Management of acute exposure to toxic gases in the oil & gas industry -a practical approach.

The objective of this work is to present the key elements in the design of emergency management and response plans in scenarios where there has been loss of containment of chemical agents of acute effect focused in the protection of not routinely exposed in a determined occupational environment. To this purpose, a validation of the current criteria for the management of accidental releases is carried out, taking into account hypothetical risk scenarios. The essential elements of the emergency management system are stated, from a systemic perspective and the corresponding risk control actions; recommendations for their implementation are showed, taking as prototype hydrogen sulfide, a highly toxic gas. Non controlled emissions of toxic gases of acute effect from an occupational standpoint represents a priority because of their human and financial high toll. Design and implementation of an appropriate emergency plan for uncontrollable emissions of toxics chemical agents must be addressed.

The Caribbean Strong Summit: Building Resilience With Equity.

The objective of the Caribbean Strong Summit was to plan an intersectoral summit to address the equity of community health and resilience for disaster preparedness, response and recovery and develop a set of integrated and actionable recommendations for Puerto Rico and the Caribbean Region post Hurricanes Irma and Maria. A three-day meeting was convened with a wide range of community, organizational and private sector leaders along with representatives from Puerto Rico, the Caribbean, the Americas, and global experts to generate recommendations for enhanced resilience based upon lessons learned and evidence-based approaches. More than 500 participants from the region gave 104 presentations with recommendations for resilience. Over 150 recommendations were generated and ranked for importance and actionability by participants. A representative sample of these are presented along with five major themes for building health resilient communities in the Caribbean. This summit was successful in compiling a set of integrated recommendations from more than 19 diverse sectors and in defining five major thematic areas for future work to enhance resilience for all types of future disasters. A follow-up meeting should be planned to continue this discussion and to showcase work that has been accomplished in these areas. A complete set of the recommendations from the Caribbean Strong Summit and their analysis and compilation would be published and should serve as a foundational effort to enhance preparedness and resiliency towards future disasters in the Caribbean.

Disaster Preparedness for Clinics - Further Study from Haiti.

OBJECTIVE: This team created a manual to train clinics in low- and middle-income countries (LMICs) to effectively respond to disasters. This study is a follow-up to a prior study evaluating disaster response. The team returned to previously trained clinics to evaluate retention and performance in a disaster simulation. BACKGROUND: Local clinics are the first stop for patients when disaster strikes LMICs. They are often under-resourced and under-prepared to respond to patient needs. Further effort is required to prepare these crucial institutions to respond effectively using the Incident Command System (ICS) framework. METHODS: Two clinics in the North East Region of Haiti were trained through a disaster manual created to help clinics in LMICs respond effectively to disasters. This study measured the clinic staff's response to a disaster drill using the ICS and compared the results to prior responses. RESULTS: Using the prior study's evaluation scale, clinics were evaluated on their ability to set up an ICS. During the mock disaster, staff was evaluated on a three-point scale in 13 different metrics, grading their ability to mitigate, prepare, respond, and recover in a disaster. By this scale, both clinics were effective (36/39; 92%) in responding to a disaster. CONCLUSION: The clinics retained much prior training, and after repeat training, the clinics improved their disaster response. Future study will evaluate the clinics' ability to integrate disaster response with country-wide health resources to enable an effective outcome for patients.

Hurricane Dorian and Disaster Response in the Face of Constant Threats.

Hurricane Dorian's impact on Eastern North Carolina and the Bahamas islands demonstrate the devastation and public health needs that can be left in the wake of a catastrophic event. The hurricane created a range of public health and healthcare challenges, strained further by the damage to infrastructure on which critical services, including the medical supply chain, depend. The recovery process is long, but offers an opportunity to build back better, more resilient communities that can withstand today's threats.

Optimizing the Use of a Precious Resource: The Role of Emergency Physicians in a Humanitarian Crisis.

Emergency physicians (EP) are uniquely suited to provide care in crises as a result of their broad training, ability to work quickly and effectively in high-pressure, austere settings, and their inherent flexibility. While emergency medicine training is helpful to support the needs of crisis-affected and displaced populations, it is not in itself sufficient. In this article we review what an EP should carefully consider prior to deployment.

Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data.

OBJECTIVES: Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. METHODS: Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. RESULTS: Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, particularly respiratory (23%) and digestive (14%). More than 53% developed infections within 3 weeks after the event. Médecins Sans Frontières registered 6407 patients in 2009; 6033 in 2011; and 7300 in 2012. A comparison indicates that postearthquake patients suffered significantly less from violence, but more from wounds, respiratory, digestive and ophthalmological diseases. CONCLUSION: This is the first comparison of postearthquake diagnoses with baseline data. Within 2 weeks after the acute phase of an earthquake, respiratory, digestive and ophthalmological problems will emerge to the prejudice of trauma. This fact should be anticipated when composing Foreign Medical Teams and Interagency Emergency Health Kits to be sent to the disaster site.

Emergency and Disaster Preparedness of School Transportation Staff and School Buses in the United States: Compliance With Recommendations for School Transportation Safety.

OBJECTIVE: The aim of the study was to determine the compliance of school transportation staff and school buses with recommendations for the safe transportation of children to and from school and school-related activities. METHODS: An electronic questionnaire was distributed to school transportation staff represented by the International Brotherhood of Teamsters during the 2013-2014 academic year. RESULTS: Analysis was performed on 558 completed questionnaires (13% usable response rate). Responders had previous training in first aid (89%), basic life support (28%), and cardiopulmonary resuscitation (52%). Seventy-eight percent of school buses in our sample had restraint devices and 87% had seat belt cutters. Responders reported the immediate availability of the following on their bus: communication devices (81%), first aid kits (97%), fire extinguishers (89%), automated external defibrillators (1%), and epinephrine autoinjectors (2%). Thirty percent of responders have had no previous training in the management of emergencies such as trouble breathing, severe allergic reaction, seizures, cardiac arrest or unresponsiveness, and head, neck, or extremity trauma. Thirteen percent of responders are unfamiliar with or have had no previous training on protocols regarding emergency shelters and community evacuation plans in the event of a disaster. CONCLUSIONS: Variability exists in the compliance of school transportation staff and school buses with recommendations for the safe transportation of children. Areas for improvement were identified, such as educating school transportation staff in the recognition and initial management of pediatric emergencies, ensuring the presence of restraint devices, increasing the immediate availability of certain emergency medications and equipment, and familiarizing school transportation staff with designated emergency shelters and community evacuation plans.

Low Compliance of Urgent Care Centers in the United States With Recommendations for Office-Based Disaster Preparedness.

OBJECTIVES: The aim of the study was to determine the compliance of urgent care centers in the United States with published recommendations for office-based disaster preparedness. METHODS: An electronic questionnaire was distributed to urgent care center administrators as identified by the American Academy of Urgent Care Medicine directory. RESULTS: One hundred twenty-two questionnaires of the 872 distributed were available for analysis (14% usable response rate). Twenty-seven percent of centers have an established disaster plan for events that involve their establishment and surrounding community; 49% practice the plan at least once a year, 19% less frequent than once a year, and 32% never practice. Forty-seven percent of centers are familiar with designated emergency shelters and community evacuation plans. Seventeen percent of centers function as part of a surveillance system to provide early detection of any biologic/chemical/nuclear agents. Twenty-two percent of centers take part in local community and hospital disaster planning, exercises, and drills through emergency medical services and public health systems. Five percent of centers aid schools, child care centers, camps, and other child congregate facilities in disaster planning. Twenty-eight percent of centers have an assembled emergency/disaster kit, containing such items as water, first aid supplies, radios, flashlights, batteries, heavy-duty gloves, food, and sanitation supplies. CONCLUSIONS: Areas for improvement in urgent care center disaster preparedness were identified, such as developing an office disaster plan that is practiced at least yearly, becoming familiar with designated emergency shelters and community evacuation plans, providing surveillance to detect potential acts of terrorism, assisting community organizations (hospitals, schools, child care centers, etc) in disaster planning, and assembling office emergency/disaster kits.

School Nurses on the Front Lines of Medicine: Emergencies 101 Ask the E.R. Pediatrician.

Pediatric emergencies, such as the exacerbation of medical conditions and injuries, may occur in the school setting. This article introduces the "School Nurses on the Front Lines of Medicine" series by discussing the incidence and the most common emergencies that occur in schools as well as published guidelines for school emergency preparedness.

Quality orthopaedic care in sudden-onset disasters: suggestions from Médecins Sans Frontières-France.

A huge change is needed in the conception and implementation of surgical care during sudden-onset disasters (SOD). The inadequate surgical response mounted by the majority of foreign medical teams (FMT) after Haiti's earthquake is a striking example of the need for a structured professional approach. Logistical capacity already exists to provide safe, timely, effective, efficient, equitable and ethical patient-centred care with minimum standards. However, knowledge, skills and training in the fields of general, orthopaedic and plastic surgery need further clarification. Surgical activity data and clinical examples from several Médecins Sans Frontières-France (MSF) projects are used here to describe the skill set and experience essential for surgeons working in SOD contexts.

Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan.

The pervasive use of electronic records in healthcare increases the dependency on technology due to the lack of physical backup for the records. Downtime in the Electronic Health Record system is unavoidable, due to software, infrastructure and power failures as well as natural disasters, so there is a need to develop a contingency plan ensuring patient care continuity and minimizing risks for health care delivery. To mitigate these risks, two applications were developed allowing healthcare delivery providers to retrieve clinical information using the Clinical Document Architecture Release 2 (CDA R2) document repository as the information source. In this paper we describe the strategy, implementation and results; and provide an evaluation of effectiveness.

The effects of funding change and reorganization on patterns of emergency response in a local health agency.

Indicators for Stress Adaptation Analytics (ISAAC) is a protocol to measure the emergency response behavior of organizations within local public health systems. We used ISAAC measurements to analyze how funding and structural changes may have affected the emergency response capacity of a local health agency. We developed ISAAC profiles for an agency's consecutive fiscal years 2013 and 2014, during which funding cuts and organizational restructuring had occurred. ISAAC uses descriptive and categorical response data to obtain a function stress score and a weighted contribution score to the agency's total response. In the absence of an emergency, we simulated one by assuming that each function was stressed at an equal rate for each of the two years and then we compared the differences between the two years. The simulations revealed that seemingly minor personnel or budget changes in health departments can mask considerable variation in change at the internal function level.

Improvements in pandemic preparedness in 8 Central American countries, 2008-2012.

BACKGROUND: In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012. METHODS: Eight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student's t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting. RESULTS: All countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01). CONCLUSIONS: Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries' response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.

Planning for the continued humane treatment of animals during disaster response.

Responding to a disruptive event is a challenging task for a research facility. One component that must be addressed in a disaster response plan for a facility that houses research animals is the care of those animals during and after a disruptive event. In this article, the author provides recommendations for the preparations, connections and training that are necessary to provide such care. He concludes that the best responses are those that mitigate the unique circumstances involved, which can be developed through practical thinking and problem solving as a community.

The 2010 Haiti earthquake response.

This article presents an overview of the mental health response to the 2010 Haiti earthquake. Discussion includes consideration of complexities that relate to emergency response, mental health and psychosocial response in disasters, long-term planning of systems of care, and the development of safe, effective, and culturally sound mental health services in the Haitian context. This information will be of value to mental health professionals and policy specialists interested in mental health in Haiti, and in the delivery of mental health services in particularly resource-limited contexts in the setting of disasters.

The recommendations of the ICRP vis-à-vis the Fukushima Dai-ichi NPP accident aftermath.

The International Commission on Radiological Protection (ICRP) created a Task Group (ICRP TG84) on the initial lessons learned from the nuclear accident at the Fukushima Dai-ichi NPPs vis-à-vis the ICRP system of radiological protection. The ICRP TG84 is expected to compile lessons learned related to the efforts carried out to protect people against radiation exposure during and after the emergency exposure situation caused by the accident and, in light of these lessons, to consider ad hoc recommendations to strengthen the ICRP system of radiological protection for dealing with this type of emergency exposure. The Chairman of ICRP TG84 presents in this paper his personal views on the main issues being considered by the group at the time of the Fukushima Expert Symposium. ICRP TG84 expects to finalize its work by the end of 2012.