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1.
Recurso na Internet em Inglês | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46991

RESUMO

Página de la Organización Mundial de la Salud con documentación técnica en inglés para respuesta a la epidemia global del nuevo coronavirus 2019 (2019-nCoV). Tipos de documentos disponibles: preparación de los países (country readiness), vigilancia y definición de casos (surveillance and case definitions), directrices para laboratorios (laboratory guidance), manejo de pacientes (patient management), prevención y control de infecciones en servicios de salud (infection prevention and control in health care facilities), investigaciones preliminares (early investigations), comunicación del riesgo y compromiso de la comunidad (risk communication and community engagement), paquete de productos básicos para enfermedades (disease commodity package) y reducción de la transmisión de animales para humanos (reduction of transmission from animals to humans).


Assuntos
Infecções por Coronavirus/prevenção & controle , Capacidade de Resposta ante Emergências , Estado de Alerta em Emergências , Infecções por Coronavirus/transmissão
3.
Am J Disaster Med ; 14(2): 75-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637688

RESUMO

OBJECTIVE: To assess emergency medical services (EMS) and hospital disaster plans and communication and promote an integrated pediatric disaster response in the state of Connecticut, using tabletop exercises to promote education, collaboration, and planning among healthcare entities. DESIGN: Using hospital-specific and national guidelines, a disaster preparedness plan consisting of pediatric guidelines and a hospital checklist was created by The Connecticut Coalition for Pediatric Disaster Preparedness. SETTING: Five school bus rollover tabletop exercises were conducted, one in each of Connecticut's five EMS regions. Action figures and playsets were used to depict patients, healthcare workers, vehicles, the school, and the hospital. PARTICIPANTS: EMS personnel, nurses, physicians and hospital administrators. INTERVENTION: Participants had a facilitated debriefing of the EMS and prehospital response to disasters, communication among prehospital organizations, public health officials, hospitals, and schools, and surge capacity, capability, and alternate care sites. A checklist was completed for each exercise and was used with the facilitated debriefing to generate an afteraction report. Additionally, each participant completed a postexercise survey. MAIN OUTCOME MEASURES: Each after-action report and postexercise survey was compared to established guidelines to address gaps in hospital specific pediatric readiness. RESULTS: Exercises occurred at five hospitals, with inpatient capacity ranging 77-1,592 beds, and between 0 and 221 pediatric beds. There were 27 participants in the tabletop exercises, and 20 complete survey responses for analysis (74 percent). After the exercises, pediatric disaster preparedness aligned with coalition guidelines. However, methods of expanding surge capacity and methods of generating surge capacity and capability varied (p < 0.031). CONCLUSION: Statewide tabletop exercises promoted coalition building and revealed gaps between actual and ideal practice. Generation of surge capacity and capability should be addressed in future disaster education.


Assuntos
Planejamento em Desastres , Desastres , Lista de Checagem , Criança , Connecticut , Humanos , Pediatria , Capacidade de Resposta ante Emergências
4.
Lima; Perú. Ministerio de Salud; 1 ed., 2 reimp; 20190900. 57 p. ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-965195

RESUMO

La publicación describe la organización, los estándares y requisitos mínimos, así como la articulación del Centro de Operaciones de Emergencia y de los Espacios de Monitoreo de Emergencias y Desastres del Sector Salud (COE SALUD). Asimismo, las funciones y los procedimientos para la adecuada gestión de la información del Centro de Operaciones de Emergencia y de los Espacios de Monitoreo de Emergencias y Desastres del sector salud a nivel nacional.


Assuntos
Capacidade de Resposta ante Emergências , Prevenção e Mitigação , Centro de Operações de Emergência , Desastres
5.
Am J Disaster Med ; 14(1): 25-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441026

RESUMO

BACKGROUND AND OBJECTIVES: Hospitals are the vital part of disaster management and their functionality should be maintained and secured. However, it can be the target of natural and man-made disasters. In Iran, Fars Province is prone to major incidents and disasters in its hospitals at any time during the course of a year. This study aimed to examine the Hospital Safety Index (HSI) in all hospitals (public and private) affiliated to Shiraz University of Medical Sciences (SUMS). MATERIALS AND METHODS: This cross-sectional study was conducted during 2015-2016, using the World Health Organization's HSI checklist. All 58 hospitals in Fars Province affiliated to SUMS were included. The hospital assessment team was formed to collect the data retrospectively and by visiting and interviewing hospital's authority based on the checklist. The collected data were analyzed using Microsoft Excel. RESULTS: The results showed that in the above-mentioned years, the structural safety of hospitals reached the highest optimal level, whereas functional safety reached the lowest level. The results of the studies conducted in 2016 showed that during this year, the overall hospital safety level improved (6 and B). CONCLUSION: Although safety in hospitals located in Fars Province has improved due to continuous disaster mitigation and preparedness activities, there is still space for more improvement to achieve and maintain higher levels of safety in hospitals. Paying attention to this, the authors recommend that proper policies, legislation, and intra and inter-institutional coordination are the requirements for a successful outcome.


Assuntos
Defesa Civil/normas , Planejamento em Desastres/organização & administração , Desastres , Hospitais/normas , Capacidade de Resposta ante Emergências/normas , Lista de Checagem , Estudos Transversais , Humanos , Irã (Geográfico) , Estudos Retrospectivos
6.
Crit Care Clin ; 35(4): 535-550, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445603

RESUMO

The "daily disasters" within the ebb and flow of routine critical care provide a foundation of preparedness for the less-frequent, larger events that affect most health care organizations at some time. Although large disasters can overwhelm, those who strengthen processes and habits through daily practice will be the best prepared to manage them.


Assuntos
Cuidados Críticos , Planejamento em Desastres , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Desastres , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Incidentes com Feridos em Massa , Capacidade de Resposta ante Emergências/organização & administração , Triagem
7.
Med. intensiva (Madr., Ed. impr.) ; 43(1): 10-17, ene.-feb. 2019. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-181525

RESUMO

Objective: To assess the performance of the ultrasound measurement of stroke volume (SV) coupled to passive leg raising (PLR) in predicting fluid responsiveness (FR). Design: A prospective cohort study was carried out in patients requiring volume expansion (VE). A transthoracic Doppler echocardiography (TTE) device was used for the measurement of SV. Four measurements were obtained: before and 90s after PLR, and before and after VE. The patients were subsequently classified according to their hemodynamic response to VE. Responders were defined by an increase in SV of at least 15% in response to VE. Results: Thirty maneuvers were studied. An increase in SV>15% in response to PLR was recorded in 21 cases. Hemodynamic indices taken in the first stage showed significant differences in the distensibility index of the inferior vena cava (dIVC), in the velocity-time integral of aortic blood flow (VTIAo) and in SV, with respective p-values of 0.009, 0.012 and 0.025. The SV changes induced by VE were significantly correlated to the SV changes induced by PLR, with a Spearman coefficient of 0.77 and a linear equation y=0.82 x+1.68. Fluid responsiveness can be efficiently predicted by assessing the effects of PLR on SV monitored by Doppler TTE, with a sensitivity of 94.7% and a negative predictive value of 88%. Conclusion: Our data support the interest of Doppler TTE as an effective tool in predicting FR through the assessment of SV in response to PLR, in hemodynamically unstable patients


Objetivo: Evaluar el rendimiento de la medida del volumen sistólico (VS) por ultrasonido junto con la elevación pasiva de piernas (EPP) para predecir la respuesta de fluidos (RF). Diseño: Estudio prospectivo de cohorte realizado en pacientes que requieren expansión de volumen (EV). Se utilizó un dispositivo doppler ecocardiográfico transtorácico (ETT) para la medición del VS. Se obtuvieron 4 mediciones: antes y 90s después de la EPP, y antes y después de la EV. Posteriormente, los pacientes se clasificaron según su respuesta hemodinámica a VE. Los respondedores se definieron por un aumento del VS de al menos 15% en respuesta a EV. Resultados: Se estudiaron 30 maniobras. Un aumento del VS>15% en respuesta a la EPP se informó en 21 casos. Los índices hemodinámicos tomados en la primera etapa mostraron diferencias significativas en el índice de distensibilidad de la vena cava inferior (dVCI), en la integral velocidad-tiempo del flujo sanguíneo aórtico (IVTAo) y en el VS con valores p respectivos en 0,009, 0,012 y 0,025. Los cambios del VS inducidos por EV se correlacionaron significativamente con los cambios del VS inducidos por EPP con un coeficiente de Spearman en 0,77 y una ecuación lineal en y=0,82× +1,68. La respuesta de fluidos se puede predecir eficazmente mediante la evaluación de los efectos de EPP en el VS vigilado por ETT-doppler con sensibilidad en el 94,7% y VPN en el 88%. Conclusión: Nuestros datos respaldan el interés del ETT-doppler como una herramienta eficaz en la predicción de la RF por la evaluación del VS en respuesta a la EPP en pacientes hemodinámicamente inestables


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Volume Sistólico/efeitos da radiação , Estudos de Coortes , Hidratação , Ecocardiografia Doppler/métodos , Perna (Membro)/irrigação sanguínea , Monitorização Hemodinâmica/métodos , Capacidade de Resposta ante Emergências , Curva ROC
8.
Burns ; 45(4): 964-973, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30598266

RESUMO

PURPOSE: To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. MATERIAL AND METHODS: The critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge. RESULTS: Fifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead. CONCLUSION: In the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.


Assuntos
Queimaduras/terapia , Serviço Hospitalar de Emergência/organização & administração , Explosões , Incidentes com Feridos em Massa , Ressuscitação , Capacidade de Resposta ante Emergências , Adolescente , Adulto , Superfície Corporal , Queimaduras por Inalação/terapia , Feminino , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Macas (Leitos)/provisão & distribução , Taiwan , Análise e Desempenho de Tarefas , Carga de Trabalho , Adulto Jovem
10.
Health Secur ; 16(5): 341-349, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30299168

RESUMO

In late 2017 and early 2018, the New York City Department of Health and Mental Hygiene deployed multiple teams to Puerto Rico and the US Virgin Islands to support public health in those territories. This article is a description of how those teams were conceived, deployed, supported, and reintegrated into the agency. This was an unprecedented mission for our agency, and what follows is a reflection on what worked and what didn't work for us. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and that collectively we can continue to advance the field of public health preparedness and response.


Assuntos
Defesa Civil/métodos , Defesa Civil/organização & administração , Tempestades Ciclônicas , Órgãos Governamentais , Vigilância da População/métodos , Saúde Pública , Humanos , Desastres Naturais , Cidade de Nova Iorque , Porto Rico , Capacidade de Resposta ante Emergências , Ilhas Virgens Americanas
11.
Health Secur ; 16(5): 356-363, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30339095

RESUMO

This commentary discusses the prospect and value of using the preparedness rule developed and implemented by the Centers for Medicare and Medicaid Services as a focal point for better integrating health system preparedness into broader community resilience efforts, whether at the local or international level. Much attention has been given to the idea that community resilience requires extensive collaboration and coordination between actors across sectors, elements that are vital to effective emergency preparedness in health care as well. To facilitate improved fiscal sustainability, the federal government has since 2012 been encouraging healthcare coalitions to pursue nonprofit status. Building such organizations for the long term will require coalitions to become more proactive in involving organizations outside of the health sector. The preparedness rule has done much to encourage more dialogue between health system actors, and we argue that this momentum should be carried forward to generate a broader discussion of the importance of health preparedness to community resilience. The value of embedding preparedness planning into larger community resilience initiatives is discussed.


Assuntos
Defesa Civil/métodos , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/organização & administração , Planejamento em Desastres/métodos , Resiliência Psicológica , Defesa Civil/tendências , Programas Governamentais/organização & administração , Humanos , Organizações sem Fins Lucrativos , Capacidade de Resposta ante Emergências , Estados Unidos
12.
J Emerg Manag ; 16(4): 213-227, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30234908

RESUMO

OBJECTIVE: The intent of this study was to assess disaster preparedness in community hospitals across New York. DESIGN: Descriptive and analytical cross-sectional survey study. The survey instrument consisted of 35 questions that examined six elements of disaster preparedness: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. SETTING: Community hospitals in New York. SUBJECTS: Contact information was obtained for 207 of 208 community hospitals. Email invitations to participate in the survey were sent to hospital CEOs and disaster preparedness coordinators. Completed surveys were received from 80 hospitals. MAIN OUTCOME MEASURES: Hospital responses to questions related to the six elements of disaster preparedness. RESULTS: Most (87.5 percent) hospitals had experienced a disaster event during the past 5 years (2012-2016). Eighty percent had disaster plans that addressed all of six major types of disasters. Only 17.5 percent believed their disaster plans were "very sufficient" and did not require any revisions. Nearly three-quarters (73.3 percent) of hospitals could continue operations for less than a week without external resources. Less than half (49.4 percent) reported being satisfied or very satisfied with the level of funding that they received from the Hospital Preparedness Program. Most (88.8 percent) respondents felt that barriers to disaster preparedness exist for their organizations. CONCLUSIONS: The results demonstrate the current level of disaster preparedness among New York hospitals. The study's approach is discussed as a model that will enable hospitals to identify focus areas for improvement and opportunities for legislation and advocacy.


Assuntos
Planejamento em Desastres/estatística & dados numéricos , Desastres , Hospitais Comunitários , Estudos Transversais , Humanos , New York , Capacidade de Resposta ante Emergências , Inquéritos e Questionários
13.
Prehosp Disaster Med ; 33(5): 459-465, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30156181

RESUMO

IntroductionHospital Acute Care Surge Capacity (HACSC), Hospital Acute Care Surge Threshold (HACST), and Total Hospital Capacity (THC) are scales that were developed to quantify surge capacity in the event of a multiple-casualty incident (MCI). These scales take into consideration the need for adequate care for both critical (T1) and moderate (T2) trauma patients. The objective of this study was to verify the validity of these scales in nine hospitals of the Milano (Italy) metropolitan area that prepared for a possible MCI during EXPO 2015. METHODS: Both HACSC and HACST were computed for individual hospitals. These were compared to surge capacities declared by individual hospitals during EXPO 2015, and also to surge capacity evaluated during a simulation organized on August 23, 2016. RESULTS: Both HACSC and HACST were smaller compared to capacities measured and reported by the hospitals, as well as those found during the simulation. This resulted in significant differences in THC when this was computed from the different methods of calculation. CONCLUSIONS: Surge capacity is dependent on the method of measurement. Each method has its inherent deficiencies. Until more reliable methodologies are developed, there is a benefit to analyze surge capacity using several methods rather than just one. Emergency committee members should be aware of the importance of critical resources when looking to the hospital capacity to respond to an MCI, and to the possibility to effectively increase it with a good preparedness plan. Since hospital capacity during real events is not static but dynamic, largely depending on occupation of the available resources, it is important that the regional command center and the hospitals receiving casualties constantly communicate on specific agreed upon critical resources, in order for the regional command center to timely evaluate the overall regional capacity and guarantee the appropriate distribution of the patients. FaccincaniR, Della CorteF, SesanaG, StucchiR, WeinsteinE, AshkenaziI, IngrassiaP. Hospital surge capacity during Expo 2015 in Milano, Italy. Prehosp Disaster Med. 2018;33(5):459-465.


Assuntos
Serviços Médicos de Emergência/organização & administração , Incidentes com Feridos em Massa , Capacidade de Resposta ante Emergências , Benchmarking , Planejamento em Desastres , Serviços Médicos de Emergência/normas , Humanos , Itália , Reprodutibilidade dos Testes , Triagem/organização & administração
14.
Rio de Janeiro; s.n; ago. 2018. 164 f p. tab, graf, ilus.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-964359

RESUMO

Introdução: Em janeiro de 2011 diversos estabelecimentos de saúde da Região Serrana do Estado do Rio de Janeiro colapsaram, em função dos efeitos do desastre socioambiental que atingiu drasticamente diversos municípios. Profissionais de Enfermagem da principal unidade hospitalar do Município de Nova Friburgo atuaram no atendimento caótico às centenas de cidadãos afetados. Inúmeros foram os desafios enfrentados por esses profissionais, especialmente relacionados à sua preparação prévia para responder àquela demanda emergencial, em cenário intra-hospitalar. Objetivo geral: Sintetizar evidências para subsidiar decisões acerca da preparação de profissionais de Enfermagem para o enfrentamento de desastres socioambientais, em cenário intra-hospitalar, a partir do caso estudado. Objetivos específicos: analisar a preparação de profissionais de Enfermagem de uma unidade hospitalar, que sofreu impacto de desastre socioambiental em janeiro de 2011, para melhor resposta no atendimento intra-hospitalar; apontar as dificuldades enfrentadas pelo Setor Saúde na resposta ao desastre socioambiental ocorrido no Município de Nova Friburgo; e identificar os desafios enfrentados na preparação de equipes de Enfermagem para o atendimento às pessoas atingidas por desastres socioambientais em cenário hospitalar. Metodologia: trata-se de um estudo de caso único, transversal, de natureza descritiva e exploratória, com abordagem qualitativa. Para alcançar os objetivos e sistematizar a coleta dos dados foram articuladas três fontes de evidência: documentos técnico-científicos sobre o tema, documentos jornalísticos da época do desastre e entrevistas com os profissionais de Enfermagem do referido hospital. Os documentos foram tratados por meio de análise documental e as entrevistas foram tratadas pelo software IRAMUTEQ®. Participaram da pesquisa enfermeiros, técnicos e auxiliares de Enfermagem deste hospital municipal de Nova Friburgo. Os resultados demonstraram que os desafios estão relacionados às dificuldades de locomoção das equipes, ao atendimento do grande número de pessoas atingidas, falta de recursos humanos e materiais, necessidade de maior investimento na área de educação e treinamento em desastres, suporte psicológico aos profissionais e percepção das equipes de Enfermagem quanto ao seu papel em situações de desastres. A partir da triangulação dos dados foi desenvolvida a síntese das evidências, com vistas a traçar recomendações específicas voltadas à preparação e melhor resposta no enfrentamento de desastres socioambientais, em cenários intra-hospitalares. Conclusão: a pesquisa revelou o quanto é imprescindível o investimento contínuo na preparação dos profissionais de Enfermagem para atuação em situações de desastres socioambientais, a fim de garantir a segurança, qualidade e continuidade da assistência, como também dar conta das demandas específicas de tais situações. Ademais, o conhecimento e desenvolvimento de competências de Enfermagem em cenários de desastres precisa ser sistematicamente considerado em programas de graduação e de pós-graduação, a fim de que os profissionais assumam com efetividade o seu papel nessas situações.(AU)


Assuntos
Humanos , Enfermagem em Emergência/educação , Educação em Desastres , Capacidade de Resposta ante Emergências
15.
Rev. Bras. Saúde Mater. Infant. (Online) ; 18(2): 437-442, Apr.-June 2018.
Artigo em Inglês | LILACS | ID: biblio-1013091

RESUMO

Abstract Objectives: to describe the strategy action from the Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) (Strategic Information on Health Surveillance Center) in response to the emergency on Congenital Syndrome associated to Zika virus infection (CSZ) in Pernambuco State between 2015 and 2016. Methods: description performed on the strategies and activities developed by Cievs/PE during the important international public health emergency related to CSZ. Results: participated in detecting suspected CSZ cases; participated in elaborating clinical epidemiological protocols; developed electronic forms to notify CSZ cases and pregnant women with exanthema rashes; prepared epidemiological reports; developed a website about the emergency on the Cievs/PE website; insert the occurrence in the Comitê de Avaliação e Monitoramento de Eventos (CAME) (Committee to Assess and Monitor Occurrence); resolution of demands during readiness; technical visits from National and International institutions. The actions developed by the Cievs/PE were fundamental in detecting and following-up on 2,073 CSZ cases. 390 cases were confirmed (18.1%) and 1,413 were discarded (65.6%), and 4,467 pregnant women had exanthema rash. Conclusions: the action from the Cievs/PE allowed to employ timely strategies on preparation and response in a qualified and cooperative way to face public health emergency on CSZ's


Resumo Objetivos: descrever a estratégia de atuação do Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) na resposta à emergência da Síndrome Congênita associada à infecção pelo vírus Zika (SCZ) no estado de Pernambuco, entre 2015 e 2016. Métodos: realizada descrição das estratégias e atividades desenvolvidas pelo Cievs/PE durante a emergência em saúde pública de importância internacional relacionada a SCZ. Resultados: participação na detecção dos casos suspeitos da SCZ; participação na elaboração dos protocolos clínico epidemiológicos; construção de formulários eletrônicos para notificação dos casos da SCZ e gestante com exantema; elaboração de informes epidemiológicos; construção de página eletrônica sobre a emergência no site do Cievs/PE; inserção do evento no Comitê de Avaliação e Monitoramento de Eventos (CAME); resolução de demandas durante a prontidão; visita técnica de instituições nacionais e internacionais. As ações desenvolvidas pelo Cievs/PE foram fundamentais para a detecção e acompanhamento de 2.073 casos da SCZ, com a confirmação 390 (18,1%) e descarte de 1.413 (65,6%) casos, e 4.467 gestantes com exantema. Conclusões: a atuação do Cievs/PE permitiu o emprego de estratégias de preparação e resposta em tempo oportuno, de forma qualificada e cooperativa no enfrentamento a emergência em saúde pública da SCZ.


Assuntos
Humanos , Estado de Alerta em Emergências , Serviços de Vigilância Sanitária , Capacidade de Resposta ante Emergências , Infecção por Zika virus/epidemiologia , Microcefalia , Administração em Saúde Pública , Brasil , Protocolos Clínicos , Zika virus
16.
Disaster Med Public Health Prep ; 12(6): 730-738, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29562948

RESUMO

OBJECTIVE: In this investigation, we reported the increase in emergency department and inpatient admission cases during the month of November 2012 post Hurricane Sandy as compared with baseline (November 2010, 2011, and 2013) for elderly patients aged 65 and up. METHODS: Medical claims data for patients aged 65 and over treated at emergency department and inpatient health care facilities in New Jersey were analyzed to examine the surge in frequencies of diagnoses treated immediately following Hurricane Sandy. The differences were quantified using gap analysis for 2 years before and 1 year after the event. RESULTS: There was an average increase of 1700 cases for the month of November 2012 relative to baseline for the top 15 most frequently diagnosed emergency department medical conditions. On a daily basis, a volume increase by an average 57 cases could be expected, including significant numbers of limb fractures and other trauma cases for these most frequently encountered medical conditions. CONCLUSIONS: Understanding the surge level in medical services needed in emergency departments and inpatient facilities during a natural disaster aftermath is critical for effective emergency preparation and response for the elderly population. (Disaster Med Public Health Preparedness. 2018;12:730-738).


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Tempestades Ciclônicas/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , New Jersey , Capacidade de Resposta ante Emergências
17.
Disaster Med Public Health Prep ; 12(6): 778-790, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29553040

RESUMO

Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;12:778-790).


Assuntos
Hospitais/normas , Incidentes com Feridos em Massa , Defesa Civil/métodos , Aglomeração , Planejamento em Desastres/métodos , Hospitais/tendências , Humanos , Alocação de Recursos/métodos , Capacidade de Resposta ante Emergências/tendências
18.
Disaster Med Public Health Prep ; 12(5): 649-656, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29465025

RESUMO

In 2016 France hosted the European football championship. In a context of an increased terrorist threat, Chemical, Bacteriological, Radiological, Nuclear (CBRN) attacks were considered possible. Three days prior to the beginning of the event, the Health Authorities required that a medium sized hospital close to a major potential target, prepare a chemical decontamination centre. Despite a low level of preparedness, little external help, and very few extra resources, an efficient decontamination chain (all premises necessary for the management of contaminated victims: from the entrance gate to the post-decontamination dressing cabins) was set up in 15 days (12 days after the unrealistic deadline). Numerous practical measures allowed three persons in CBRN personal protective equipment (PPE) to manage the whole chain, providing a maximum flow of 24 persons/hour. Volunteers were trained in PPE dressing, undressing and in decontamination procedures. This experience, offers a novel paradigm in managing chemical decontamination, in terms of attitude, and with adaptations to overcome practical constraints. It demonstrates that it is possible to set up a decontamination chain rapidly at very low cost. This provides an attractive option for less advanced countries and in humanitarian contexts. Some additional refinements, enhancements may be considered to further improve results. (Disaster Med Public Health Preparedness. 2018;12:649-656).


Assuntos
Vazamento de Resíduos Químicos/economia , Descontaminação/métodos , Capacidade de Resposta ante Emergências/economia , Descontaminação/economia , França , Hospitais/estatística & dados numéricos , Humanos , Incidentes com Feridos em Massa/economia
19.
Disaster Med Public Health Prep ; 12(4): 513-522, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29041994

RESUMO

The National Center for the Study of Preparedness and Catastrophic Event Response (PACER) has created a publicly available simulation tool called Surge (accessible at http://www.pacerapps.org) to estimate surge capacity for user-defined hospitals. Based on user input, a Monte Carlo simulation algorithm forecasts available hospital bed capacity over a 7-day period and iteratively assesses the ability to accommodate disaster patients. Currently, the tool can simulate bed capacity for acute mass casualty events (such as explosions) only and does not specifically simulate staff and supply inventory. Strategies to expand hospital capacity, such as (1) opening unlicensed beds, (2) canceling elective admissions, and (3) implementing reverse triage, can be interactively evaluated. In the present application of the tool, various response strategies were systematically investigated for 3 nationally representative hospital settings (large urban, midsize community, small rural). The simulation experiments estimated baseline surge capacity between 7% (large hospitals) and 22% (small hospitals) of staffed beds. Combining all response strategies simulated surge capacity between 30% and 40% of staffed beds. Response strategies were more impactful in the large urban hospital simulation owing to higher baseline occupancy and greater proportion of elective admissions. The publicly available Surge tool enables proactive assessment of hospital surge capacity to support improved decision-making for disaster response. (Disaster Med Public Health Preparedness. 2018;12:513-522).


Assuntos
Defesa Civil/métodos , Simulação por Computador/estatística & dados numéricos , Capacidade de Resposta ante Emergências/estatística & dados numéricos , Defesa Civil/estatística & dados numéricos , Medicina de Desastres/instrumentação , Medicina de Desastres/métodos , Previsões/métodos , Humanos , Internet , Tempo de Internação/estatística & dados numéricos , Incidentes com Feridos em Massa/estatística & dados numéricos , Método de Monte Carlo
20.
Disaster Med Public Health Prep ; 12(3): 411-414, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29198239

RESUMO

BACKGROUND: On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned. METHODS: This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals. RESULTS: A total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied. CONCLUSIONS: The risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411-414).


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Explosões/estatística & dados numéricos , Fatores de Tempo , Vazamento de Resíduos Químicos/estatística & dados numéricos , China , Serviços Médicos de Emergência/métodos , Humanos , Incidentes com Feridos em Massa/estatística & dados numéricos , Estudos Retrospectivos , Capacidade de Resposta ante Emergências/estatística & dados numéricos , População Urbana
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