The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel. METHODOLOGY: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience. RESULTS: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent. POSTINTERVENTION RESULTS: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the postintervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. CONCLUSION: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance

Need for continual education about disaster medicine for health professionals in China-a pilot study

<p>Abstract</p> <p>Background</p> <p>Disaster Medicine training is not included in medical education curriculum in China, even though the country has suffered various disasters annually. We intended to assess the need for continual education regarding disaster management for health professionals in China.</p> <p>Methods</p> <p>A survey was conducted among 324 health professionals who participated in the response to the Wenchuan earthquake medical relief and public health assessment in October, 2008.</p> <p>Results</p> <p>The most of participants (67.3%) received informal disaster medicine training, and only a few (12.7%) participated in disaster drills. Most of the participants wanted to get continual education about disaster medicine training (89.8%), but prefer on-line training course for the flexibility of time scheduling and travel through China.</p> <p>Conclusion</p> <p>The need for continual disaster medicine training is high; health professionals should be equipped with knowledge and skills for disaster management.</p

Microenvironmental adaptation of experimental tumours to chronic vs acute hypoxia

This study investigated long-term microenvironmental responses (oxygenation, perfusion, metabolic status, proliferation, vascular endothelial growth factor (VEGF) expression and vascularisation) to chronic hypoxia in experimental tumours. Experiments were performed using s.c.-implanted DS-sarcomas in rats. In order to induce more pronounced tumour hypoxia, one group of animals was housed in a hypoxic atmosphere (8% O2) for the whole period of tumour growth (chronic hypoxia). A second group was acutely exposed to inspiratory hypoxia for only 20 min prior to the measurements (acute hypoxia), whereas animals housed under normal atmospheric conditions served as controls. Acute hypoxia reduced the median oxygen partial pressure (pO2) dramatically (1 vs 10 mmHg in controls), whereas in chronically hypoxic tumours the pO2 was significantly improved (median pO2=4 mmHg), however not reaching the control level. These findings reflect the changes in tumour perfusion where acutely hypoxic tumours show a dramatic reduction of perfused tumour vessels (maybe the result of a simultaneous reduction in arterial blood pressure). In animals under chronic inspiratory hypoxia, the number of perfused vessels increased (compared to acute hypoxia), although the perfusion pattern found in control tumours was not reached. In the chronically hypoxic animals, tumour cell proliferation and tumour growth were significantly reduced, whereas no differences in VEGF expression and vascular density between these groups were observed. These results suggest that long-term adaptation of tumours to chronic hypoxia in vivo, while not affecting vascularity, does influence the functional status of the microvessels in favour of a more homogeneous perfusion

The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

"Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel. METHODOLOGY: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience. RESULTS: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent. POSTINTERVENTION RESULTS: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the postintervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. CONCLUSION: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

Primary health care disaster preparedness: A review of the literature and the proposal of a new framework

With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Frame-work in 2019, the World Health Organization (WHO) emphasized the need for disaster prepared-ness in all sectors of the health system, including primary health care (PHC). PHC disaster pre-paredness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster pre-paredness and lays the groundwork to deliver operational recommendations to assess and im-prove PHC disaster preparedness. A systematic literature review was performed and a total of 145 records were analyzed. Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework. The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and then boost their disaster pre-paredness. This manuscript will hopefully help to raise awareness among international policy -makers and health practitioners on the importance to design interventions that integrate the PHC system into overall DM strategies, as well as to assess the preparedness of PHC systems in differ-ent political, developmental, and cultural contexts

Analytical accuracy of the handheld PICO monitoring device during emergencies

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Introduction: General practitioners (GP) use few technical devices during emergency situations. They have to recognise which patients have a life-threatening disease in order to treat or refer them appropriately. Monitoring by a wearable device could help GPs while waiting for the emergency physician to arrive. The PICO monitor is a handheld monitoring device, capable of registering five routine parameters and small enough to be carried in the GP's bag. We aim to determine the analytical accuracy of the PICO monitor in adults, comparing the recorded vital signs and ECGs of the PICO with those of a standard emergency department (ED) monitor. Methods: Adult (≥18 years) patients, admitted on two inpatient university EDs in Belgium, were recruited. We recorded the SpO 2 , heart rate (HR), respiration rate (RR), temperature (T°) and 5-lead ECGs. We analysed the correlation and agreement between the continuous and dichotomous variables of the PICO and the ED monitors. Results: We included 226 patients (84% of 268 approached), mean age 66 years, 61% were men. The Bland and Altman analysis confirmed the good accuracy, giving a nearly perfect agreement for SpO 2 (difference - 0.9%), for HR ('1.5 beats), for RR between the monitors (0.1 breaths), for RR between the manually counted and the PICO or the monitor (respectively 0.2 and 0.0 breaths), also confirmed by the regression analysis (Passing-Bablok). Analysis of 219 ECG records provided a near perfect agreement between the devices (kappa respectively 0.61-0.80 and 0.81-1.00) for the most important ECG abnormalities. In none of the comparisons, differences were clinically relevant. Conclusion: We were able to confirm the analytical accuracy of the PICO monitor in comparison with the ED monitors. The PICO monitor can be considered a reliable device for monitoring patients during emergencies by GPs and even in ambulances or EDs as a mobile alternative.status: Published onlin

The European Masters Degree in Disaster Medicine (EMDM): A Decade of Exposure.

Disaster medicine education has become extremely important, following the increase in mass casualty incidents, acts of terrorism and complex humanitarian emergencies. Recent studies have reported that health care professionals do not feel sufficiently knowledgeable in this area. The European Master in Disaster Medicine (EMDM) is a II level master organized by the University of Eastern Piedmont (Novara, Italy) and the Free University of Brussels (Belgium). Up to know, the EMDM has trained more than 400 students from all over the world, providing them with the appropriate competencies to coordinate medical response during crisis situations. This article provides a general overview of the Master’s framework and reports its influence on graduates' professional career