Quality of healthcare services provided in disaster shelters: An integrative literature review.

BACKGROUND: Globally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters. OBJECTIVES: To determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents. METHODS: An integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar). RESULTS: Limited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services. CONCLUSIONS: A small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse.

A importância do protocolo de Manchester na Emergência do Hospital Nossa Senhora da Conceição

O objetivo deste trabalho é demonstrar como ocorre o atendimento pelo Sistema Manchester de Classificação de Risco, aqui conhecido por Protocolo de Manchester na Emergência do Hospital Nossa Senhora da Conceição (HNSC), que pertence ao Grupo Hospitalar Conceição (GHC). Trata-se de um relato a partir da observação que foi feita no estágio da Prática Profissional Simulada II do curso Técnico em Registros e Informações em Saúde no segundo semestre do ano de 2011. O Protocolo de Manchester ajuda a organizar o fluxo de paciente na emergência e urgência, utiliza uma escala de cores onde; Vermelho é emergente, Laranja é muito urgente, Amarelo é urgente, Verde é pouco urgente, Azul é não urgente e Branco para situações administrativas, para estabelecer o tempo limite para o paciente receber assistência médica. Prioriza os casos mais graves, mas não deixa de atender os casos mais simples, qualifica e facilita o atendimento por ordem de gravidade e não mais por ordem de chegada.

Longitudinal expandable shelter for medical response during disasters.

INTRODUCTION: During medical emergencies, hospitals represent the final point of the whole rescue process. Therefore, effective health mobile structures have to be inserted between hospitals and the place of the event with the aim of giving the best of cures (using appropriate and easy to use equipment) for a safer and faster evacuation to hospitals. METHODS: Literature review and national and international disaster medicine standards were the basis for this study to provide clinical, hygienical, and organizational needs to satisfy for the medical structure design. Project requirements have been obtained by analyzing structural, organizational, and clinical process necessities. Structural requirements respond to the possibility of installation on every ground type, resistance to every weather condition, and necessity of easy and fast transportation. Technological equipment is obtained from clinical evaluation for patient stabilization. RESULTS: The designed structure results to be a longitudinal expandable shelter (LES) for medical emergencies response organized in three internal functional areas. Possibility of automatic expandability allows rapid transportation and easy deployment. The functional internal organization provides three areas: "Diagnostic," "Therapeutic," and "Pre-evacuation monitoring." Further, longitudinal expandability supports the basic hygienical rules in healthcare processes allowing the unidirectional flow of casualties from dirtier to cleaner areas of the structure. CONCLUSIONS: LES represents the answer to expressed requisites by disaster medicine standards and guidelines. It aims to provide an efficient and effective support for sanitary aid in response to disasters or emergencies, by improving aspects related to effectiveness, hygiene, and quality of clinical performances especially for highest critical cases.

Tactical combat casualty care 2007: evolving concepts and battlefield experience.

The Tactical Combat Casualty Care (TCCC) project begun by the Naval Special Warfare Command and continued by the U.S. Special Operations Command developed a set of tactically appropriate battlefield trauma care guidelines that were initially published in 1996. Transition of these guidelines into use throughout the Department of Defense has been ongoing since that time. The need for updates to the TCCC guidelines was recognized early on and has been carried out by the Committee on Tactical Combat Casualty Care established and operated by the Naval Operational Medicine Institute. The evolution of these guidelines from the 1996 recommendations to the present is described. Numerous reports in the medical literature and collected from combat first responders have documented that TCCC is saving lives on the battlefield and improving the tactical flow of missions on which casualties have occurred. Present challenges to the optimized implementation of TCCC in U.S. combat units include the need to expedite transition of new TCCC techniques and technologies to deploying units, to provide TCCC training for all U.S. combatants, and to ensure adequate funding for the Committee on TCCC.

Instalaciones Sanitarias Desplegables Multinacionales. Modelos de Colaboración / Multinational Deployable Medical Treatment Facilities. Types of cooperation

This article presents the general framework for the multinational deployable medical treatment facilities. This framework has as a reference the NATO medical doctrine, routinely utilized in the Spanish deployments abroad. The different options of this mode of medical support are likewise discussed, in accordance with NATO medical doctrine, as it represents an up-to-date solution to improve the effectiveness of the medical support with a simultaneous decrease in the contribution of national medical assets. An important conclusion is that roles 1 and 4 will usually be national, while the composition of roles 2 and 3 will depend on the mission, medical situation in the area of operations and agreements with other countries. In the case of high intensity conflicts, although there will always be mutual supports among nations, it is necessary to resort to all national resources (AU)

El presente artículo expone el marco en el que se basan las instalaciones sanitarias desplegables multinacionales, marco que toma como referencia a la doctrina sanitaria OTAN, que es esencialmente la que se utiliza en las misiones exteriores españolas. Asimismo se analizan, con base a lo anterior, las diferentes posibilidades de esta modalidad de apoyo sanitario, que representa una solución actual para mejorar la eficacia de la acción sanitaria disminuyendo simultáneamente el aporte de los recursos sanitarios nacionales. Una conclusión importante es que normalmente serán nacionales los escalones primero y cuarto, mientras que la composición de los escalonessegundo y tercero dependerá de las misiones, situación sanitaria en el área de operaciones y acuerdos con otras naciones. En caso de conflictos de alta intensidad, aunque siempre habrá intercambios de apoyos entre naciones, será necesario recurrir a la implicación de todos los recursos nacionales (AU)

Causas de satisfacción e insatisfacción en Ugencias / Emergency satisfaction and dissatisfaction causes

Objetivo: Determinar qué elementos de la atención en urgencias generan satisfacción y cuáles insatisfacción. Diseño: Investigación cualitativa basada en grupos de discusión seguida de encuesta estructurada. Sujetos: En los grupos de discusión participaron un total de 50 sujetos. Adicionalmente se entrevistó a 296 pacientes dados de alta en Urgencias de un hospital del sistema público. Análisis de los datos: el análisis de las dinámicas se realizó a través de la espontaneidad y la coincidencia de las diferentes ideas aportadas por los grupos. Los datos de las entrevistas se analizaron mediante análisis estadísticos univariantes y bivariantes. Resultados: La información, amabilidad e implicación del personal sanitario junto a la rapidez en la atención parecen ser los aspectos más valorados por los pacientes, y/o acompañantes, que acuden a los servicios de urgencias. El tiempo percibido de espera sin recibir ninguna explicación (t=2,93, p=0,004) parece ser la principal causa de insatisfacción. El tiempo percibido en urgencias se relacionó con la insatisfacción (p<0,035) pero no el tiempo real en urgencias. La información al paciente (p=0,04) y a los acompañantes (p=0,019) supusieron incrementos en los niveles de satisfacción. Accesibilidad y capacidad de respuesta del hospital y ser derivados desde el propio centro de salud, son los motivos más frecuentes para preferir urgencias del hospital. Conclusiones: Capacidad de respuesta, empatía e información son las dimensiones que los pacientes y acompañantes más valoran cuando acuden a urgencias. Mientras que el tiempo percibido se asocia a insatisfacción no sucede lo mismo con el tiempo real en urgencias. La percepción de medios técnicos y la accesibilidad, unidos a la propia indicación de los profesionales de Atención Primaria, justifican la predilección por urgencias hospitalarias (AU)