Utility of Point of Care and Rapid Diagnostics in Humanitarian Emergencies.

BACKGROUND: In 2019, there were 70.8 million forcibly displaced people worldwide. Among the top causes of morbidity and mortality were measles, diarrhea, respiratory illness, and malaria. Availability of accurate diagnostics that are of low complexity, affordable, and produce timely results on site without the need for expensive laboratory equipment, extensive training, or distant transport of samples, are essential tools in the response to humanitarian emergencies (HE). Early detection of infectious diseases with epidemic potential and coordinated outbreak response, can result in significant decrease in morbidity and mortality. CONTENT: This review explores the utility of point of care and rapid diagnostic tests (POCT/RDTs) in HE and presents a review and analysis of the low complexity, availability, and ease of use of these diagnostic modalities that make them helpful tools in these settings, despite the generally lower test performance metrics associated with them over conventional laboratory-based assays. We review the literature to understand how POCT/RDTs have been used in HE response to produce lifesaving information without the need for a robust system for transporting test samples to more sophisticated laboratories, as this is often prohibitive in areas affected by conflict or natural disasters. SUMMARY: We propose that POCT/RDTs be considered essential healthcare tools provided to countries following a HE and suggest that UN agencies and vulnerable countries include effective RDTs in their essential diagnostics as part of their national preparedness and response plans.

Medical services at ultra-endurance foot races in remote environments: medical issues and consensus guidelines.

An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.

Success of Senegal's first nationwide distribution of long-lasting insecticide-treated nets to children under five - contribution toward universal coverage.

BACKGROUND: In 2009, the first national long-lasting insecticide-treated net (LLIN) distribution campaign in Senegal resulted in the distribution of 2.2 million LLINs in two phases to children aged 6-59 months. Door-to-door teams visited all households to administer vitamin A and mebendazole, and to give a coupon to redeem later for an LLIN. METHODS: A nationwide community-based two-stage cluster survey was conducted, with clusters selected within regions by probability proportional to size sampling, followed by GPS-assisted mapping, simple random selection of households in each cluster, and administration of a questionnaire using personal digital assistants (PDAs). The questionnaire followed the Malaria Indicator Survey format, with rosters of household members and bed nets, and questions on campaign participation. RESULTS: There were 3,280 households in 112 clusters representing 33,993 people. Most (92.1%) guardians of eligible children had heard about the campaign, the primary sources being health workers (33.7%), neighbours (26.2%), and radio (22.0%). Of eligible children, 82.4% received mebendazole, 83.8% received vitamin A, and 75.4% received LLINs. Almost all (91.4%) LLINs received during the campaign remained in the household; of those not remaining, 74.4% had been given away and none were reported sold. At least one insecticide-treated net (ITN) was present in 82.3% of all households, 89.2% of households with a child < 5 years and 57.5% of households without a child < 5 years. Just over half (52.4%) of ITNs had been received during the campaign. Considering possible indicators of universal coverage, 39.8% of households owned at least one ITN per two people, 21.6% owned at least one ITN per sleeping space and 34.7% of the general population slept under an ITN the night before the survey. In addition, 45.6% of children < 5 years, and 49.2% of pregnant women had slept under an ITN. CONCLUSIONS: The nationwide integrated LLIN distribution campaign allowed household ITN ownership of one or more ITNs to surpass the RBM target of 80% set for 2010, though additional distribution strategies are needed to reach populations missed by the targeted campaign and to reach the universal coverage targets of one ITN per sleeping space and 80% of the population using an ITN.

Search and rescue in Yosemite National Park: a 10-year review.

OBJECTIVE: To describe the general characteristics and epidemiology of search and rescue (SAR) in Yosemite National Park (YNP) and identify possible areas for intervention directed at reduction in use of these services. METHODS: Yosemite Search and Rescue (YOSAR) personnel record every search and rescue mission on a Search and Rescue Incident Report. The information contained in these reports was used to perform a retrospective review of all SAR missions within YNP during the 10-year study period between January 1990 and December 1999. RESULTS: YOSAR performed 1912 SAR missions, assisting 2327 individuals and recording 2077 injuries and illnesses. Popular trails in and around Yosemite Valley collectively accounted for 25% of all individuals needing SAR services. Lower extremity injuries and dehydration/hypovolemia/hunger were commonly identified reasons to need SAR services. The duration of SAR missions averaged 5 hours, used 12 SAR personnel, and cost $4400. Helicopter was the primary mode of transport in 28% of SAR incidents. There were 112 fatalities, yielding a SAR case fatality rate of 4.8%. The majority of fatalities occurred while hiking/snowshoeing, with falling the most common mechanism of lethal injury. CONCLUSIONS: Day-hikers in and around Yosemite Valley use a large portion of SAR services, with lower extremity injuries and dehydration/hypovolemia/hunger the most common reasons. It seems reasonable to direct future intervention to prevention of these commonly identified problems in this particular population of Park visitors.

Pattern of injury and illness during expedition-length adventure races.

OBJECTIVE: To describe injuries and illnesses treated during an expedition-length adventure race and combine the results with those from previous studies to identify common patterns of injury and illness during these events. METHODS: The 2003 Subaru Primal Quest Expedition Length Adventure Race was held in Lake Tahoe, CA, from September 5 to 14, 2003. Eighty teams of 4 individuals participated. During the event, medical volunteers providing on-site medical care recorded each medical encounter on a medical encounter form. This information was used to describe the injuries and illnesses treated and was combined with previous investigations to identify common patterns of injury and illness during these events. RESULTS: During the 10-day study period, 356 patient encounters and 406 injuries and illnesses were recorded. The most frequent reason to require on-site medical care was injury of the skin and soft tissue (70.4%), with blisters the single most common of these injuries (45.6%). Other reasons were orthopedic injury (14.8%), respiratory illness (3.7%), and heat illness or dehydration (3.7%). CONCLUSIONS: The results of this and previous studies demonstrate a common pattern of injury and illness that includes a high frequency of skin and soft tissue injury, especially blisters. Injuries and illnesses such as altitude illness, contact dermatitis, and respiratory illness varied considerably among events. The number of patient encounters per athlete is similar among the studies, providing an approximation of the number of medical encounters expected given the number of participants. These results should assist medical providers for future events; however, it is imperative to carefully review the individual event to best predict the frequency of injury and illness.

Injury and illness during a multiday recreational bicycling tour.

OBJECTIVE: To describe the incidence and types of injury and illness treated during a multiday recreational bicycling tour. METHODS: In July 2001, 2100 bicyclists rode 520 miles from Minneapolis, MN, to Chicago, IL, during the 2001 Heartland AIDS Ride. A volunteer medical staff provided medical care along the route. All patient encounters were recorded in an injury and illness log. Information from the log was used to describe the incidence and types of injury and illness treated during the event. RESULTS: A total of 2100 riders participated, with 244 patient encounters recorded. The 2 most common reasons for requiring medical care were dehydration (35%) and orthopedic injuries (27%). Forty patients were transferred to the hospital and 7 required admission. CONCLUSIONS: Individuals charged with providing medical care for recreational bicycling events should be prepared to treat a wide variety of injuries and illnesses. In this and other studies, dehydration, heat illness, and overuse injuries were the most common reasons to require medical care. The results of this study suggest that implementation of prevention strategies before and during bicycling events may significantly reduce the requirement for on-site medical care.

Wilderness medicine: strategies for provision of medical support for adventure racing.

In adventure racing, or multisporting, athletes perform multiple disciplines over a course in rugged, often remote, wilderness terrain. Disciplines may include, but are not limited to, hiking, trail running, mountain biking, caving, technical climbing, fixed-line mountaineering, flat- and white-water boating, and orienteering. While sprint races may be as short as 6 hours, expedition-length adventure races last a minimum of 36 hours up to 10 days or more and may cover hundreds of kilometres. Over the past decade, adventure racing has grown in popularity throughout the world with increasing numbers of events and participants each year. The provision of on-site medical care during these events is essential to ensure the health and safety of the athletes and thus the success of the sport. At present, there are no formal guidelines and a relatively small amount of literature to assist in the development of medical support plans for these events. This article provides an introduction to the provision of medical support for adventure races. Since a wide variety of illness and injury occur during these events, the medical support plan should provide for proper personnel, equipment and supplies to provide care for a wide range of illness and injury. Foot-related problems are the most common reasons for athletes to require medical attention during these events. This article also highlights some of the controversies involved in the provision of medical support for these events. Suggested penalties for acceptance of medical care during the event and strategies for removal of an athlete from the event for medical reasons are offered. In addition, some of the challenges involved in the provision of medical support, including communication, logistics and liability are discussed. This information should prove useful for medical directors of future, similar events. Because of their extreme nature, expedition-length adventure races represent a new and unique area of wilderness and event medicine.

To air is human: altitude illness during an expedition length adventure race.

OBJECTIVE: To calculate the incidence and prevalence of altitude illness (acute mountain sickness [AMS], high altitude pulmonary edema, and high altitude cerebral edema) during an expedition length adventure race and to determine factors contributing to its development as well as identify cases requiring medical treatment, withdrawal from the event, or both. METHODS: The Primal Quest Expedition Length Adventure Race was held in Colorado in July 2002. Sixty-two coed teams of four participated in the event. It began at an altitude of over 9500 feet, ascended to an altitude over 13,500 feet with a cumulative elevation gain of 69,400 feet, of which 40,000 feet occurred in the first 12 hours of the event. There was 138,800 total feet of altitude change during the event. All racers underwent a prerace medical assessment 24 hours before the start of the race and completed an Environmental Systems Questionnaire version 3-R (ESQ 3-R). Onsite medical staff provided treatment during the event. A standard medical encounter form was used to record all patient encounters including a presumed diagnosis and disposition. RESULTS: At the start of the race, the prevalence of altitude illness was 4.5%. The incidence of altitude illness requiring medical treatment during the race was 14.1% (AMS, 33 [13.3%]; high altitude pulmonary edema, 2 [.81%]) resulting in 4 (14.3%) of the 28 medical withdrawals from the race. There was no correlation between home altitude, prerace ESQ scores, and successful completion of the race. CONCLUSIONS: Altitude illness occurs among participants in expedition length adventure races and contributes significantly to withdrawal from the event.

Event medicine: injury and illness during an expedition-length adventure race.

To describe the incidence and type of injury and illness occurring during an expedition-length adventure race and identify those resulting in withdrawal from the event, a prospective cohort study was conducted of the injuries and illness treated during the Subaru Primal Quest Expedition Adventure Race trade mark held in Colorado July 7-16, 2002. All racers, support crewmembers, and race staff were eligible to participate in the study. When a member of the study group received medical care due to an injury or illness, the encounter was recorded on a Medical Encounter Form. If an injury or illness resulted in withdrawal from the race, this was also recorded. Information from the Medical Encounter Forms was used to generate the Medical Log. There were 671 individuals eligible to participate in the study. A total of 243 medical encounters and 302 distinct injuries and illnesses were recorded. There were 179 (59%) injuries and 123 (41%) illnesses. Skin and soft tissue injuries and illness were the most frequent (48%), with blisters on the feet representing the single most common (32.8%). Second was respiratory illness (18.2%), including upper respiratory infection, bronchitis and reactive airway disease-asthma. Respiratory illness was the most common medical reason for withdrawal from the event. Injuries accounted for almost 60% of all injury and illness yet they contributed to less than 15% of the medical withdrawals from the race. Blisters accounted for almost one-third of all conditions treated. Providers of medical support for expedition-length adventure races should be prepared to treat a wide variety of injury and illness.