KZN, South Africa and potentially Africa. Overall Conclusions: In the developed world trauma systems have been shown to substantially reduce mortality and morbidity after major and moderate trauma. Few such systems and centres of excellence exist within the developing world scenario. The solutions offered by such systems may not be entirely relevant to the African scenario. A trauma system relevant to KwaZulu-Natal, South Africa and the African continent is essential to reduce the huge mortality burden in low to middle income regions, where trauma is a major source of reduced life-years. The results of the studies presented here are valuable in providing insight to the needs and potential solutions to the challenges faced in our environment. A plea is therefore made for pilot implementation at provincial level. This will involve further research into the feasibility of introduction and how such an introduction could be audited and refined for broader adoption in South Africa and the African continent

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2011

Highlights examples of preparedness programs and capacities at risk of federal budget cuts or elimination, examines state and local public health budget cuts, reviews ten years of progress and shortfalls, and outlines policy issues and recommendations

Are We Failing the Homeless and Uninsured Trauma Patient? An Exploration in the Nurse Practitioner Role in Trauma, and Identification of Disparity in Treatment and Barriers to Follow-up for the Acutely Injured

The purpose of this dissertation was to examine disparities in healthcare related to insurance status and homelessness through three scholarly projects. Within the projects, the nurse practitioner’s role for trauma care in the homeless was reviewed. Two additional studies were conducted to identify if there is disparity in care for acutely injured patients based on insurance status at a national and/or a local level. Project I described the Trauma and Homelessness Initiative, which showed that essentially all homeless persons are exposed to trauma and then outlined a basic program that can be utilized to help care for those persons. Nurse Practitioner attributes were then reviewed and show that the nurse practitioner is well positioned to implement and lead similar programs. Project II was a secondary data analysis of a large national database (the National Hospital Ambulatory Medical Care Survey). Insurance status was associated with the number of patients returning to the emergency department within 72 hours of initial discharge for those who suffered an acute injury. When controlling for demographics and other variables studied, minority race and homelessness significantly associated with return visits. Project III was an exploratory, retrospective chart review performed to determine if lacking insurance is associated with the occurrence an adverse event prior to being able to obtain surgical correction of an unstable ankle injury. In patients seen at one of two emergency departments within a single healthcare system, neither insurance status nor demographic factors were associated with an increase in adverse events. There were more patients admitted from the emergency department than expected, which could be one explanation for the lack of disparity found. Evidence from these studies could provide nurses with knowledge about populations that face healthcare disparity. As primary patient care advocates and bedside healthcare providers, nurses, including advanced practice nurses, can use this knowledge to work toward providing the best care to all patients, regardless of their socioeconomic status or social situation