Medical Coordination Rescue Members' and Ambulance Nurses' Perspectives on a New Model for Mass Casualty and Disaster Management and a Novel Terror Attack Mitigation Approach in the Netherlands: A Qualitative Study.

INTRODUCTION: Mass-casualty incidents (MCIs), specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, availability, and adequate provision of prehospital and hospital-based emergency care. In the Netherlands, a new model for Mass Casualty and Disaster Management (MCDM) along with a Terror Attack Mitigation Approach (TAMA) was introduced in 2016. STUDY OBJECTIVE: The objective of this study was to provide insight in the first experiences of health policy advisors and managers with a medical rescue coordinator and ambulance nursing background regarding the new MCDM and TAMA in order to identify strengths and pitfalls in emergency preparedness and to provide recommendations for improvement. METHODS: The study had a qualitative design and was performed from January 2017 through June 2018. Purposeful sampling was used and the inclusion comprehended health policy advisors and managers with a medical rescue coordinator and ambulance nursing background involved in emergency preparedness. The respondents were interviewed semi-structured and the researchers used a topic list that was based on the literature and content of the newly introduced model and approach. All interviews were typed out verbatim and qualitative content analyzing was used in order to identify relevant themes. RESULTS: Respondents based their perceptions on large-scale training exercises, as MCDM and TAMA were not yet used during MCIs. Perceived issues of MCDM were the two-tiered triage system, the change in focus from "stay and play" towards "scoop and run," difficulties with new tasks and roles of professionals, and improvement in material provision. Regarding TAMA, all respondents supported the principles (do the most for the most; scoop and run; acceptable personal risk; never walk alone; and standard operational procedure); however, the definitions were lacking clarity while the awareness of optimal personal safety of professionals was absent.As there are currently regional differences in the level of implementation of MCDM and TAMA, this may pose a risk for an optimal inter-regional collaboration. CONCLUSION: The conclusions refer to experiences of professionals in the Netherlands. Elements of the MCDM and TAMA were highly appreciated and seemed to improve emergency preparedness, while other aspects needed further attention, training, and integration in daily routine. The Netherlands' MCDM model and TAMA will need continuous systematic evaluation based on (inter)national performance criteria in order to underpin the useful and effective elements and to improve the observed pitfalls in emergency preparedness.

TAP CBRN preparedness: knowledge, training and networks.

The main goal of this targeted agenda program (TAP) was the establishment of an international network that would be able to advise on how to improve education and training for chemical, biological, radiological, or nuclear (CBRN)) responders. By combining the members of the TAP group, the CBRN Task Force of the World Association for Disaster and Emergency Medicine (WADEM) and the European network of the Hesculaep Group, an enthusiastic and determined group has been established to achieve the defined goal. It was acknowledged that the bottlenecks for education and training for CBRN responders are mainly awareness and preparedness. For this reason, even basic education and training on CBRN is lacking. It was advised that the focus for the future should be on the development of internationally standardized protocols and standards. The face-to-face discussions of the TAP will be continued at future Hesculaep expert meetings. The intention is that during the 16WCDEM, the achievements of the established network will be presented.

Leukemia risk in caprolactam workers exposed to benzene.

PURPOSE: To investigate the leukemia risk in a group of benzene exposed workers. METHODS: We conducted a retrospective cohort mortality study on 311 men who worked between January 1, 1951 and December 31, 1968 in a Caprolactam plant in the Netherlands. In the production of Caprolactam (the Nylon 6 monomer) pure benzene is used as an extracting agent and the workers at this plant have been exposed to substantial concentrations of benzene. The cohort was followed for mortality until January 1, 2001. The total mortality was below the expected number, which was mainly caused by a deficit of cardiovascular disease mortality. RESULTS: In the total group, there was one death from leukemia, compared with an expected number of 1.17. Despite the substantial exposures to benzene (on average 159 ppm-years per person) there was no indication for increased leukemia mortality within the cohort. We have applied earlier quantitative risk assessments to our cohort and conclude that some of these assessments overestimate the risk observed in our cohort of Caprolactam workers.

A proposal for evaluation of exposure data.

There is a growing need for transparency concerning ways in which existing exposure data are weighted for their relative value and quality. Currently, this evaluation is largely subjective and is dependent on the quality of the judgement of the individual assessor or expert group. In this paper some general guidelines are presented for a quality assessment procedure. Such a predetermined procedure potentially enhances the consistency among different assessors and assessments and facilitates harmonization of assessment procedures. The guidelines are presented in the context of a decision tree with four decision rules for data quality, i.e. 'availability of occupational hygiene information', 'variability and precision issues', 'internal validity' and 'external validity'. These methodological issues are considered to be the most important aspects of data quality and will be discussed in this paper. The decision tree eventually results in three quality classes, i.e. exposure data providing sufficient information, supplementary information and data which should be excluded from the exposure assessment process. The guidelines should not be used in a rigid manner but have to be interpreted in the light of the particular circumstances and purposes of the assessment.