Mass casualty incident training in a resource-limited environment.

BACKGROUND: A mass casualty incident (MCI) occurs when a disaster involves a large number of injured people, overwhelming the capacity of local emergency medical services. This article describes the planning and execution of a MCI workshop created for use in Sierra Leone, a low-income country. METHODS: Surgeons OverSeas (SOS), an international non-governmental organization, partnered with the Sierra Leone Office of National Security and Connaught Hospital to develop a 2-day MCI workshop designed to meet needs specific to their resource-limited environment. Pre- and post-course questionnaires were completed. Day 1 consisted of didactic teaching focused on triage principles, resource deployment, communication/operations and tabletop drills. On day 2 a mock MCI with performance assessments by independent observers was staged, followed by post-event debriefing. RESULTS: Pre-course questionnaires identified the following deficits: lack of triage training (29 per cent), and transportation (19 per cent) and communication (17 per cent) shortfalls. Only 11 per cent could define MCI. During the drill, on-scene and hospital triage was accurate in 28 (93 per cent) and 23 (77 per cent) of 30 casualties respectively. Systematic deficiencies identified included: transport issues, no accurate system for tracking victims, and undersized triage areas. Participants identified interagency coordination (63 of 136 responses; 46·3 per cent) and triage (32 of 136; 23·5 per cent) as the most valuable lessons learned. CONCLUSION: Pre-existing MCI programmes based on first-world logistics do not account for challenges encountered when caring for casualties in resource-constrained settings. Logistical training, rather than medical skills or knowledge, was identified as the educational priority.

[Evaluation of customer satisfaction with the hospital catering system in the city of Palermo (Italy)]. / Valutazione della Customer Satisfaction nella "Ristorazione Ospedaliera" della città di Palermo.

The aim of the study was to evaluate patients' customer satisfaction with the hospital catering services of two public hospitals and one private sector hospital in the city of Palermo (Italy). A multiple choice questionnaire was administered by face-to-face interview to 207 of 227 hospitalized patients. Positive responses regarding the perceived quality of food were given especially by patients of the private sector hospital, 80% of which reported being satisfied with the catering service. A higher percentage of patients in the private sector hospital were satisfied with the food distribution modalities with respect to the two public hospitals. Only 3% of patients in the private sector hospital required their families to bring food from home, with respect to 7.9% and 30% respectively in the two public hospitals. Private sector patients also reported appreciating the wide availability of food and the help given by health care workers (79% vs a mean of 55% in the two public hospitals). No differences were found amongst hospitals with regards to the hygienic characteristics of meals. The results of this study indicate the need to make changes in the management of the catering service of one of the involved public hospitals especially.