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1.
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
2.
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
3.
Enferm. glob ; 18(55): 510-524, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186249

RESUMO

Objetivo: describir el perfil demográfico, laboral y evaluar la calidad de vida en el trabajo del equipo de enfermería actuante en la Unidad de Urgencias. Método: estudio transversal, realizado en 2017 con 109 trabajadores. Se utilizó un cuestionario con perfil demográfico y laboral y la calidad de vida en el trabajo fue evaluada por medio de la adaptación del modelo de Walton. Resultados: de los 109 trabajadores, 75,2% eran del sexo femenino, 45,9% casados, 34,9% enfermeros, 53,2% técnicos de enfermería y 11,9% auxiliares de enfermería; El 89,9% tenía una carga horaria semanal de trabajo 30 horas y el 39,4% poseía otro empleo en la enfermería. La escala de la calidad de vida en el trabajo reveló que el 39,5% están insatisfechos y el 60,5% están satisfechos, se destaca que hubo mayor insatisfacción con la calidad de vida en el trabajo entre los profesionales enfermeros. Conclusión: los hallazgos de este estudio podrán guiar a las autoridades del sistema de salud a desarrollar estrategias, para promover mejor calidad de vida en el trabajo a los trabajadores de enfermería insatisfechos y, así, permitirles prestar una asistencia de mejor calidad a sus pacientes


Objetivo: descrever o perfil demográfico, laboral e avaliar a qualidade de vida no trabalho da equipe de enfermagem atuante na Unidade de Pronto Atendimento. Método: estudo transversal, realizado em 2017 com 109 trabalhadores. Foi utilizado um questionário com perfil demográfico e laboral e a qualidade de vida no trabalho foi avaliada por meio da adaptação do modelo de Walton. Resultados: dos 109 trabalhadores, 75,2% eram do sexo feminino, 45,9% casados, 34,9% enfermeiros, 53,2% técnicos de enfermagem e 11,9% auxiliares de enfermagem; 89,9% tinham carga horária semanal de trabalho 30 horas e 39,4% possuíam outro emprego na enfermagem. A escala da qualidade de vida no trabalho revelou que 39,5% estão insatisfeitos e 60,5% estão satisfeitos, destaca-se que houve maior insatisfação com a qualidade de vida no trabalho entre os profissionais enfermeiros. Conclusão: os achados deste estudo poderão nortear as autoridades do sistema de saúde a desenvolverem estratégias, para promover melhor qualidade de vida no trabalho aos trabalhadores de enfermagem insatisfeitos e, assim, permitir a eles prestar uma assistência de melhor qualidade aos seus pacientes


Objective: to describe the demographic and labor profile and evaluate the quality of working life of the nursing team working in an emergency care unit. Method: cross-sectional study, carried out in 2017 with 109 workers. A questionnaire with demographic and labor profile was used and the quality of life at work was evaluated through the adaptation of the Walton model. Results: of the 109 workers, 75.2% were female, 45.9% were married, 34.9% were nurses, 53.2% were nursing technicians and 11.9% were nursing assistants; 89.9% had a weekly workload of 30 hours and 39.4% had another job in nursing. The quality of life at work scale revealed that 39.5% are dissatisfied and 60.5% are satisfied.There was greater dissatisfaction with quality of life at work among nurses. Conclusion: the findings of this study may guide health system authorities to develop strategies to promote better quality of working life for dissatisfied nursing workers and thus enable them to provide better quality care to their patients


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Socorristas/estatística & dados numéricos , Esgotamento Profissional/psicologia , Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Qualidade de Vida , Enfermagem em Emergência/organização & administração , Condições de Trabalho , Qualidade da Assistência à Saúde/tendências , Equipe de Enfermagem/estatística & dados numéricos
4.
Emerg Med J ; 36(8): 456-458, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31217181

RESUMO

INTRODUCTION: Recent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment, they not only impair vision but also significantly reduce speech intelligibility. The recent introduction of electronic voice projection units (VPUs), attached to a respirator, may improve communication while wearing personal respiratory protection. OBJECTIVE: To determine the influence of currently used respirators and VPUs on medical communication and speech intelligibility. METHODS: 37 trauma anaesthetists carried out an evaluation exercise of six different respirators and VPUs including one control. Participants had to listen to audio clips of a variety of sentences dealing with scenarios of emergency triage and medical history taking. RESULTS: In the questionnaire, operators stated that speech intelligibility of the Avon C50 respirator scored the highest (mean 3.9, ±SD 1.0) and that the Respirex Powered Respiratory Protective Suit (PRPS) NHS-suit scored lowest (1.6, 0.9). Regarding loudness the C50 plus the Avon VPU scored highest (4.1, 0.7), followed by the Draeger FPS-7000-com-plus (3.4, 1.0) and the Respirex PRPS NHS-suit scored lowest (2.3, 0.8). CONCLUSIONS: We found that the Avon C50 is the preferred model among the tested respirators. In our model, electronic voice projection modules improved loudness but not speech intelligibility. The Respirex PRPS NHS-suit was rated significantly less favourably in respect of medical communication and speech intelligibility.


Assuntos
Comunicação , Socorristas/estatística & dados numéricos , Desenho de Equipamento/normas , Substâncias Perigosas/efeitos adversos , Ventiladores Mecânicos/efeitos adversos , Desenho de Equipamento/estatística & dados numéricos , Desenho de Equipamento/tendências , Humanos , Inteligibilidade da Fala , Inquéritos e Questionários , Avaliação da Tecnologia Biomédica/métodos , Avaliação da Tecnologia Biomédica/estatística & dados numéricos , Reino Unido , Ventiladores Mecânicos/estatística & dados numéricos , Ventiladores Mecânicos/tendências , Qualidade da Voz
5.
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
6.
Prehosp Disaster Med ; 34(3): 274-281, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31204642

RESUMO

INTRODUCTION: While the impact of disasters is strongly felt by those directly affected, they also have significant impact on the mental and physical health of rescue/relief workers and volunteers during the response phase of disaster management. METHOD: Semi-structured interviews were conducted with 11 experts in the field of disaster management from Nepal, inquiring specifically about the impact of the 2015 mega-earthquake on the mental and physical health of rescue/relief workers and volunteers. A thematic approach was used to analyze the results. These were used to assess the applicability of a previously developed conceptual framework which illustrates the hazards and risk factors affecting disaster response workers and the related hazard mitigation approaches. RESULTS: The findings suggested a relationship between the type of injuries to responders and the type of disaster, type of responder, and vulnerability of location. The conceptual framework derived from literature was verified for its applicability with a slight revision on analysis of experts' opinion based on particular context and disaster setting. Technical skills of responders, social stigma, governance, and the socio-economic status of the affected nation were identified as critical influencing factors to heath injuries and could be minimized utilizing some specific or collective measures targeted at the aforementioned variables. Some geographic and weather-specific risks may be challenging to overcome. CONCLUSION: To prevent or minimize the hazards for disaster relief workers, it is vital to understand the variables that contribute to injuries. Risk minimization strategies should address these critical factors.


Assuntos
Terremotos , Socorristas/psicologia , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Adulto , Socorristas/estatística & dados numéricos , Feminino , Seguimentos , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Desastres Naturais , Nepal , Pesquisa Qualitativa , Trabalho de Resgate , Medição de Risco , Comportamento de Redução do Risco , Fatores de Tempo
7.
Prehosp Disaster Med ; 34(3): 335-339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31204643

RESUMO

OBJECTIVE: The objective of this study was to explore preferred self-care practices among paramedics and emergency medical technicians (EMTs) who responded to the September 11, 2001 terrorist attack (9/11) in New York City (New York USA). DESIGN, SETTING, AND PARTICIPANTS: Qualitative research methodology with convenience and subsequent snowball sampling was utilized. Participants were adult (at least 18 years of age) paramedics or EMTs who self-reported as responding to the 9/11 terrorist attack in New York City. MAIN OUTCOME MEASURES: Preferred self-care practices; participant characteristics; indications and patterns of self-care use; perceived benefits and harms; and views on appropriate availability of support and self-care services were the main outcome measures. RESULTS: The 9/11 paramedic and EMT participants reported a delay in recognizing the need for self-care. Preferred physical self-care practices included exercise, good nutrition, getting enough sleep, and sticking to routine. Preferred psychosocial self-care practices included spending time with family and friends, participating in peer-support programs and online support forums, and routinely seeing a mental health professional. Self-care was important for younger paramedics and EMTs who reported having less-developed supportive infrastructure around them, as well as for retiring paramedics and EMTs who often felt left behind by a system they had dedicated their lives to. Access to cooking classes and subsidized gym memberships were viewed as favorable, as was the ability to include family members in self-care practices. CONCLUSION(S): A range of physical and psychosocial self-care practices should be encouraged among paramedic students and implemented by Australian ambulance services to ensure the health and well-being of paramedics throughout their career and into retirement.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Auxiliares de Emergência/estatística & dados numéricos , Autocuidado/métodos , Ataques Terroristas de 11 de Setembro , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Auxiliares de Emergência/psicologia , Socorristas/psicologia , Socorristas/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Cidade de Nova Iorque , Pesquisa Qualitativa , Medição de Risco , Amostragem , Autocuidado/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Fatores de Tempo
8.
Prehosp Disaster Med ; 34(3): 260-264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31057142

RESUMO

INTRODUCTION: International Emergency Medical Teams' (I-EMTs) response to disasters has been characterized by a late arrival, an over-focus on trauma care, and a lack of coordination and accountability mechanisms. Analysis of I-EMT performance in past and upcoming disasters is deemed necessary to improve future response. OBJECTIVE: This study aimed to describe the characteristics, timing, and activities of I-EMTs deployed to the 2015 Nepal earthquake, and to assess their registration and adherence to the World Health Organization Emergency Medical Teams' (WHO-EMT; Geneva, Switzerland) minimum standards compared to past disasters. METHODS: An online literature search was performed and key web sites related to I-EMT deployments were purposively examined. The methodology used is reported following the STARLITE principles. All articles and documents in English containing information about characteristics, timing, and activities of I-EMTs during Nepal 2015 were included in the study. Data were retrieved from selected sources to compile the results following a systematic approach. The findings were validated by the Nepalese focal point for the coordination of I-EMTs after the earthquake. RESULTS: Overall, 137 I-EMTs deployed from 36 countries. They were classified as Type I (65%), Type II (15%), Type III (1%), and specialized cells (19%). Although national teams remained the first responders, two regional I-EMTs arrived within the first 24 hours post-earthquake. According to daily reporting, the activities performed by I-EMTs included 28,372 out-patient consultations (comprising 6,073 trauma cases); 1,499 in-patient admissions; and 440 major surgeries. The activities reported by I-EMTs during their deployment were significantly lower than the capacities they offered at arrival. Over 80% of I-EMTs registered through WHO or national registration mechanisms, but daily reporting of activities by I-EMTs was low. The adherence of I-EMTs to WHO-EMT standards could not be assessed due to lack of data. CONCLUSION: The I-EMT response to the Nepal earthquake was quicker than in previous disasters, and registration and follow-up of I-EMTs was better. Still, there is need to improve I-EMT coordination, reporting, and quality assurance while strengthening national EMT capacity.Amat Camacho N, Karki K, Subedi S, von Schreeb J. International Emergency Medical Teams in the aftermath of the 2015 Nepal earthquake. Prehosp Disaster Med. 2019;34(3):260-264.


Assuntos
Planejamento em Desastres/organização & administração , Terremotos , Socorristas/estatística & dados numéricos , Cooperação Internacional , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Masculino , Desastres Naturais , Nepal , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo , Organização Mundial da Saúde
9.
Artigo em Inglês | MEDLINE | ID: mdl-31067756

RESUMO

Thyroid cancer incidence is higher in World Trade Center (WTC) responders compared with the general population. It is unclear whether this excess in thyroid cancer is associated with WTC-related exposures or if instead there is an over-diagnosis of malignant thyroid cancer among WTC first responders due to enhanced surveillance and physician bias. To maximize diagnostic yield and determine the false positive rate for malignancy, the histological diagnoses of thyroid cancer tumors from WTC responders and age, gender, and histology matched non-WTC thyroid cancer cases were evaluated using biomarkers of malignancy. Using a highly accurate panel of four biomarkers that are able to distinguish benign from malignant thyroid cancer, our results suggest that over-diagnosis by virtue of misdiagnosis of a benign tumor as malignant does not explain the increased incidence of thyroid cancer observed in WTC responders. Therefore, rather than over-diagnosis due to physician bias, the yearly screening visits by the World Trade Center Health Program are identifying true cases of thyroid cancer. Continuing regular screening of this cohort is thus warranted.


Assuntos
Socorristas/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro , Neoplasias da Glândula Tireoide , Adulto , Biomarcadores/metabolismo , Estudos de Coortes , Erros de Diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Preconceito , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/metabolismo
10.
Artigo em Inglês | MEDLINE | ID: mdl-31052246

RESUMO

The World Trade Center Health Program (WTCHP) provides mental health services through diverse service delivery mechanisms, however there are no current benchmarks to evaluate utilization or quality. This quality improvement (QI) initiative sought to examine the delivery and effectiveness of WTCHP mental health services for World Trade Center (WTC) responders who receive care through the Northwell Health Clinical Center of Excellence (CCE), and to characterize the delivery of evidence-based treatments (EBT) for mental health (MH) difficulties in this population. Methods include an analysis of QI data from the Northwell CCE, and annual WTCHP monitoring data for all responders certified for mental health treatment. Nearly 48.9% of enrolled responders with a WTC-certified diagnosis utilized treatment. The majority of treatment delivered was focused on WTC-related conditions. There was significant disagreement between provider-reported EBT use and independently-evaluated delivery of EBT (95.6% vs. 54.8%, p ≤ 0.001). EBT delivery was associated with a small decrease in Posttraumatic Stress Disorder (PTSD) symptoms over time. Providers engaged in the process of data collection, but there were challenges with adherence to outcome monitoring and goal setting. Data from this report can inform continued QI efforts in the WTCHP, as well as the implementation and evaluation of EBT.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Socorristas/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Socorristas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
11.
Prehosp Disaster Med ; 34(3): 330-334, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31025618

RESUMO

It has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330-334.


Assuntos
Traumatismos do Braço/terapia , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Socorristas/estatística & dados numéricos , Traumatismos da Perna/terapia , Melhoria de Qualidade , Amputação/métodos , Traumatismos do Braço/diagnóstico , Conflito de Interesses , Desastres , Guias como Assunto , Humanos , Escala de Gravidade do Ferimento , Cooperação Internacional , Traumatismos da Perna/diagnóstico , Medição de Risco , Organização Mundial da Saúde
13.
Artigo em Inglês | MEDLINE | ID: mdl-30970543

RESUMO

An increased incidence of thyroid cancer among 9/11 rescue workers has been reported, the etiology of which remains unclear but which may, at least partly, be the result of the increased medical surveillance this group undergoes. This study aimed to investigate thyroid cancer in World Trade Center (WTC) responders by looking at the demographic data and questionnaire responses of thyroid cancer cases from the Mount Sinai WTC Health Program (WTCHP). WTCHP thyroid cancer tumors were of a similar size (p = 0.4), and were diagnosed at a similar age (p = 0.2) compared to a subset of thyroid cancer cases treated at Mount Sinai without WTC exposure. These results do not support the surveillance bias hypothesis, under which smaller tumors are expected to be diagnosed at earlier ages. WTCHP thyroid cancer cases also reported a past history of radiation exposure and a family history of thyroid conditions at lower rates than expected, with higher than expected rates of previous cancer diagnoses, family histories of other cancers, and high Body Mass Indexes (BMIs). Further research is needed to better understand the underlying risk factors that may play a role in the development of thyroid cancer in this group.


Assuntos
Socorristas/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Trabalho de Resgate/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Neoplasias da Glândula Tireoide/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Vigilância da População
14.
Mil Med ; 184(Suppl 1): 310-317, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901420

RESUMO

OBJECTIVES: A cuffed bag valve mask (BVM) is the most common device used by emergency medical responders to ventilate patients. The BVM can be difficult for users to seal around the patient's mouth and nose. An intraoral mask (IOM) with snorkel-like design may facilitate quicker and better ventilation particularly under austere conditions. METHODS: Both a BVM and IOM were utilized by 27 trained emergency medical technicians and paramedics to ventilate a lightly embalmed cadaver. Ventilation efficacy, workload, and usability were assessed for both devices across four study conditions. RESULTS: The IOM was superior to the BVM in delivered tidal volume ratio (measure of leak, p < 0.03) and minute ventilation (p < 0.0001). Workload, ergonomic and usability assessments indicated that the IOM facilitated gripping through the reduced hand interface size (p < 0.01), decreased user effort (p < 0.001), and reduced upper limb workload (p = 0.0088). CONCLUSIONS: In the assessed model, the IOM represented a better choice for airway management than the standard cuffed BVM. An emergency medical device that is intuitive, efficacious and less demanding has the potential to reduce responder stress and improve resuscitation efforts, especially during austere rescue and patient transport.


Assuntos
Manuseio das Vias Aéreas/normas , Competência Clínica/normas , Serviços Médicos de Emergência/normas , Manuseio das Vias Aéreas/métodos , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Socorristas/estatística & dados numéricos , Humanos , Máscaras Laríngeas , Militares/estatística & dados numéricos , Nebraska , Ressuscitação/métodos , Ressuscitação/normas , Inquéritos e Questionários , Volume de Ventilação Pulmonar/fisiologia
15.
Mil Med ; 184(Suppl 1): 347-360, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901425

RESUMO

Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users' skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.


Assuntos
Avaliação Educacional/métodos , Hemorragia/terapia , Ensino/normas , Torniquetes , Socorristas/educação , Socorristas/estatística & dados numéricos , Desenho de Equipamento/normas , Humanos , Medicina Militar/educação , Ressuscitação/educação , Ressuscitação/métodos , Treinamento por Simulação/métodos , Ensino/tendências
16.
Disaster Med Public Health Prep ; 13(1): 82-89, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30841955

RESUMO

OBJECTIVE: The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters. METHODS: A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed. RESULTS: After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0-6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale - Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity. CONCLUSIONS: The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89).


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Socorristas/psicologia , Psicometria/normas , Pesquisadores/psicologia , Estresse Psicológico/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Socorristas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Porto Rico/epidemiologia , Reprodutibilidade dos Testes , Pesquisadores/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Inquéritos e Questionários
17.
Artigo em Inglês | MEDLINE | ID: mdl-30866415

RESUMO

Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003⁻2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1⁻5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0⁻10.4), compared to those with low exposure. A test for exposure-response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.


Assuntos
Poeira , Socorristas/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Fibrose Pulmonar/epidemiologia , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros
18.
Med. segur. trab ; 65(254): 24-36, ene.-mar. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187819

RESUMO

OBJETIVO: Determinar la prevalencia del Burnout en el personal de urgencias extrahospitalarias. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y transversal. Se les aplicó una ficha con unos datos profesionales y el cuestionario de Maslach de 22 items y se realizó un análisis estadístico descriptivo basado en obtener las frecuencias tanto absolutas como relativas. Además de la media y la desviación típica, se ha realizado un contraste de la hipótesis de Kruskal-Wallis y la de Wilcoxon. Para analizar la fiabilidad y validez de la escala se ha obtenido los coeficientes alfa de Cronbach para las 3 subescalas. RESULTADOS: Respecto al tiempo trabajado dentro de la categoría profesional los conductores que llevan menos de un año presentan mayor burnout. En relación al tipo de contrato, son los de contrato fijo. A peor estado de salud (regular o malo) mayor es el burnout. Las personas solteras presentan mayor cansancio emocional y no trabajar con los mismos compañeros aumenta también la presencia de este fenómeno. El burnout no se presenta en los trabajadores con turno de 24 horas, sin embargo, se ve en los otros turnos. No hay diferencias estadísticas en la puntuación por el escaso tamaño de la muestra con jornada reducida. CONCLUSIONES: El interés de este estudio radica en conocer el grado de cansancio emocional que presentan los profesionales de urgencias extrahospitalarias y evidenciar la necesidad de tomar medidas preventivas. Los resultados de nuestro estudio están en la línea de los publicados


OBJECTIVE: To determine the prevalence of Burnout in out-of-hospital emergency medical personnel. MATERIAL AND METHODS: Observational, descriptive and transversal study. A professional data sheet and the Maslach Burnout Inventory of 22 items were applied. In order to get the absolute and relative frequencies a descriptive statistical analysis was performed. In addition to the mean and the standard deviation, a contrast to the Kruskal-Wallis hypothesis and the Wilcoxon hypothesis was shown. In order to analyze the reliability and validity of the scale, Cronbach's alpha coefficients were obtained for the 3 subscales. RESULTS: Regarding the time worked in the professional category, the drivers who have been driving for less than a year have higher levels of burnout. In relation to the type of contract are those of fixed-term contract. The worse the state of health (regular or bad) is, the greater the burnout. Single people have greater emotional exhaustion. The fact of not working with the same partners also increases this phenomenon. Burnout does not occur in workers with 24-hour shift, but it occurs in other shifts. Due to the small size of the short-time working sample, no statistical differences were found in the score. CONCLUSIONS: The interest of this study lies in knowing the emotional exhaustion level from the out-of-hospital emergency professionals, as well as evidencing the need to take preventive measures. The results of our study are in line with those published


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Serviços Médicos de Emergência , Socorristas/psicologia , Socorristas/estatística & dados numéricos , Esgotamento Psicológico/diagnóstico , Esgotamento Psicológico/psicologia , Estudos Transversais , Estatísticas não Paramétricas , Inquéritos e Questionários
19.
Chest ; 155(2): 375-383, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30739642

RESUMO

BACKGROUND: Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS). METHODS: A total of 601 subjects (83% men; age, 33-87 years; BMI, 29.9 ± 5.5 kg/m2) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% ≥ 5 events/h or respiratory disturbance index of ≥ 15 events/h. CRS was assessed using nasal symptom questionnaires. RESULTS: The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P = .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P = .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. CONCLUSIONS: The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.


Assuntos
Socorristas/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Rinite/epidemiologia , Ataques Terroristas de 11 de Setembro , Sinusite/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Exposição Ocupacional , Prevalência , Fatores de Risco
20.
Crit Care ; 23(1): 60, 2019 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791952

RESUMO

BACKGROUND: Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and help determine subsequent management and disposition. We sought to evaluate and compare the prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of in-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected infection. METHODS: We retrospectively analyzed prospectively collected data (2012-2016) of consecutive RRT patients from two hospitals. The primary outcome was in-hospital mortality. We calculated the number needed to examine (NNE), which indicates the number of patients that need to be evaluated in order to detect one future death. RESULTS: Five thousand four hundred ninety-one patients were included, of whom 1837 (33.5%) died in-hospital. Mean age was 67.4 years, and 51.6% were male. A HEWS above the low-risk threshold (≥ 5) had a sensitivity of 75.9% (95% confidence interval (CI) 73.9-77.9) and specificity of 67.6% (95% CI 66.1-69.1) for mortality, with a NNE of 1.84. A NEWS2 above the low-risk threshold (≥ 5) had a sensitivity of 84.5% (95% CI 82.8-86.2), and specificity of 49.0% (95% CI: 47.4-50.7), with a NNE of 2.20. The area under the receiver operating characteristic curve (AUROC) was 0.76 (95% CI 0.75-0.77) for HEWS and 0.72 (95% CI: 0.71-0.74) for NEWS2. Among suspected infection patients (n = 1708), AUROC for HEWS was 0.79 (95% CI 0.76-0.81) and for NEWS2, 0.75 (95% CI 0.73-0.78). CONCLUSIONS: The HEWS has comparable clinical accuracy to NEWS2 for prediction of in-hospital mortality among RRT patients.


Assuntos
Mortalidade Hospitalar/tendências , Projetos de Pesquisa/normas , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Socorristas/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Estatísticas não Paramétricas
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