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1.
Toxicol Lett ; 321: 90-94, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31881244

RESUMO

Potent opioids are increasingly responsible for morbidity and mortality in the Western world. Fentanyl and fentanyl derivatives are increasingly prevalent as adulterants or substitutes for opioid drugs of abuse in Europe and in North America. Trafficking and distribution of these chemicals evolve continuously and are poorly characterized at this time. Rescue and emergency personnel are increasingly concerned with the possibility of unintentional environmental exposures that might occur in the course of their operational duties. There is evidence that opioid agonists have been broadcast or applied directly in an offensive manner as incapacitating agents. Defending against toxicity from such agents requires a thoughtful plan for protection, decontamination, and treatment.


Assuntos
Analgésicos Opioides/efeitos adversos , Substâncias para a Guerra Química/efeitos adversos , Tráfico de Drogas , Socorristas , Fentanila/efeitos adversos , Exposição Ocupacional/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Trabalho de Resgate , Descontaminação , Fentanila/análogos & derivados , Humanos , Exposição Ocupacional/prevenção & controle , Medição de Risco , Fatores de Risco
2.
MMWR Recomm Rep ; 68(4): 1-14, 2019 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-31834290

RESUMO

This report updates the 2009 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding use of anthrax vaccine in the United States (Wright JG, Quinn CP, Shadomy S, Messonnier N. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP)], 2009. MMWR Recomm Rep 2010;59[No. RR-6]). The report 1) summarizes data on estimated efficacy in humans using a correlates of protection model and safety data published since the last ACIP review, 2) provides updated guidance for use of anthrax vaccine adsorbed (AVA) for preexposure prophylaxis (PrEP) and in conjunction with antimicrobials for postexposure prophylaxis (PEP), 3) provides updated guidance regarding PrEP vaccination of emergency and other responders, 4) summarizes the available data on an investigational anthrax vaccine (AV7909), and 5) discusses the use of anthrax antitoxins for PEP. Changes from previous guidance in this report include the following: 1) a booster dose of AVA for PrEP can be given every 3 years instead of annually to persons not at high risk for exposure to Bacillus anthracis who have previously received the initial AVA 3-dose priming and 2-dose booster series and want to maintain protection; 2) during a large-scale emergency response, AVA for PEP can be administered using an intramuscular route if the subcutaneous route of administration poses significant materiel, personnel, or clinical challenges that might delay or preclude vaccination; 3) recommendations on dose-sparing AVA PEP regimens if the anthrax vaccine supply is insufficient to vaccinate all potentially exposed persons; and 4) clarification on the duration of antimicrobial therapy when used in conjunction with vaccine for PEP.These updated recommendations can be used by health care providers and guide emergency preparedness officials and planners who are developing plans to provide anthrax vaccine, including preparations for a wide-area aerosol release of B. anthracis spores. The recommendations also provide guidance on dose-sparing options, if needed, to extend the supply of vaccine to increase the number of persons receiving PEP in a mass casualty event.


Assuntos
Vacinas contra Antraz/uso terapêutico , Antraz/prevenção & controle , Adolescente , Adulto , Comitês Consultivos , Idoso , Antraz/epidemiologia , Vacinas contra Antraz/efeitos adversos , Criança , Socorristas , Feminino , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Gravidez , Estados Unidos/epidemiologia , Adulto Jovem
3.
J Bus Contin Emer Plan ; 13(2): 160-173, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31779743

RESUMO

Understanding the explosive threat landscape is paramount to having a sound evacuation protocol. Security procedures and response to threats can no longer be static and uniformly applied; rather, they must be tailored to ever-evolving terrorist and criminal tactics. This paper introduces recent statistics regarding the decreasing number of domestic bombings in the USA. Data related to the increasing number of bomb threats is also brought into the discussion, along with data showing how threats are almost exclusively hoaxes. A case study of the disparate responses of two major cities to the same bomb threat reveals how and why the threat was handled differently, along with ramifications. Terrorist and criminal bombings often target evacuees and first responders, and devices, if they exist, are generally small and ineffective; therefore, sheltering in place, in the protection of the building, may be a better course of action than evacuation. The concept of treating a bomb threat as a possible dry run is discussed, along with information regarding detection of surveillance. The paper also ventures beyond data-gathering and explores the use of intuition in decision-making. These perspectives should be factored into bomb threat preparation, mitigation and response policy and procedures.


Assuntos
Bombas (Dispositivos Explosivos) , Planejamento em Desastres , Socorristas , Terrorismo , Humanos
4.
Am J Disaster Med ; 14(2): 113-119, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637692

RESUMO

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel. METHODOLOGY: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience. RESULTS: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent. POSTINTERVENTION RESULTS: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the postintervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. CONCLUSION: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.


Assuntos
Planejamento em Desastres/organização & administração , Planejamento em Desastres/normas , Serviços Médicos de Emergência/organização & administração , Socorristas/educação , Incidentes com Feridos em Massa , Recursos Humanos em Hospital/educação , Triagem/normas , Estudos Transversais , Avaliação Educacional , Serviços Médicos de Emergência/normas , Auxiliares de Emergência/educação , Hospitais Universitários , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos
5.
J Spec Oper Med ; 19(3): 123-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539448

RESUMO

Tourniquets have become ubiquitous tools for controlling hemorrhage in the modern prehospital environment, and while commercial products are preferable, improvised tourniquets play an important role when commercial options are not available. A properly constructed improvised tourniquet can be highly effective provided the user adheres to certain principles. This review article identifies key skills in the construction and application of improvised tourniquets on an extremity. An improvised tourniquet design for an extremity should include three components: a strap, a rod, and a securing mechanism. The strap can be made from a variety of materials, but cravat- like fabric has been shown to work well. Optimal strap dimensions should be at least 2cm in width and a continuous segment long enough to extend around the extremity while still offering ends to accommodate and secure the rod. The rod should be constructed from a material that is hard, strong, and capable of withstanding the torque placed on it without bending or breaking. After torque is applied, the rod must be secured into position to maintain the constricting force and survive patient transport. Finally, the need for an improvised tourniquet is a contingency that all first responders should anticipate. Hands-on training should be conducted routinely in conjunction with other first responder tasks.


Assuntos
Competência Clínica , Socorristas , Hemorragia/prevenção & controle , Torniquetes , Extremidades , Humanos
6.
Pan Afr Med J ; 33: 132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558931

RESUMO

Introduction: Studies have reported that emergency medical care practitioners (EMCPs) encounter challenges when attending to psychiatric emergencies. The EMC provider's ability to understand, assess and manage psychiatric emergencies has been reported to be poor due to limited knowledge and insufficient training. In South Africa (SA), little is known about the knowledge of EMCPs on pre-hospital management of psychiatric emergencies. The objective of this study was to assess the knowledge of EMCPs working in the Free State province on aspects of pre-hospital management of psychiatric emergencies. Methods: This descriptive study used a questionnaire survey to obtain data on the knowledge of EMCPs on aspects of pre-hospital management of psychiatric emergencies. Results: Only 159 of the initial 192 questionnaires distributed were returned, giving a response rate of 82.8%. The majority (87.4%) of the participants reported inadequate knowledge of pre-hospital management of psychiatric emergencies. More than a third of the participants reported that they are not knowledgeable on how to assess a psychiatric patient (P < 0.01), 64.2% and 73.6% (P < 0.001 in both cases) could not perform mental status examination and lack the knowledge of crisis intervention skills for managing a psychiatric emergencies. The majority (76.7%; P < 0.001) of the participants are not conversant with the Mental Health Care Act 2002 (Act no. 17 of 2002). Finally, participants (94.3% and 86.8%, respectively; P < 0.001) agree that teaching and prior exposure to a psychiatric facility, as in work integrated learning, will empower EMC graduates with skills required to effectively manage psychiatric emergencies. Conclusion: EMC practitioners are often the first healthcare professionals arriving at any scene of medical emergencies including psychiatric emergencies. To avoid malpractices, which could be detrimental to patient's health, it is of utmost importance that EMCPs are well trained and equipped to manage any form of medical emergency including those involving psychiatric patients.


Assuntos
Serviços Médicos de Emergência/métodos , Socorristas/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/terapia , Adulto , Competência Clínica , Emergências , Serviços Médicos de Emergência/normas , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Projetos Piloto , África do Sul , Inquéritos e Questionários , Adulto Jovem
7.
Am J Disaster Med ; 14(1): 5-8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441023

RESUMO

The Center for Domestic Preparedness (CDP) in partnership with the US Department of Health and Human Services Assistant Secretary for Preparedness and Response is using a multiagency/organization, targeted, collaborative approach to adjust existing courses and develop responsive new courses to provide best practices education and experiential learning techniques in healthcare facility emergency resilience, preparedness, response, and recovery applicable to all first receivers. The CDP in Anniston, AL, is a Federal Emergency Management Agency training facility for the Nation's state, local, tribal, and territorial first responders and healthcare professionals. The Center's role has rapidly evolved to provide healthcare emergency preparedness, response, and management training. Through the integration of its Noble Training Facility, a former military hospital, the training courses replicate disaster and mass casualty emergency situations. Patient simulators enable triage and assessment of treatment for mass casualty surge skills application while an isolation ward serves as a training laboratory for the care of patients with infectious diseases of specific concern. Ambulance simulators and an eight-bay treatment area add authenticity to an integrated capstone event accompanying select classes.


Assuntos
Defesa Civil , Planejamento em Desastres/métodos , Socorristas/educação , Incidentes com Feridos em Massa , Assistência à Saúde , Humanos , Simulação de Paciente
8.
J Bus Contin Emer Plan ; 13(1): 52-66, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31462363

RESUMO

This case study focuses on the ability of Metro Vancouver's fire personnel to access their regular workplace and home location immediately following, and in the hours and days after a major earthquake. In the event of such an incident, transportation infrastructure will be disrupted, limiting accessibility in the region. By examining the travel routes required by fire personnel, emergency planning can address any anomalies or identified gaps in service needs. This case study provides information to guide the development of regional policies and coordinated efforts to ensure that available fire personnel resources are deployed in the most beneficial and effective way. Other first-responder and receiver agencies should consider conducting similar evaluations as the findings and recommendations presented here generalise to other disasters where staff resources will be limited. Further research is recommended to determine resource needs in the event of a major disaster. Once a better picture of the total resource needs is known, a gap analysis can be conducted to identify what resources are available and accessible from within Metro Vancouver and what resources would need to come from outside the region.


Assuntos
Planejamento em Desastres , Terremotos , Bombeiros , Transportes , Desastres , Emergências , Socorristas , Humanos
9.
J Bus Contin Emer Plan ; 13(1): 81-90, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31462365

RESUMO

This paper is based on research examining how supervisors within the Delta Police Department in British Columbia lead frontline police officers following exposure to traumatic events. The study finds that the role of the patrol supervisor is incredibly important in the provision of guidance and leadership to teams following traumatic events. The recommendations include the consistent enhancement of current knowledge bases, but also new initiatives to strengthen psychological support and awareness. The conclusions are applicable to other first-responder organisations and highlight the importance of supervision in post-trauma response. This work will help reduce the stigma related to mental health and create an environment of emotionally intelligent supervisors.


Assuntos
Planejamento em Desastres , Socorristas , Liderança , Colúmbia Britânica , Humanos , Polícia
10.
Prehosp Disaster Med ; 34(4): 442-448, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389325

RESUMO

INTRODUCTION: Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed. METHODS: Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs). DISCUSSION: Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and "tactical triage." CONCLUSION: Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.


Assuntos
Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Terrorismo/estatística & dados numéricos , Triagem/organização & administração , California , Socorristas/educação , Feminino , França , Necessidades e Demandas de Serviços de Saúde , Humanos , Internacionalidade , Masculino , Incidentes com Feridos em Massa/estatística & dados numéricos , Noruega , Inovação Organizacional , Paris
11.
Prehosp Disaster Med ; 34(4): 401-406, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389327

RESUMO

INTRODUCTION: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. METHODS: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. RESULTS: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. CONCLUSIONS: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.


Assuntos
Simulação por Computador , Emergências , Socorristas , Hemorragia/prevenção & controle , Instituições Acadêmicas/organização & administração , Triagem/métodos , Adulto , Algoritmos , Criança , Feminino , Hemorragia/terapia , Humanos , Masculino , Incidentes com Feridos em Massa , Pessoa de Meia-Idade , Competência Profissional , Estudos Prospectivos , Estudantes/estatística & dados numéricos , Torniquetes
12.
Prehosp Disaster Med ; 34(4): 415-421, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31298202

RESUMO

When a disaster exceeds the capacity of the affected country to cope with its own resources, the provision of external rescue and health services is required, and the deployment of relief units requested. Recently, the cost of international relief and the belief that such deployment is cost-effective has been questioned by the international community; unfortunately, there is still little informed debate and few detailed data are available. This paper presents the results of a comparative review on the cost-effectiveness analysis (CEA) of search and rescue (SAR) and Emergency Medical Team (EMT) deployment. The aim of this work is to provide an overview of the topic, highlight the criteria used to assess the effectiveness, and identify gaps in existing literature. The results show that both deployments are highly expensive, and their success is strongly related to the time they need to be operational; SAR deployments are characterized by limited outcomes in terms of lives saved, and EMTs by insufficient data and lack of detailed assessment. This research highlights that the criteria used to assess the effectiveness need to be explored further, considering different purposes, lengths of stay, and different activities performed, especially for any comparison. This study concludes that data reporting should be mandatory for humanitarian response agencies.


Assuntos
Análise Custo-Benefício , Desastres/economia , Serviços Médicos de Emergência/economia , Trabalho de Resgate/economia , Altruísmo , Socorristas/estatística & dados numéricos , Feminino , Humanos , Internacionalidade , Masculino
13.
Cochrane Database Syst Rev ; 7: CD012764, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31323120

RESUMO

BACKGROUND: Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival. OBJECTIVES: To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in adults and children older than four weeks of age, in terms of survival and neurological function. SEARCH METHODS: We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation Council. SELECTION CRITERIA: We included randomized and quasi-randomized trials (RCTs and q-RCTs) that compared routine emergency medical services (EMS) care versus EMS care plus mobilization of CFRs in instances of OHCA.Trials with randomization by cluster were eligible for inclusion, including cluster-design studies with intervention cross-over.In some communities, the statutory ambulance service/EMS is routinely provided by the local fire service. For the purposes of this review, this group represents the statutory ambulance service/EMS, as distinct from CFRs, and was not included as an eligible intervention.We did not include studies primarily focused on opportunistic bystanders. Individuals who were present at the scene of an OHCA event and who performed CPR according to telephone instruction provided by EMS call takers were not considered to be CFRs.Studies primarily assessing the impact of specific additional interventions such as administration of naloxone in narcotic overdose or adrenaline in anaphylaxis were also excluded.We included adults and children older than four weeks of age who had experienced an OHCA. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed all titles and abstracts received to assess potential eligibility, using set inclusion criteria. We obtained and examined in detail full-text copies of all papers considered potentially eligible, and we approached authors of trials for additional information when necessary. We summarized the process of study selection in a PRISMA flowchart.Three review authors independently extracted relevant data using a standard data extraction form and assessed the validity of each included trial using the Cochrane 'Risk of bias' tool. We resolved disagreements by discussion and consensus.We synthesized findings in narrative fashion due to the heterogeneity of the included studies. We used the principles of the GRADE system to assess the certainty of the body of evidence associated with specific outcomes and to construct a 'Summary of findings' table. MAIN RESULTS: We found two completed studies involving a total of 1136 participants that ultimately met our inclusion criteria. We also found one ongoing study and one planned study. We noted significant heterogeneity in the characteristics of interventions and outcomes measured or reported across these studies, thus we could not pool study results.One completed study considered the dispatch of police and fire service CFRs equipped with automatic external defibrillators (AEDs) in an EMS system in Amsterdam and surrounding areas. This study was an RCT with allocation made by cluster according to non-overlapping geographical regions. It was conducted between 5 January 2000 and 5 January 2002. All participants were 18 years of age or older and had experienced witnessed OHCA. The study found no difference in survival at hospital discharge (odds ratio (OR) 1.3, 95% confidence interval (CI) 0.8 to 2.2; 1 RCT; 469 participants; low-certainty evidence), despite the observation that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group (OR and 95% CI - not applicable; 1 RCT; 469 participants; moderate-certainty evidence). This study reported increased survival to hospital admission in the intervention group (OR 1.5, 95% CI 1.1 to 2.0; 1 RCT; 469 participants; moderate-certainty evidence).The second completed study considered the dispatch of nearby lay volunteers in Stockholm, Sweden, who were trained to perform cardiopulmonary resuscitation (CPR). This represented a supplementary CFR intervention in an EMS system where police and fire services were already routinely dispatched to OHCA in addition to EMS ambulances. This study, an RCT, included both witnessed and unwitnessed OHCA and was conducted between 1 April 2012 and 1 December 2013. Participants included adults and children eight years of age and older. Researchers found no difference in 30-day survival (OR 1.34, 95% CI 0.79 to 2.29; 1 RCT; 612 participants; low-certainty evidence), despite a significant increase in CPR performed before EMS arrival (OR 1.49, 95% CI 1.09 to 2.03; 1 RCT; 665 participants; moderate-certainty evidence).Neither of the included completed studies considered neurological function at hospital discharge or at 30 days, measured by cerebral performance category or by any other means. Neither of the included completed studies considered health-related quality of life. The overall certainty of evidence for the outcomes of included studies was low to moderate. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted.The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured.We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types.


Assuntos
Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Socorristas , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Criança , Cardioversão Elétrica , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida
14.
Am Surg ; 85(6): 601-605, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267900

RESUMO

The Stop the Bleed (STB) course teaches trainees prehospital hemorrhage control with a focus on mass education. Identifying populations most likely to benefit can help save on the significant cost and limited resources. In this study, we attempted to identify those populations and performed a cost analysis. Trainees underwent STB education and completed a survey on completion to assess demographics and prior experiences where STB skills could have been useful. Five hundred seventy-one trainees categorized as first responders (14%), students (56%), and the working public (30%) completed the survey. Most trainees found the lecture and simulation helpful, 96 per cent and 98 per cent, respectively. There were significant differences among groups who had previously been in situations where the STB course would have been helpful (88% first responders versus 40% students versus 43% public workers) (P < 0.001). Teaching a class of 10 students costs approximately $455; the cost can be as high as $1246 for a class of 50 students. Most STB trainees found the course helpful. First responders are most likely to be exposed to situations where course information could be helpful. Focusing on specific high-yield groups rather than mass education might be a more efficient approach to STB education.


Assuntos
Serviços Médicos de Emergência/organização & administração , Socorristas/educação , Hemorragia/prevenção & controle , Incidentes com Feridos em Massa/prevenção & controle , Adulto , Distribuição de Qui-Quadrado , Educação Médica/organização & administração , Educação Profissionalizante/organização & administração , Tratamento de Emergência , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/educação , Melhoria de Qualidade , Medição de Risco , Inquéritos e Questionários , Taxa de Sobrevida , Estados Unidos
15.
J Bus Contin Emer Plan ; 12(4): 342-353, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31200797

RESUMO

Galvanised by the increasing complexity in managing incidents of mass violence and mass casualty, the emergency response agencies in Calgary, Canada identified the need to develop research-based policies, establish common strategies/ tactics and conduct more joint training across all hazards. By identifying the challenges with initial command, coordination and control activities at scene, the Calgary first-responder community designed and implemented an integrated training programme to support interoperability between front-line incident commanders and supervisors. The training programme was created to address the differences in each respective agency's policies, procedures and cultures that can be barriers to integrating into a single incident management structure or unified command. Using features of interoperability like shared situational awareness and joint risk assessment, and applying the concepts into tactics like rescue taskforce, the training is building critical command relationships for the future. This training has further expanded into a programme with joint policy and procedure development, incident debriefings, expanded exercises, and tactic specific training. This paper describes how the members of Calgary's first-responder community are stepping beyond their silos of excellence and unifying their planning, preparedness and response programme.


Assuntos
Planejamento em Desastres , Socorristas , Incidentes com Feridos em Massa , Canadá , Emergências , Humanos
16.
Artigo em Inglês | MEDLINE | ID: mdl-31159380

RESUMO

Despite improvements in chemical safety management systems, incidents involving the release of hazardous chemicals continue to happen. In some cases, they result in the evacuation of residents. For hazardous chemical release accidents, an evacuation plan needs to be selective enough to consider both the indoor and outdoor concentrations of nearby buildings and the time in which the maximum allowable concentration may occur. In this study, a real-time risk analysis tool was developed based on the geographic information system (GIS) in order to establish the emergency response and risk communication plan for effectively assisting decision-making personnel. A selective evacuation plan was also established by a proposed assessment module considering the indoor/outdoor pollution concentration of buildings and the release duration time of chlorine gas leakage. The GIS-based simulated modules were performed based on eleven buildings of Ulsan city, located near an industrial cluster and home to a high population density. As a result of the simulated real-time risk assessment, only four buildings were affected by chlorine gas concentration according to wind direction and diffusion time. In addition, it was considered effective to establish an indoor/outdoor evacuation plan as opposed to an outdoor evacuation plan which is outside the range of the damage. Subsequently, an emergency evacuation plan was established with the concentration of a hazardous chemical according to the decision-making matrix. This study can enlighten the real-time emergency risk assessment based on GIS while effectively supporting the emergency action plans in response to the release of hazardous chemicals in clustered plants and the community.


Assuntos
Acidentes , Vazamento de Resíduos Químicos , Sistemas de Informação Geográfica , Substâncias Perigosas/toxicidade , Gestão da Segurança/organização & administração , Socorristas , Humanos , Concentração Máxima Permitida , República da Coreia , Medição de Risco/métodos
17.
Artigo em Inglês | MEDLINE | ID: mdl-31163571

RESUMO

The construction of smart cities is a theme of urban development, and building fires greatly threaten public safety and urban environmental governance, in which fire emergency management is one of the key factors. However, most studies on the evaluation of emergency response capacity ignore the process of improvement, as well as the intelligence and practicality of the results. The evaluation system of building fire emergency response capability maturity (FE-CMM) was innovatively proposed based on the capability maturity model (CMM), including the evaluation index, evaluation grade, evaluation method, and evaluation process. At the same time, a plug-in for evaluating fire emergency response capability was developed based on the building information modeling (BIM) platform. Finally, an empirical study was carried out in combination with the case of a district fire center. The research demonstrates that the evaluation system can effectively judge the maturity of fire emergency response capability, and the established plug-in can preliminarily realize the intelligent evaluation of building fire emergency response capability, which improves the practice and intelligence of the fire emergency response capability evaluation system when fully considering the process of improvement. It has guiding significance for ex ante control and refined management of building fires, thus providing support for urban public safety and environmental governance.


Assuntos
Emergências , Socorristas/estatística & dados numéricos , Fogo/estatística & dados numéricos , China , Humanos
18.
Nonlinear Dynamics Psychol Life Sci ; 23(3): 347-376, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31173703

RESUMO

Human dyads and larger teams tend to acquire synchronized movements and autonomic arousal levels while working together or simply socializing. The synchronization of arousal patterns is of theoretical interest for group dynamics because they may add predictive value to the dynamics of group cohesion and team performance. This study examined the four-way relationship among experimental conditions: team size, task difficulty, time pressure (between-subjects) and subsequent experimental sessions (within-subjects). Previously, we have shown these conditions affect subjective ratings of workload that come from individual and group-level sources, synchronization of arousal, and team performance. In an experiment involving an emergency response (ER) simulation, 360 undergraduates, who were wearing electrodermal sensors, were organized into 44 teams of various sizes. Workload was experimentally varied by team size (three, four, seven or eight members), number of opponents (one or two), and time pressure; the latter was introduced sooner or later across two experimental sessions. Results showed that the experimental conditions affected synchronization levels, either at the beginning of a session or in the middle; synchronization and experimental conditions were not directly related to team performance. Subjective group workload ratings of the coordination demand of the task correlated with synchronization at the beginning of a session while team satisfaction was correlated with greater synchrony at the end of a session. The competitive nature of the ER task, as compared to strictly cooperative tasks, could be responsible for the complexity of these empirical relationships.


Assuntos
Nível de Alerta/fisiologia , Comportamento Competitivo , Socorristas/psicologia , Processos Grupais , Carga de Trabalho/psicologia , Humanos , Relações Interpessoais , Estudantes/psicologia , Análise e Desempenho de Tarefas
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 513-527, 2019 05.
Artigo em Chinês | MEDLINE | ID: mdl-31198133

RESUMO

OBJECTIVE: To improve the popularization of the knowledge of the first responders and promote the establishment of the awareness of the first aid, First Aid Professional Committee of Chinese Aging Well Association formulated the Expert consensus on the first responder of the first aid. This consensus aims at the critical and weak link of emergency medical service system (EMSS) in China, providing the public with the first responders action guidance, and guiding the public how to effectively rescue the "first scene", "first time" and "first responder" in the event of sudden injury or illness. Strengthen risk pre-control, environmental control and overall joint control in the "first scene" of different emergencies were emphasized. How to correctly judge, recognize, call for help and give first aid in the "first time" were presented. The first aid skills of the "first responder" should include cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) defibrillation, Heimlich (abdominal impingement), hemostasis, dressing, fixation, and handling. The best place, the best training method and the best communication way to popularize the first aid knowledge and skills were proposed, and the first responder action plan was jointly promoted from various social levels such as policy, law, science and technology, culture and so on. This consensus refers to relevant foreign guidelines and scientific basis and combines with Chinese actual national conditions to provide guidance for the first responders' action and training, aiming to promote the development of first aid in China.


Assuntos
Socorristas , Primeiros Socorros , China , Consenso , Serviços Médicos de Emergência , Humanos
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