Responding to natural disasters vs. disease outbreaks: Do emergency medical service providers have different views?

INTRODUCTION: Our planet has been experiencing a huge burden of natural disasters and public health emergencies in the last three decades. Emergency medical service providers are expected to be in the frontlines during such emergencies. Yet, this system is badly understudied when it comes to its roles and performance during disasters and public health emergencies. This study is designed to enhance understanding by assessing a sample U.S EMS providers' views about working during natural disasters and disease outbreaks and explores whether they are coming to work during such conditions. METHODS: This study utilized a qualitative approach using face-to-face interviews with EMS workers from the State of Delaware, USA. Participants were asked about their views, insights, and potential behavior of working during natural disasters and disease outbreaks. Data collected were transcribed and coded using ATLAS.ti software to develop themes of the study using an inductive approach. RESULTS: Three themes were emerged from interviews regarding working during natural disasters; respondents expressed excitement, concern, or no real differences. For disease outbreaks, however, the two themes were concerned and no additional risk. While participants expressed varying concerns about working during disasters and pandemic conditions, everyone felt willing and obligated to come to work despite the perceived high risk for some of them to work in some conditions. CONCLUSION: This study helps to provide the base upon which EMS, public health, and emergency management agencies can formulate actions that emerged from the views of EMS providers concerning work during disasters and public health emergencies.

"Just-in-Time" Personal Preparedness: Downloads and Usage Patterns of the American Red Cross Hurricane Application During Hurricane Sandy.

OBJECTIVE: Personal preparedness is a core activity but has been found to be frequently inadequate. Smart phone applications have many uses for the public, including preparedness. In 2012 the American Red Cross began releasing "disaster" apps for family preparedness and recovery. The Hurricane App was widely used during Hurricane Sandy in 2012. METHODS: Patterns of download of the application were analyzed by using a download tracking tool by the American Red Cross and Google Analytics. Specific variables included date, time, and location of individual downloads; number of page visits and views; and average time spent on pages. RESULTS: As Hurricane Sandy approached in late October, daily downloads peaked at 152,258 on the day of landfall and by mid-November reached 697,585. Total page views began increasing on October 25 with over 4,000,000 page views during landfall compared to 3.7 million the first 3 weeks of October with a 43,980% increase in views of the "Right Before" page and a 76,275% increase in views of the "During" page. CONCLUSIONS: The Hurricane App offered a new type of "just-in-time" training that reached tens of thousands of families in areas affected by Hurricane Sandy. The app allowed these families to access real-time information before and after the storm to help them prepare and recover. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

Comparison of prediction models for use of medical resources at urban auto-racing events.

UNLABELLED: INTRODUCTION Predicting the number of patient encounters and transports during mass gatherings can be challenging. The nature of these events necessitates that proper resources are available to meet the needs that arise. Several prediction models to assist event planners in forecasting medical utilization have been proposed in the literature. HYPOTHESIS/PROBLEM: The objective of this study was to determine the accuracy of the Arbon and Hartman models in predicting the number of patient encounters and transportations from the Baltimore Grand Prix (BGP), held in 2011 and 2012. It was hypothesized that the Arbon method, which utilizes regression model-derived equations to estimate, would be more accurate than the Hartman model, which categorizes events into only three discreet severity types. METHODS: This retrospective analysis of the BGP utilized data collected from an electronic patient tracker system. The actual number of patients evaluated and transported at the BGP was tabulated and compared to the numbers predicted by the two studied models. Several environmental features including weather, crowd attendance, and presence of alcohol were used in the Arbon and Hartman models. RESULTS: Approximately 130,000 spectators attended the first event, and approximately 131,000 attended the second. The number of patient encounters per day ranged from 19 to 57 in 2011, and the number of transports from the scene ranged from two to nine. In 2012, the number of patients ranged from 19 to 44 per day, and the number of transports to emergency departments ranged from four to nine. With the exception of one day in 2011, the Arbon model over predicted the number of encounters. For both events, the Hartman model over predicted the number of patient encounters. In regard to hospital transports, the Arbon model under predicted the actual numbers whereas the Hartman model both over predicted and under predicted the number of transports from both events, varying by day. CONCLUSIONS: These findings call attention to the need for the development of a versatile and accurate model that can more accurately predict the number of patient encounters and transports associated with mass-gathering events so that medical needs can be anticipated and sufficient resources can be provided.

A poor association between out-of-hospital cardiac arrest location and public automated external defibrillator placement.

INTRODUCTION: Much attention has been given to the strategic placement of automated external defibrillators (AEDs). The purpose of this study was to examine the correlation of strategically placed AEDs and the actual location of cardiac arrests. METHODS: A retrospective review of data maintained by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), specifically, the Maryland Cardiac Arrest Database and the Maryland AED Registry, was conducted. Location types for AEDs were compared with the locations of out-of-hospital cardiac arrests in Howard County, Maryland. The respective locations were compared using scatter diagrams and r2 statistics. RESULTS: The r2 statistics for AED location compared with witnessed cardiac arrest and total cardiac arrests were 0.054 and 0.051 respectively, indicating a weak relationship between the two variables in each case. No AEDs were registered in the three most frequently occurring locations for cardiac arrests (private homes, skilled nursing facilities, assisted living facilities) and no cardiac arrests occurred at the locations where AEDs were most commonly placed (community pools, nongovernment public buildings, schools/educational facilities). CONCLUSION: A poor association exists between the location of cardiac arrests and the location of AEDs.

Methicillin-resistant staphylococcus aureus nasal colonization prevalence among Emergency Medical Services personnel.

INTRODUCTION: The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel. Hypothesis/ Problem The hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population. METHODS: This was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the Study Size 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) 'Δ' = 4.53% can be detected at α = 5% and power = 80% with N = 110. RESULTS: Samples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population. CONCLUSION: There is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.

A public health enforcement initiative to combat underage drinking using Emergency Medical Services call data.

OBJECTIVE: The objective of this study was to determine whether Emergency Medical Services (EMS) records can identify bars that serve a disproportionate number of minors, and if government officials will use this data to direct underage drinker enforcement efforts. METHODS: Emergency Medical Services call logs to all bars in the study area were cross-referenced with a local hospital's records. The records of patients with alcohol-related complaints were analyzed. Outlier bars were identified, and presented to government officials who completed a survey to assess if this information would prompt new enforcement efforts. RESULTS: Emergency Medical Services responded to 149 establishments during the study period. Eighty-four responses were distributed across six bars, and 78 were matched with the hospital's records. Fifty-one patients, 18 (35%) of whom were underage, were treated for alcohol intoxication, with 46% of the cases originating from four bars. Government officials found the information useful, and planned to initiate new operations based on the information. CONCLUSIONS: Alcohol consumption by minors can lead to life-long abuse, with high personal, financial, and societal costs. Emergency Medical Services response data and hospital records can be used to identify bars that allow underage drinking, which is useful in directing law enforcement efforts.

Bacterial pathogens in ambulances: results of unannounced sample collection.

UNLABELLED: The concern that the health care environment may harbor a substantial reservoir of infectious agents has been vigorously examined by microbiology and infectious disease experts. Although universal precautions and disposable equipment reduces risks to patients and providers, the ambulance remains vulnerable to bacterial contamination from biological secretions. Additionally, the nature of emergency medical services creates pressures on prehospital care providers. OBJECTIVE: We hypothesized that a discrepancy exists between the expectation of disinfection of reusable equipment in emergency medical services (EMS) and the cleaning that actually occurs. METHODS: We chose five areas within the ambulance for specimen collection for their reasoned propensity to yield a large spectrum of bacteria. Four first-due ambulances were selected for culturing. The crews did not have advance knowledge of the study or sample collection. Specific identifications with antibiotic susceptibility were completed, identifying three multidrug resistant organisms. RESULTS: Specimens from all four ambulances grew moderate-to-large quantities of environmental and skin flora. Newer, automated microbiological techniques and concerns regarding multiple-drug-resistant organism prevalence as well as the potential for biological warfare make complete identification more important. CONCLUSIONS: This study examined the bacterial pathogens found in EMS vehicles. Four of the seven species isolated were substantial nosocomial pathogens, and three of these four possess formidable antibiotic resistance patterns. All of the organisms detected are susceptible to the disinfectant agents currently in common use by EMS agencies.

Epidemic and bioterrorism preparation among emergency medical services systems.

INTRODUCTION: The purpose of this research was to determine the preparedness of emergency medical services (EMS) agencies in one US state to cope with a massive epidemic event. METHODS: Data were collected primarily through telephone interviews with EMS officials throughout the State. To provide a comparison, nine out-of-state emergency services agencies were invited to participate. RESULTS: Emergency medical services agencies from nine of the 23 counties (39%) provided responses to some or all of the questions in the telephone survey. Seven of the nine out-of-state agencies provided responses to the survey. Most of the EMS agencies do not have broad, formal plans for response to large-scale bio-terrorist or pandemic events. CONCLUSIONS: The findings indicate that EMS agencies in this state fundamentally are unprepared for a large-scale bioterrorism or pandemic event. The few existing plans rely heavily on mutual aid from agencies that may be incapable of providing such aid. Therefore, EMS agencies must be prepared to manage a response to these incidents without assistance from any agencies outside of their local community. In order to accomplish this, they must begin planning and develop close working relationships with public health, healthcare, and elected officials within their local communities.

Evidence of the effectiveness of health sector preparedness in disaster response: the example of four earthquakes.

In this article, evidence that health sector preparedness improves response performance in disasters was examined. Case fatality and survival data were compared for four earthquakes, in relation to health sector emergency preparedness levels. Vast differences in performance were found. The two California systems, with a high preparedness index, had low case fatality rates (about one death per 100 injuries). Kobe, Japan, with mixed levels of preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness index) had 167. Public health and health sector preparedness made a significant difference in the ability to respond effectively to meet patient needs in disasters, although it is only one of several factors that determine the health outcome of disaster victims.

Ambulance snatching: how vulnerable are we?

Out of concern that ambulances might be targeted for hijack for terrorism purposes, we observed security-related behaviors of a cross-section of ambulance crews and their vehicles in Emergency Department ambulance bays. We sent observers to a convenience sample of trauma and suburban Emergency Department ambulance entrances in several states. We observed 151 total ambulance arrivals. Overall, the average time present was 21.5 min, 23.2% of units were left with the engine running, 26.5% were left open, 90.1% were left unattended, 84.1% were unlocked, and 16.6% had a non-crew visitor in the ambulance bay. Several issues were identified demonstrating potential "attractiveness" to individuals who may wish to disrupt Emergency Medical Services or steal an emergency vehicle. We are concerned that this is the case at the majority of ambulance bays in our country. Emergency services agencies should take steps to train their personnel to secure the ambulance.

Vaccine administration by paramedics: a model for bioterrorism and disaster response preparation.

The events of 11 September 2001 have had a profound effect on disaster planning efforts in the United States. This is true especially in the area of bioterrorism. One of the major tenets of bioterrorism response is the vaccination of at-risk populations. This paper investigates the efficacy of training emergency medical services paramedics to administer vaccines in public health settings as preparation for and response to bioterrorism events and other disaster events. The concept of vaccination administration by specially trained paramedics is not new. Various programs to provide immunizations for emergency services personnel and at-risk civilian populations have been reported. Vaccination programs by paramedics should follow the guidelines of the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC). This paper compares the seven standards of the CDC guidelines to routine paramedic practice and education. It is concluded that paramedics are adequately trained to administer vaccines. However, specific training and protocols are needed in the areas of administrative paperwork and patient education. A proposed outline for a paramedic-training program is presented.

Health and hurricanes in the developing world : A case study in the Dominican Republic

This is a study of the public health consequences of a 1979 hurricane disaster in the Dominican Republic. An evaluation of the health relief that followed the disaster, and an investigation of the role that three communities played in their own protection and recovery the epidemiology section of the study used from provincial and community levels. The provincial data, covering approximately three and one half years prior to and one half years following the disaster, demonstrate delayed-impact epidemic increases in typhoid fever gastroenteritis, measles, and hepatitis. The delays represented two to three generations of the incuration periods of the pathogens, resulting in peak incidences one to six months following the hurricanes previous studies failed to show these delayed impact epidemics. The community-level date were obtained by surveys administered two weeks and two years after the disaster

Delayed-impact infectious disease after a natural disaster

Most recent studies of natural disasters have shown little increase in post-disaster infectious disease. The result has been a de-emphasis of the disease control portion of many disaster relief programs. This study demonstrates a significnt increase in four out of the five diseases studied following two hurricanes in the Dominican Republic, with the major impact of the increases coming several months after disaster. Posited reason for the increase in infectious diseases are: (a) overcrowding of makeshift refugee centers with insufficient sanitary facilities, and (b) flood-caused water transmission of pathogens(AU)