Abrassart, S.

Hoffmeyer, P.

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s20 Abstracts-IPRED 2010code. A vector comprised of six body regions, where a digitindicates the presence of an injury in that region and ahyphen denotes no injury in that region was created. Thisvector, called MIP, is used as a categorical patient charac-teristic that is analyzed as would any other variable. Datafrom the 2006 Lebanon war was used to demonstrate thebenefits of the application of this approach.Results: This method enables the association of morbidityand mortality more accurately to the exact profile of a com-plex injury, clarifying the obscured "multiple injury" diag-nosis that resulted in loss of information.Data on 689 soldiers injured or killed in the 2ndLebanon War was used to demonstrate the application.The fatality rate among casualties with only head injurieswas 10%, among isolated chest injuries, 12% yet, amongcombined head and chest, it was 71.4%. Previously, thisinformation would have been lost.Conclusions: The use of MIP enabled the production of amore comprehensive picture of injury due to the detailedrecording of injuries that were previously concealed as partof "multiple". The MIP demonstrates that some combina-tions of injuries are more deadly, indicating causes of mortali-ty previously masked due to the general category "multiple",orthe association with one of the components.Keywords: multiple injuriesPrehosp Disaster MedAnalysis of Preventable Deaths According to Post-MortemReports in Traumatic DeathsMurat Durusu;1 Mehmet Eryilmaz;2 Mehmet Toygar;3Ersin Baysat*1. Emergency Department, Diyarbakir Military Hospital,Diyarbakir, Turkey2. Emergency Department, Gata Faculty of Medicine, Ankara,Turkey3. Forensic Medicine Department, Gata Faculty of Medicine,Ankara, Turkey4. Council Of Forensic Medicine, Diyarbakir, TurkeyThe aim of this study was to investigate the preventabledeaths due to trauma after autopsies and postmortemexaminations were performed at the Diyarbakir Council ofForensic Medicine.In this retrospective study, descriptive, demographic,type of injury, cause of injury, locations of injuries, cause ofdeath, and scene of death data were examined using thereports of the deaths due to trauma at the DiyarbakirCouncil of Forensic Medicine between 01 January 2008and 31 December 2008. Medical errors in these deaths andpreventable deaths were analyzed using these data.Of the 747 cases considered, 31 (4.15%) were pre-ventable, 121 (16.20%) were potentially preventable, and595 (79.65%) were unpreventable. Suboptimal care in 75(49.34%), delay in treatment 63 (41.45%), missed diagno-sis in 16 (10.53%), clinical judgment error in 16 (10.53),missed medical administration in 11 (7.23%), and othermistakes in 6 (3.95%) of the cases have been found.When the results were compared with the other studiesperformed in areas where modern trauma care and trauma cen-ters are located, the preventable death were high. As a result,forming modern trauma system and trauma centers have a sig-nificant role in decreasing the preventable death ratios.Keywords: autopsy; forensic science; preventable death; traumaPrehosp Disaster MedSurvey on Willingness of Emergency Department Staffto Work during Mass-Casualty EventsDr. Juliana Poh; Dr. Seth PuneetSingapore Health Services, SingaporeIntroduction: The availability of healthcare staff is vital toeffective disaster surge response. Factors likely to affectwillingness of staff to work during disasters have beenstudied in the West. Having experienced high staffturnover during the 2003 severe acute respiratory syn-drome (SARS) outbreak in Singapore, the aim of this studywas to examine such factors in the Asian context.Methods: Using a self-administered questionnaire, the aimof this study was to gauge the factors influencing willing-ness of emergency department staff to work during differ-ent disasters and possible incentives to improve turn-uprate. Responses were anonymous.Results: Twenty-six questions were posed to 206 respon-dents. During a disaster, only 25 (12.1%) would considerresignation. Of these 25, likely triggers for resigningincluded long working hours for 16 (64%), use of uncom-fortable equipment for 16 (64%), enforcement of compli-ance with protocol for 11 (44%), and communicable diseaseoutbreak for 21 (84%). A total of 202 (98%) would beinterested in receiving training for their role in a disaster.Factors affecting willingness to work included fear andconcern for family (139; 67.4%), fear and concern for self(82; 39.8%), personal health problems (75; 36.4%) andchildcare/eldercare issues (72; 34.9%). A total of 175 (84.9%)would be encouraged to work with a pay increment. Theaverage increment expected was 46% (range = 5-300%).Participants were most willing to work after a building col-lapse and least willing to work during a chemical disaster orradiation accident. If incentives were offered, the most pop-ular ones would be insurance for death/injury and extrapayment per hour, followed by transport facilities, taxrebates, and volunteers for family care.Conclusions: While most staff are likely to continue work-ing during a disaster, willingness to work can be enhancedif barriers are removed and incentives offered. These find-ings have significant implications for community and orga-nizational emergency planning and policymaking whenresources are limited.Keywords: emergency department; limited resources; mass-casualtyincident; personnel; willingness to workPrehosp Disaster MedGlycemia: A Means of Triage during EmergenciesS. Abrassart; P. HoffmeyerHopital Universitaire de Geneve, Geneva, SwitzerlandIntroduction: Improved survival rates of patients withmultiple injuries have increased the general interest in thequality of polytrauma management. A special and simplescore is needed for the triage of the polytraumatized. ThePrehospital and Disaster Medicine http://pdm.medicine.wisc.edu Supplementhttps:/www.cambridge.org/core/terms. https://doi.org/10.1017/S1049023X00022202Downloaded from https:/www.cambridge.org/core. University of Basel Library, on 30 May 2017 at 20:27:52, subject to the Cambridge Core terms of use, available atAbstracts-IPRED 2010 s21purpose of this study was to observe the polytrauma popu-lation and to correlate lesions with initial blood sugar.Methods: A prospective study was conducted of 204patients polytraumatized between January 2006 andDecember 2007; this database is in conformity with theethics committee. Patients were selected according to theadmission code "polytrauma" with National Committee onAeronautics Score System (NACA) score >4. Blood analy-sis was performed as soon as the patient arrived. For eachpatient, the Injury Severity Score (ISS) was compared tothe blood sugar level.Results: The ISS and glycemia curve demonstrates a linearrelation between the two values, especially for blood sugarconcentration <8. Abdominal injuries always increase thelevel of blood sugar. Simple limb trauma or spine fracturedid not impair glycemia, except when associated with openwound fractures, compression syndrome, or paraplegia. Theaverage glycemia of pelvic trauma was 9.0 and the averageISS was 41. Head injury associated with abdominal or tho-racic trauma always enhances glycemia when there are lifethreatening lesions associated. There was no correlationbetween ISS and age or sex.Conclusions: High glucose levels may indicate seriouslesions according ISS levels; this correlation provides valu-able information for prehospital triage and transfer to thebest hospital system.Keywords: blood sugar; glycemia; Injury Severity Score; polytrauma;triagePrehosp Disaster MedResilience of Hospitals in CrisisMajor liana Gens, RN, MPH, MOccHIsraelIntroduction: The health system and general hospitals inIsrael constitute one of the main pillars for preparing foremergency situations and improvement of hospitals to copewith varying threats.Background: The 2nd Lebanon War and the ongoing con-frontation around Gaza brought a significant change in theperception of threat, emphasizing the fact that in everyconflict, the civilian home front will be one of the mainobjectives of injury.Despite these high levels of preparedness, hospitals innorthern and southern Israel found themselves in a long-lasting crisis situation. While they were under missileattacks, they were expected to be fully functional level.This long emergency situation was a real test of organiza-tional strength and resilience, and emphasized the need forhospital functioning abilities as an essential and decisivecomponent in creating and reinforcing a sense of resilienceof the hospital.Proposed Model: The literature offers several models thatdiscuss dealing with resilience in three key parameters thataffect the resilience: (1) personal safety; (2) family safety;and (3) knowledge/preparedness.During Operation Cast Lead, the three parametersmodel, which included the following issues was adopted:1. Personal Safety—In order to improve the level of pro-tection in the hospital, the wards from last floors orone-floor buildings were transferred to shelters orother well protected areas;2. Family Safety—Day care centers were opened withinhospital facilities, to provide an adequate answer todisabled education system for the stuff children. Oneof such centers included >300 children for aboutthree weeks, thus allowed to approximately 95% ofstuff to continue their work; and3. Knowledge and Preparedness—During routine hospi-tals are preparing emergency plans including theemergency deployment of their practice. The hospi-tals that have experienced this kind of emergency sit-uation before managed by downloading hospitaloccupancy from 100% to 60% and transferring wardsto protected areas in three hours.Additional Findings: In addition to the parametersdescribed above, several other components were found tobe able to affect the hospitals resilience:1. Independent, internal control and coping capabilitiesof the hospital;2. Guarantee that essential workers stay in the hospital; and3. Support of environmental factors including press.Summary: Early and proper preparation of hospitals canaffect all parameters affecting the resilience level of thehospital, which includes improving the level of protection,dealing with arrangements for child care, developing anddrilling emergency plans, and guaranteeing that essentialworkers remain in the hospital.The model was tested at two hospitals during a relative-ly small and limited conflict. More research required inmore hospitals for the health system learning.Keywords: hospital; Israel; preparedness; resilient; safe hospitalPrehosp Disaster MedCollaboration in Disaster ManagementInteragency Collaboration Topology for CounteractingGlobal ThreatsFernando Galindo;1 Elin Gursky, Ron LaPorte,JFaina Linkov;4 Alessandra Rosddodivita:5Eugene Shubnikov;6 Elisaveta Stikova,Andrey Trufanov; Natalya Vinograd^1. University of Saragossa, Saragossa, Spain2. ANSER/Analytic Services, Inc., Arlington, Virginia USA3. University of Pittsburgh, Pitttsburgh, Pennsylvania USA4. University of Pittsburgh Cancer Institute, Pitttsburgh, PennsylvaniaUSA5. San Raffaele Hospital Scientific Foundation University, Milan,Italy6. Institute of Internal Medicine, Novosibirsk, Russia7. University "St. Cyril and Methodius", Skopje, Macedonia8. Irkutsk State Technical University, Irkutsk, Russia9. Danylo Halytski Lviv National Medical University, Lviv. UkraineIntroduction: Counteracting global disasters and mitigat-ing their consequences requires cooperative efforts ofdiverse national and international entities. Effectiveness ofsuch cooperation depends on the information-sharingenvironment the agencies act within. In robust and produc-tive information interaction that is reflected by its networktopology is needed. The network topology is determinedonly by the graphical mapping of the configuration andconnections between nodes (agency employees). This studyIPRED 2010 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicinehttps:/www.cambridge.org/core/terms. https://doi.org/10.1017/S1049023X00022202Downloaded from https:/www.cambridge.org/core. University of Basel Library, on 30 May 2017 at 20:27:52, subject to the Cambridge Core terms of use, available at

Glycemia: A Means of Triage during Emergencies

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