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American Journal of Disaster Medicine
January/February 2011, Volume 6
, Number 1


Article
The legacy of the Gulf oil spill: Analyzing acute public health effects and predicting chronic ones in Louisiana
James H. Diaz, MD, MPH, DrPH, FACOEM, FACMT
January/February 2011; pages 5-22

Abstract
Objectives: To describe the acute health impacts of the Deepwater Horizon oil spill in Louisiana as compared with the acute health impacts reported from prior crude oil spills. To predict potential chronic health impacts in Louisiana as compared with the chronic health impacts reported from prior crude oil spills. Setting: Offshore and onshore coastal southeastern Louisiana. Patients and participants: Oil spill offshore and onshore cleanup workers and the general population of coastal southeastern Louisiana. Interventions: Not applicable to an observational study. Main outcome measures: Adverse acute health effects of petrochemical and dispersant exposures in highly exposed offshore and onshore cleanup workers and the general population; prior chronic adverse health effects reported from prior oil spills; and predicted chronic adverse health effects based on intensity of chemical exposures and on seroprevalences of genetic polymorphisms. Results: Acute health effects in cleanup workers mirrored those reported in cleanup workers following prior oil spills as ranked by systems (and by symptoms). Acute health effects in lesser exposed members of the general population mirrored those reported in similar coastal residents following prior oil spills but differed from cleanup workers as ranked by systems (and symptoms). Conclusions: Subpopulations of cleanup workers and the general population with specific conditions or genetic polymorphisms in enzyme systems that detoxify polycyclic aromatic hydrocarbons in petrochemicals and glycols in dispersants will require long-term surveillance for chronic adverse health effects including cancer, liver and kidney diseases, mental health disorders, and fetal alcohol spectrum disorders. Key words: disasters, manmade, oil spills, oil tanker spills, Ixtoc 1 oil spill, Deepwater Horizon oil spill, adverse human health effects, mental health DOI:10.5055/ajdm.2011.0040


Article
Vaccine availability in the United States during the 2009 H1N1 outbreak
Stan N. Finkelstein, MD; Kallie J. Hedberg, Undergraduate Student; Julia A. Hopkins, Undergraduate Student; Sahar Hashmi, MD; Richard C. Larson, PhD
January/February 2011; pages 23-30

Abstract
Objective: After initial flu cases are reported, months elapse before vaccine becomes available. The authors report the experience of US states during the fall of 2009 on H1N1 vaccine availability in relation to the occurrence of disease. Design: The authors used data from the Centers for Disease Control and prevention and state health departments to approximate second wave H1N1 epidemic curves. The authors compared these curves to two sources of vaccine distribution data—shipment and administration. Results: Ten states received their first shipments of vaccine after the epidemic peaked, four states during the week of the peak, and 10 states only 1 week prior to the peak. In nearly half of all states, the epidemic had already begun to decline before any individuals could have been protected. Conclusions: A sensible approach would be to highlight the importance of diligent hygienic behavior and to reduce the rate of human-to-human contacts before vaccine is available. Key words: vaccine availability, influenza, H1N1, nonpharmaceutical interventions DOI:10.5055/ajdm.2011.0041


Article
Enhanced Contaminated Human Remains Pouch: Initial development and preliminary performance assessments
Angela M. Iseli, BS; Hai-Doo Kwen, PhD; Mayeen Ul-Alam, MS; Mahalingam Balasubramanian, PhD; Shyamala Rajagopalan, PhD
January/February 2011; pages 31-38

Abstract
Objectives: To produce a proof of concept prototype Enhanced Contaminated Human Remains Pouch (ECHRP) with self-decontamination capability to provide increased protection to emergency response personnel. Design: The key objective was to decrease the concentration of toxic chemicals through the use of an absorbent and reactive nanocellulose liner. Additionally, nanomaterials with biocidal properties were developed and tested as a “stand-alone” treatment. Setting: Private company research laboratory. Patients/participants: Not applicable. Interventions: Not applicable. Main outcome measures: Production of a functional prototype. Results: A functional prototype capable of mitigating the threats due to sulfur mustard, Soman, and a large variety of liquid and vapor toxic industrial chemicals was produced. Stand-alone biocidal treatment efficacy was validated. Conclusions: The ECHRP provides superior protection from both chemical and biological hazards to various emergency response personnel and human remains handlers. Key words: contaminated human remains pouch, emergency response, decontamination, chemical and biological warfare agent, toxic industrial chemicals DOI:10.5055/ajdm.2011.0042


Article
A framework for physician activity during disasters and surge events
Jane L. Griffiths, RN, BAN, MHP; Aurora Estipona, BSN; James A. Waterson, RN, BA (Hons), MMed Ed
January/February 2011; pages 39-46

Abstract
Objectives: Delineation of the problem of physician role during disaster activations both for disaster responders and for general physicians in a Middle East state facility. Setting: The hospital described has 500 medical surgical beds, 59 intensive care unit beds, eight operating rooms (ORs), and 60 emergency room (ER) beds. Its ER sees 150,000 presentations per year and between 11 and 26 multitrauma cases per day. Most casualties are the result of industrial accidents (50.5 percent) and road traffic accidents (34 percent). It is the principle trauma center for Dubai, UAE. The hospital is also the designated primary regional responder for medical, chemical, and biological events. Its disaster plan has been activated 10 times in the past 3 years and it is consistently over its bed capacity. Interventions: A review of the activity of physicians during disaster activations revealed problems of role identification, conflict, and lack of training. Interventions included training nonacute teams in reverse triaging and responder teams in coordinated emergency care. Both actions were fostered and controlled by a Disaster Control Centre and its Committee. Results: Clear identification of medical leadership in disaster situations, introduction of a process of reverse triage to meet surge based on an ethical framework, and improvement of flow through the ER and OR. Conclusions: Reverse triage can be made to work in the Middle East despite its lack of primary healthcare infrastructure. Lessons from the restructuring of responder teams may be applicable to the deployment to prehospital environments of hospital teams, and further development of audit tools is required to measure improvement in these areas. Key words: reverse triage, surge capacity, responding teams, physician role, Middle East DOI:10.5055/ajdm.2011.0043


Article
Emergent use of social media: A new age of opportunity for disaster resilience
Mark E. Keim, MD; Eric Noji, MD
January/February 2011; pages 47-54

Abstract
Social media are forms of information and communication technology disseminated through social interaction. Social media rely on peer-to-peer (P2P) networks that are collaborative, decentralized, and community driven. They transform people from content consumers into content producers. Popular networking sites such as MySpace™, Facebook™, Twitter™, and Google™ are versions of social media that are most commonly used for connecting with friends, relatives, and employees. The role of social media in disaster management became galvanized during the world response to the 2010 Haiti earthquake. During the immediate aftermath, much of what people around the world were learning about the earthquake originated from social media sources. Social media became the new forum for collective intelligence, social convergence, and community activism. During the first 2 days following the earthquake, “texting” mobile phone users donated more than $5 million to the American Red Cross. Both public and private response agencies used Google Maps™. Millions joined MySpace™ and Facebook™ discussion groups to share information, donate money, and offer comfort and support. Social media has also been described as “remarkably well organized, self correcting, accurate, and concentrated,” calling into question the ingrained view of unidirectional, official-to-public information broadcasts. Social media may also offer potential psychological benefit for vulnerable populations gained through participation as stakeholders in the response. Disaster victims report a psychological need to contribute, and by doing so, they are better able to cope with their situation. Affected populations may gain resilience by replacing their helplessness with dignity, control, as well as personal and collective responsibility. However, widespread use of social media also involves several important challenges for disaster management. Although social media is growing rapidly, it remains less widespread and accessible than traditional media. Also, public officials often view P2P communications as “backchannels” with potential to spread misinformation and rumor. In addition, in absence of the normal checks and balances that regulate traditional media, privacy rights violations can occur as people use social media to describe personal events and circumstances. Key words: social media, resilience, vulnerability, disaster management, peer-to-peer architecture, emergency response, information/communication technology DOI:10.5055/ajdm.2011.0044


Article
Disaster management mobile protocols: A technology that will save lives
Hope M. Williamson, Major, USA, DNP, ACNP-BC, CCNS, CEN, NREMT
January/February 2011; pages 55-64

Abstract
Although training and education have long been accepted as integral to disaster preparedness, many currently taught practices are neither evidence based nor standardized. The need for effective evidence-based disaster education for healthcare workers at all levels in the multidisciplinary medical response to major events has been designated by the disaster response community as a high priority. This article describes a disaster management mobile application of systematic evidence-based practice. The application is interactive and comprises portable principles, algorithms, and emergency protocols that are agile, concise, comprehensive, and response relevant to all healthcare workers. Early recognition through clinical assessment versus laboratory and diagnostic procedures in chemical, biological, radiological, and nuclear (CBRNE) exposures grounded in an evidence based skill set is especially important. During the immediate threat, the clinical diagnosis can get frustrating because CBRNE casualties can mimic everyday healthcare illnesses and initially present with nonspecific respiratory or flu-like symptoms. As there is minimal time in a catastrophic event for the medical provider to make accurate decisions, access to accurate, timely, and comprehensive information in these situations is critical. The CBRNE mobile application is intended to provide a credible source for treatment and management of numerous patients in an often intimidating environment with scarce resources and overwhelming tasks. Key words: chemical, biological, radiological, nuclear, and high-yield explosives, weapons of mass destruction, mass casualty incident, disaster management mobile protocols DOI:10.5055/ajdm.2011.0045

American Journal of Disaster Medicine
March/April 2011, Volume 6
, Number 2


Article
Editorial Human stampedes: A neglected disaster in the developing world
Gowda Parameshwar Prashanth, MBBS, MD
March/April 2011; pages 69-70

Abstract
DOI:10.5055/ajdm.2011.0046


Article
Editorial Impact of organizational structure on vaccination of first responders: A case study
Christine McGuire-Wolfe, MPH, EMT-P (Doctoral Candidate)
March/April 2011; pages 71-72

Abstract
The experience of H1N1 vaccine delivery to public safety personnel in a suburban county in Florida suggests a relationship between the degree of hierarchy of an agency and successful implementation of a vaccination program for novel 2009 H1N1 influenza virus. This case study describes the structural organization of the Sheriff’s Office and Fire Rescue in County X, provides timelines for vaccine program implementation and numbers of personnel vaccinated, and illustrates the impact of autonomy on the timeliness of vaccine implementation. An “emergency approval pathway” is recommended for organizations or departments that are likely to encounter delays in disaster or pandemic response due to organizational structure. Key words: first responders, H1N1 vaccine, organizational structure, pandemic influenza DOI:10.5055/ajdm.2011.0047


Article
Strengthening hospital preparedness for chemical, biological, radiological, nuclear, and explosive events: Clinicians’ opinions regarding physician/physician assistant response and training
Joan E. McInerney, MD, MBA, MA, FACEP; Anke Richter, PhD
March/April 2011; pages 73-87

Abstract
Objectives: This research explores the attitudes of physicians and physician assistants (PA) regarding response roles and responsibilities as well as training opinions to understand how best to partner with emergency department physicians and to effectively apply scarce healthcare dollars to ensure successful emergency preparedness. Design: Physicians and PAs representing 21 specialties in two level I trauma public hospitals were surveyed. Participants scored statements within four categories regarding roles and responsibilities of clinicians in a disaster; barriers to participation; implementation of chemical, biological, radiological, nuclear, and explosive training; and training preferences on a Likert scale of 1 (strongly agree) to 5 (strongly disagree). Additional open-ended questions were asked. Results: Respondents strongly feel that they have an ethical responsibility to respond in a disaster situation and that other clinicians would be receptive to their assistance. They feel that they have clinical skills that could be useful in a catastrophic response effort. They are very receptive to additional training to enable them to respond. Respondents are neutral to slightly positive about whether this training should be mandated, yet requiring training as a condition for licensure, board certification, or credentialing was slightly negative. Therefore, it is unclear how the mandate would be encouraged or enforced. Barriers to training include mild concerns about risk and malpractice, the cost of training, the time involved in training, and the cost for the time in training (eg, lost revenue and continuing medical education time). Respondents are not concerned about whether they can learn and retain these skills. Across all questions, there was no statistically significant difference in responses between the medical and surgical subspecialties. Conclusions: Improving healthcare preparedness to respond to a terrorist or natural disaster requires increased efforts at organization, education and training. Physicians are willing to increase their knowledge base if it is possible to create a mutually positive win-win environment to minimize cost and disruption while maximizing preparedness. There is no clear consensus on the implementation of this training, but to most efficiently and effectively use scare homeland security dollars, a dialogue must begin between the medical profession, medical societies, and US Department of Health and Human Services to determine the best training strategies. Key words: CBRNE education, disaster, hospital preparedness, opinions DOI:10.5055/ajdm.2011.0048


Article
Understanding estimated worker absenteeism rates during an influenza pandemic
Meridith H. Thanner, PhD; Jonathan M. Links, PhD; Martin I. Meltzer, MS, PhD; James J. Scheulen, PA, MBA; Gabor D. Kelen, MD
March/April 2011; pages 89-105

Abstract
Objectives: Published employee absenteeism estimates during an influenza pandemic range from 10 to 40 percent. The purpose of this study was to estimate daily employee absenteeism through the duration of an influenza pandemic and to determine the relative impact of key variables used to derive the estimates. Design: Using the Centers for Disease Control and Prevention’s FluWorkLoss program, the authors estimated the number of absent employees on any given day over the course of a simulated 8-week pandemic wave by using varying attack rates. Employee data from a university with a large academic health system were used. Sensitivity of the program outputs to variation in predictor (inputs) values was assessed. Finally, the authors examined and documented the algorithmic sequence of the program. Results: Using a 35 percent attack rate, a total of 47,270 workdays (or 3.4 percent of all available workdays) would be lost over the course of an 8-week pandemic among a population of 35,026 employees. The highest (peak) daily absenteeism estimate was 5.8 percent (minimum 4.8 percent; maximum 7.4 percent). Sensitivity analysis revealed that varying days missed for nonhospitalized illness had the greatest potential effect on peak absence rate (3.1 to 17.2 percent). Peak absence with 15 and 25 percent attack rates were 2.5 percent and 4.2 percent, respectively. Conclusions: The impact of an influenza pandemic on employee availability may be less than originally thought, even with a high attack rate. These data are generalizable and are not specific to institutions of higher education or medical centers. Thus, these findings provide realistic and useful estimates for influenza pandemic planning for most organizations. Key words: influenza pandemic, pandemic planning, employee absenteeism pandemic DOI:10.5055/ajdm.2011.0049


Article
Regional public health preparedness teams in North Carolina: An analysis of their structural capacity and impact on services provided
Jennifer A. Horney, PhD, MPH; Milissa Markiewicz, MPH; Anne Marie Meyer, PhD; Julie Casani, MD, MPH; Jennifer Hegle, MPH; Pia D. M. MacDonald, PhD, MPH
March/April 2011; pages 107-117

Abstract
In December 2001, the North Carolina Division of Public Health established Public Health Regional Surveillance Teams (PHRSTs) to build local public health capacity to prevent, prepare for, respond to, and recover from public health incidents and events. Seven PHRSTs are colocated at local health departments (LHDs) around the state. The authors assessed structural capacity of the PHRSTs and analyzed the relationship between structural capacity and the frequency of support and services provided to LHDs by PHRSTs. Five categories of structural capacity were measured: human, fiscal, informational, physical, and organizational resources. In addition, variation in structural capacity among teams was also examined. The most variation was seen in human resources. Although each team was originally designed to include a physician/epidemiologist, industrial hygienist, nurse/epidemiologist, and administrative support technician, team composition varied such that only the administrative support technician is common to all teams. Variation in team composition was associated with differences in the support and services that PHRSTs provide to LHDs. Teams that reported having a medical doctor or a doctor of osteopathic medicine (?2 = 9.95; p < 0.01) or an epidemiologist (?2 = 5.35; p < 0.02) had larger budgets and provided more support and services, and teams that housed a pharmacist reported more partners (?2 = 52.34; p < 0.01). Teams that received directives from more groups (such as LHDs) also provided more support and services in planning (Z = 21.71; p < 0.01), communication and liaison (Z = 12.11; p < 0.01), epidemiology and surveillance (Z = 5.09; p < 0.01), consultation and technical support (Z = 2.25; p = 0.02), H1N1 outbreak assistance (Z = 10.25; p < 0.01), and public health event response (Z = 2.19; p = 0.03). In the last 10 years, significant variation in structural capacity, particularly in human resources, has been introduced among PHRSTs. These differences explain much of the variation in support and services provided to LHDs by PHRSTs. Key words: public health, preparedness, structural capacity DOI:10.5055/ajdm.2011.0050


Article
Risk perceptions and preparedness of typhoon disaster on coastal inhabitants in China
Li-Ping Jiang, PhD, RN; Lan Yao, PhD; Eleanor F. Bond, PhD, RN, FAAN; Yu-Ling Wang, MSN, RN; Li-quan Huang, MSN, RN
March/April 2011; pages 119-126

Abstract
China is highly vulnerable to natural disasters. Southeastern China situated on the Pacific Ocean experiences severe and devastating typhoons and hydrogeological disasters every year. Although respondents are highly aware of the typhoon outbreaks, they do not have necessary precautionary actions. This retrospective study evaluates the inhabitants’ sociodemographic characteristics with risk perceptions and preparedness. Subjects (434 adults) were recruited from two rural areas in coastal south-eastern China, both with high typhoon exposure. One area (landfall area [LA]) was more severely affected than the other (surrounding area [SA]) by the 2006 typhoon “Saomai.” Subjects were interviewed using a structured questionnaire with items addressing sociodemographic characteristics and exposure to public education related to emergency preparedness, risk perception, and coping strategies. Overall, most residents (92 percent) were aware that they lived in a high-risk area. About 54.6 percent respondents chose media as the first approach to obtain preparedness education, and 32.4 percent of respondents thought that personal experience is an important tool to defend themselves from typhoon. In LA, residents perceived themselves to be at higher risk than those who lived in the SA. More than 66.5 percent of respondents were terrified by typhoon, and 62.2 percent of respondents were afraid of its recurrence. Respondents emphasized that their life style (61.4 percent), property losses (54.5 percent), and threat to life (52.4 percent) were influenced by typhoon attack. Coping behavior most likely to be adopted was “anticipatory food, water storage and residents in LA is significantly higher than SA (p < 0.01). Risk perception with Spider Map analysis depicted that the item of disaster information is similar in both familiarity or dread associated with the risk axes (p > 0.05). However, in rescue and recovery of typhoon items, the score of familiarity with risk and dread with the risk axes is below 2.5. Regression analyses indicated that poor coping behavior was positively associated with age, risk perception, residential location, and knowledge of preparedness. The results indicated that risk perceptions and precaution activity were strongly related with inhabitants’ sociodemographic characteristics and vulnerability of disaster-affected zone. Key words: typhoon, disaster preparedness, risk perception DOI:10.5055/ajdm.2011.0051


Article
Fatalities of the 2008 Los Angeles train crash: Autopsy findings
Stacy Shackelford, MD; Lawrence Nguyen, MD; Thomas Noguchi, MD; Lakshmanan Sathyavagiswaran, MD; Kenji Inaba, MD; Demetrios Demetriades, PhD, MD
March/April 2011; pages 127-131

Abstract
Introduction: Train crashes represent a devastating multicasualty event.The purpose of this study was to analyze the injury severity, specific organ injuries, and cause of death in the fatalities of the 2008 Chatsworth, Los Angeles train crash. Methods: This is a review of the medical examiner records of the 25 fatalities in the train crash. The Injury Severity (ISS) Score, body area with severe injuries (Abbreviated Injury Scale [AIS] > 4), specific organ injuries, and causes of death were recorded. The immediate cause of death was determined to be the most severe or most rapidly fatal injury in the opinion of the reviewers. Results:A total of 25 fatalities occurred, including 24 victims who were pronounced dead at the accident scene and one who died 4 days later in the hospital. One victim did not undergo full autopsy. All of the decedents were located in the locomotive or in the passenger car immediately behind the locomotive. Overall, 15/24 decedents (63 percent) sustained unsurvivable injuries to at least one body region rendering an ISS of 75. The chest was the most severely injured body area (AIS > 4; 18/24, 75 percent), followed by the head (13/24, 54 percent), the extremities (11/24, 46 percent), and the abdomen (7/24, 29 percent). Spinal fractures were recorded in 17/24 (71 percent), and the cervical spine was the most commonly injured site. Thoracic aortic rupture was found in eight cases (33 percent) and cardiac ruptures in five cases (21 percent). Conclusions: The Metrolink train crash in 2008 in Chatsworth, Los Angeles, was the worst train crash in the history of California with 25 fatalities. The most common cause of death was due to chest injury (cardiac and aortic laceration) followed by head injury. This review could aid in improving passenger protection from head-on collision and in further development of head protection in train seats, as well as be useful in disaster planning and a benchmark for future rescue and triage operations. Key words: train, crash, fatalities DOI:10.5055/ajdm.2011.0052

American Journal of Disaster Medicine
May/June 2011, Volume 6
, Number 3


Article
Editorial Health Emergencies in Large Populations: A disaster medicine learning experience
Paul Singh Dhillon, BA, MB BCh BAO, LRCPSI, DRCOG
May/June 2011; pages 137-141

Abstract
The Health Emergencies in Large Populations course, organized by the International Committee of the Red Cross and Red Crescent Societies, is delivered in a decentralized manner by a number of academic centers around the world. It was one of the first formal educational opportunities developed for those in humanitarian assistance organizations, and its initial aim was to upgrade professionalism in humanitarian assistance programs conducted in emergency situations. This article summarizes the history and describes the current content, structure, and costs of the course. Key words: humanitarian, Red Cross, course, disaster DOI:10.5055/ajdm.2011.0053


Article
Bioterrorism--A Health Emergency: Do physicians believe there is a threat and are they prepared for it?
Claudia A. Switala, Med; Joshua Coren, DO, MBA; Frank A. Filipetto, DO; John P. Gaughan, PhD; Carman A. Ciervo, DO
May/June 2011; pages 143-152

Abstract
Objective: To determine whether bioterrorism training provided increased awareness and understanding of bioterrorism and to assess physicians’ beliefs about the threat of bioterrorism and how it impacts on preparedness. Design: This is a retrospective review of data obtained from a bioterrorism training grant. Data were obtained from a postevaluation form completed by trainees with an 80 percent return rate. The Institutional Review Board approved this study. Informed consent was not required as data were deidentified and demographic information regarding study subjects was not used. Setting:The Department of Family Medicine within the University of Medicine and and Dentistry of New Jersey, School of Osteopathic Medicine in Stratford, NJ, conducted the training and follow-up study. Participants: The bioterrorism preparedness training was targeted to physicians, residents, and third- and fourth-year medical students in New Jersey. There were 578 trainees; however, responses to each question were varied. Outcome measures: Trainees were asked to complete an evaluation form. Specific questions were selected from the form. Frequency statistics were used to describe responses to the questions. Results: Ninety-four percent of the respondents agreed that the bioterrorism training increased their awareness and/or understanding of bioterrorism; however, only 49 percent believe there is a high probability that a bioterrorism event or other health emergency will occur in the near future in New Jersey, and 42 percent considered themselves prepared to respond as a healthcare professional to a bioterrorism event. Conclusions: Physicians in New Jersey increased their awareness and understanding of bioterrorism through training. However, concerns remain that a physician’s belief in a low threat of bioterrorism translates into a low need for bioterrorism preparedness training. Key words: bioterrorism, preparedness training, emergency preparedness DOI:10.5055/ajdm.2011.0054


Article
WiFi RFID demonstration for resource tracking in a statewide disaster drill
Stacey L. Cole, MBA; Javeed Siddiqui, MD, MPH; David J. Harry, PhD; Christian E. Sandrock, MD, MPH, FCCP
May/June 2011; pages 155-162

Abstract
Objective: To investigate the capabilities of Radio Frequency Identification (RFID) tracking of patients and medical equipment during a simulated disaster response scenario. Design: RFID infrastructure was deployed at two small rural hospitals, in one large academic medical center and in two vehicles. Several item types from the mutual aid equipment list were selected for tracking during the demonstration. A central database server was installed at the UC Davis Medical Center (UCDMC) that collected RFID information from all constituent sites. The system was tested during a statewide disaster drill. During the drill, volunteers at UCDMC were selected to locate assets using the traditional method of locating resources and then using the RFID system. Results: This study demonstrated the effectiveness of RFID infrastructure in real-time resource identification and tracking. Volunteers at UCDMC were able to locate assets substantially faster using RFID, demonstrating that real-time geolocation can be substantially more efficient and accurate than traditional manual methods. A mobile, Global Positioning System (GPS)-enabled RFID system was installed in a pediatric ambulance and connected to the central RFID database via secure cellular communication. This system is unique in that it provides for seamless region-wide tracking that adaptively uses and seamlessly integrates both outdoor cellular-based mobile tracking and indoor WiFi-based tracking. Conclusions: RFID tracking can provide a realtime picture of the medical situation across medical facilities and other critical locations, leading to a more coordinated deployment of resources. The RFID system deployed during this study demonstrated the potential to improve the ability to locate and track victims, healthcare professionals, and medical equipment during a region-wide disaster. Key words: Radio Frequency Identification, RFID, disaster preparedness, emergency, ambulance, technology DOI:10.5055/ajdm.2011.0055


Article
Experimental induction of psychogenic illness in the context of a medical event and media exposure
Joan E. Broderick, PhD; Evonne Kaplan-Liss, MD, MPH; Elizabeth Bass, MPH
May/June 2011; pages 163-172

Abstract
Objectives:Mass psychogenic illness can be a significant problem for triage and hospital surge in disasters; however, research has been largely limited to posthoc observational reports. Reports on the impact of public media during a disaster have suggested both salutary as well as iatrogenic psychological effects. This study was designed to determine if psychogenic illness can be evoked and if media will exacerbate it in a plausible, controlled experiment among healthy community adults. Methods: A randomized controlled experiment used a simulated biological threat and elements of social contagion—essential precipitants of mass psychogenic illness. Participants were randomly assigned to one of three groups: no-intervention control group, psychogenic illness induction group, or psychogenic illness induction plus media group. Measures included three assessments of symptom intensity, heart rate, blood pressure, as well as questionnaires to measure potential psychogenic illness risk factors. Results: The two psychogenic induction groups experienced 11 times more symptoms than the control group. Psychogenic illness was observed in both men and women at rates that were not significantly different. Higher rates of lifetime history of traumatic events and depression were associated with greater induction of illness. Media was not found to exacerbate symptom onset. Conclusions: Psychogenic illness relevant to public health disasters can be evoked in an experimental setting. This sets the stage for further research on psychogenic illness and strategies for mitigation. Key words: disaster medicine, mass media, psychogenic illness, trauma, psychosomatic DOI:10.5055/ajdm.2011.0056


Article
Transportation resource requirements for hospital evacuation
Richard M. Zoraster, MD, MPH; Roel Amara, RN, BSN; Kay Fruhwirth, RN, MSN
May/June 2011; pages 173-186

Abstract
Hospitals are physical structures with the same risk as other large buildings; the physical plant is vulnerable to acts of nature and man. When hospitals need to evacuate the patient population, logistical support for patient transport will be required. However, a disaster impacting a hospital will likely also affect the surrounding community, and transport resources such as ambulances may be limited as they will also be needed to support the community response. To determine the most efficient deployment of limited transportation resources, a hospital survey was designed specifically to assess information on hospital occupancy and patient transportation needs. Information was obtained from 62 hospitals within Los Angeles County and was used to establish a tool for determining transportation requirements in the event of a hospital evacuation. This survey demonstrated that approximately 20 percent of hospital inpatients could be discharged to home within a few hours, about 40 percent of hospital inpatients could be transported via vans, buses, or private cars; and the remaining 40 percent would need ambulance transportation for evacuation. Additionally, the survey provides information about the distribution of emergency department and intensive care unit patients and the resources they would require during a hospital evacuation. Key words: evacuation, hospital, infrastructure DOI:10.5055/ajdm.2011.0057


Article
Pandemic influenza and major disease outbreak preparedness in US emergency departments: A selected survey of emergency health professionals
Melinda J. Morton, MD, MPH; Edbert B. Hsu, MD, MPH; Sneha H. Shah, MD; Yu-Hsiang Hsieh, PhD; Thomas D. Kirsch, MD, MPH
May/June 2011; pages 187-195

Abstract
Objective: To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS). Methods, design, and setting: A cross-sectional survey of ACEP DMS members was performed. A total of 300 members were surveyed both via e-mail and with paper surveys during the 2009 ACEP Scientific Assembly DMS Meeting. An optional comments section was included for section members’ perspectives on barriers to preparedness. A 15-item pandemic preparedness score was calculated for each respondent based on key preparedness indicators as defined by the authors. Results were analyzed with descriptive statistics, ?2 analysis, Cochran-Armitage trend test, and analysis of variance. Free text comments were coded and subjected to frequency-based analysis. Results: A total of 92 DMS members completed the survey with a response rate of 31 percent. Although 85 percent of those surveyed indicated that their hospital had a plan for pandemic influenza response and other infectious disease threats, only 68 percent indicated that their ED had a plan, and 52 percent indicated that their hospital or ED had conducted disaster preparedness drills. Only 57 percent indicated that there was a plan to augment ED staff in the event of a staffing shortage, and 63 percent indicated that there were adequate supplies of personal protective equipment. While 63 percent of respondents indicated that their ED had a plan for distribution of vaccines and antivirals, only 32 percent of EDs had a plan for allocation of ventilators. A total of 42 percent of respondents felt that their ED was prepared in the event of a pandemic influenza or other disease outbreak, and only 35 percent felt that their hospital was prepared. The average pandemic preparedness score among respondents was 8.30 of a total of 15. Larger EDs were more likely to have a higher preparedness score (p = 0.03) and more likely to have a pandemic preparedness plan (p = 0.037). Some major barriers to preparedness cited by section members included lack of local administration support, challenges in funding, need for dedicated disaster preparedness personnel, staffing shortages, and a lack of communication among disaster response agencies, particularly at the federal level. Conclusions: There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work.This may reflect a broader underlying inadequacy of preparedness measures. Key words: disaster medicine, disaster preparedness, pandemic influenza, emergency department preparedness, pandemic preparedness DOI:10.5055/ajdm.2011.0058

American Journal of Disaster Medicine
July/August 2011, Volume 6
, Number 4


Article
Teen dating violence and substance use following a natural disaster: Does evacuation status matter?
Jeff R. Temple, PhD; Patricia van den Berg, PhD; John F. “Fred” Thomas, PhD; James Northcutt, OTR, MOT; Christopher Thomas, MD; Daniel H. Freeman Jr, PhD
July/August 2011; pages 201-206

Abstract
Objectives: In September 2008, the Texas coast was directly hit by Hurricane Ike. Galveston Island was flooded by 4.25 m of storm surge, affecting most of the island’s housing and infrastructure. The purpose of this study is to examine whether youth who did not evacuate (11 percent), and subsequently were exposed to Hurricane Ike, exhibit higher rates of substance use and physical and sexual teen dating violence (TDV; both perpetration and victimization) when compared with adolescents who did evacuate. Setting: Public high school in southeast Texas that was in the direct path of Hurricane Ike. Participants: An anonymous survey was conducted in March 2009 to 1,048 high school students who returned to the Galveston Island post-storm (41 percent Hispanic, 23 percent African American, and 27 percent White). Main outcome measures: Teen dating violence and substance use. Results: Mantel-Haenszel odds ratios, adjusting for age and ethnicity, were computed. When compared with boys who evacuated, nonevacuating boys were more likely to perpetrate physical dating violence and sexual assault and to be a victim of sexual assault. Nonevacuating boys and girls were more likely to report recent use of excessive alcohol, marijuana, and cocaine than those who did evacuate. Conclusions: School personnel, medical personnel, and mental health service providers should consider screening for evacuation status in seeking to identify those adolescents who most need services after a natural disaster. In addition to addressing internalized emotions and psychological symptoms associated with experiencing trauma, intervention programs should focus on reducing externalized behavior such as substance use and TDV. Key words: substance use, teen dating violence, adolescents, hurricane, disaster DOI:10.5055/ajdm.2011.0059


Article
Challenges and solutions: Pandemic 2009 H1N1 influenza A in a pediatric emergency department
James Graham, MD; Steven Shirm, MD; Elizabeth Storm, MD; Kristen Lyle, MD; W. Matthew Linam, MD; José Romero, MD
July/August 2011; pages 211-218

Abstract
Objective: The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children’s hospital in the summer and fall of 2009. Design: In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children’s Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data. Results: When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent). Conclusions: The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low. Key words: pandemic, influenza, emergency department, pediatrics DOI:10.5055/ajdm.2011.0060


Article
A long-term care facility pandemic influenza preparedness planning assessment tool
Philip W. Smith, MD; Keith Hansen, BS; Harlan Sayles, MS; Brendan Brodersen; Sharon Medcalf, RN, Med
July/August 2011; pages 219-230

Abstract
Objectives: To assess qualitative aspects of longterm care facility (LTCF) preparedness programs and to test the utility of a LTCF pandemic preparedness Tool. Design: A Tool was developed and weighted with input from various subject matter experts. Setting: LTCFs. Participants: LTCF preparedness programs. Interventions: A 61-question Tool was used in facilities. Main outcome measures: Prevalence of pandemic preparedness elements was assessed, and total Tool scores were calculated and graphed. Results: The Tool results were used to assess overall preparedness and specific preparedness measures in LTCFs. Results suggested that LTCFs that are engaged in planning are addressing many but not all key plan details. LTCFs scored better on plan elements rated as most important (eg, does the LTCF designate an individual in charge during a disaster?) than on all pooled plan elements. The LTCF preparedness Tool score correlated positively with both facility size and whether the facilities had exercised their plan. Conclusions: Most LTCFs had developed a number of aspects of a preparedness program, but additional preparedness measures remain to be implemented. The LTCF should focus on the identified key plan elements and exercise their plan before a disaster occurs. Key words: pandemic, influenza, preparedness, long-term care facility DOI:10.5055/ajdm.2011.0061


Article
Refugee site health service utilization: More needs to be done
Sarah Meyer, Mphil; Hannah Tappis, MPH; William Weiss, DrPH, MA; Paul Spiegel, MD, MPH; Alexander Vu, DO, MPH
July/August 2011; pages 231-242

Abstract
Objective: Refugees in long-term camp-based settings are often provided health services through health systems parallel to national health systems. This article, through literature review, explores the question of health service delivery in the context of long-term refugee situations, examining in particular the impact on host national population. The objective is to identify data and themes in literature that shed light on the utilization of health services for refugees and host population. Design: To explore this objective, a broad literature review was conducted. Literature was categorized into the following three topics: the impact of refugee camps on the health and livelihood of host population, the impact of services on access to care and health outcomes of refugee population, and the impact of services on access to care and health outcomes of host population. Conclusions: Literature reports varied impacts of refugee hosting on host national population. The need for a contextual approach to understand the impact of refugee hosting is indicated through these findings. Some studies found that refugee hosting improved the quality and accessibility of health services and, in some cases, health outcomes for host national population; however, the data supporting integrating health services for refugees and host population are limited, and both reduce the strength of the integration argument. The overall body of evidence to reach conclusions on what is the ideal model of health service delivery for refugees and host population is limited. Improved data collection and analysis of utilization patterns for refugees and host population could strengthen program and policy design in this area. Key words: refugees, health services, refugee camps DOI:10.5055/ajdm.2011.0062


Article
Case study Planning for the next influenza pandemic: Using the science and art of logistics
O. Shawn Cupp, PhD; Brad G. Predmore, MHA
July/August 2011; pages 243-254

Abstract
The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). The first step in this planning process is the development of specific triage requirements during an influenza pandemic. The second step is identification of logistical resources required during such a pandemic, which are then analyzed within the proposed logistics science and art model for planning purposes. Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients. Key words: pandemic, influenza, logistics, bed space, oxygen DOI:10.5055/ajdm.2011.0063


Article
Case study A novel intervention for decreasing hospital crowding following the blizzards of 2010
J. Lee Levy, MSc, MD; Kevin Seaman, MD; Matthew J. Levy, MSc, DO
July/August 2011; pages 255-258

Abstract
Recent evidence demonstrates that emergency department (ED) and inpatient hospital crowding contributes to unsafe patient care. The blizzards of 2010 produced conditions that prohibited the safe discharge of admitted inpatients and were identified as a major factor in crowding of the ED at Howard County General Hospital (HCGH). At one point, admitted patients occupied 35 of the 36 treatment beds in the ED. A novel intervention was conceived and created that used the resources of Howard County Fire and Rescue (HCFR) to transport discharged patients from the inpatient floors to their home, thereby decreasing ED boarding and crowding. Throughout the 12-hour operation, HCFR personnel transported 13 patients from hospital inpatient floors to their home, and two ED interfacility transports were performed. In addition, HCFR units conducted one rescue and successful resuscitation of a patient with a sudden cardiac arrest during a 911 emergency call. During this call, HCFR and HCGH also coordinated the emergency transport of an interventional cardiologist through the blizzard to HCGH to perform emergency cardiac catheterization. At the end of the operational period, the ED had regained all but four beds pending inpatient admission. These efforts fortified a strong partnership between a community hospital and local fire department to facilitate the expeditious discharge and disposition of inpatients during the blizzards of 2010 to decrease crowding. Key words: crowding, disaster, emergency medical Services DOI:10.5055/ajdm.2011.0064

American Journal of Disaster Medicine
September/October 2011, Volume 6
, Number 5


Article
The public health impact of industrial disasters
Mark E. Keim, MD
September/October 2011; pages 265-272

Abstract
The recent Deepwater Horizon oil spill and Japanese earthquake/tsunami radiation disaster have increased public concerns regarding the public health impact of industrial disasters. Industrial disasters are known to impose a unique set of challenges for public health emergency response. There are critical gaps in scientific knowledge regarding assessment and control of public health disasters related to industrial releases of hazardous materials. There is also a fundamental lack of familiarity regarding industrial disasters among the public health and medical communities, in general. There are few sources in the current public health literature that review this disaster phenomenon in a comprehensive manner. This article offers a review of the public health impact and unique considerations related to industrial disasters. Key words: industrial disasters, technological disasters, emergency response, public health emergency, hazardous materials DOI:10.5055/ajdm.2011.0065


Article
Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January-May 2010
Theresa M. Dulski, MPH; Sridhar V. Basavaraju, MD; Gillian A. Hotz, PhD; Likang Xu, MD, MS; Monica U. Selent, DVM, MPH; Vincent A. DeGennaro, MD; David Andrews, MD; Henri Ford, MD; Victor G. Coronado, MD, MPH; Enrique Ginzburg, MD
September/October 2011; pages 275-284

Abstract
Objective: To describe factors associated with inpatient mortality in a field hospital established following the 2010 Haiti earthquake. Design: Data were abstracted from medical records of patients admitted to the University of Miami Global Institute/Project Medishare hospital. Decedents were compared to survivors in terms of age, sex, length of stay, admission ward, diagnosis, and where relevant, injury mechanism and surgical procedure. Three multivariate logistic regression models were constructed to determine predictors of death among all patients, injured patients, and noninjured patients. Results: During the study period, 1,339 patients were admitted to the hospital with 100 inpatient deaths (7.5 percent). The highest proportion of deaths occurred among patients aged = 15 years. Among all patients, adult intensive care unit (ICU) admission (adjusted odds ratio [AOR] = 7.6 and 95% confidence interval [CI] = 3.4-16.8), neonatal ICU/pediatric ICU (NICU/PICU) admission (AOR = 7.8 and 95% CI = 2.7-22.9), and cardiac/respiratory diagnoses (AOR = 8.5 and 95% CI = 4.9-14.8) were significantly associated with death. Among injured patients, adult ICU admission (AOR = 7.4 and 95% CI = 1.7-33.3) and penetrating injury (AOR = 3.3 and 95% CI = 1.004-11.1) were significantly associated with death. Among noninjured patients, adult ICU admission (AOR = 6.6 and 95% CI = 2.7-16.4), NICU/PICU admission (AOR = 8.2 and 95% CI = 2.1-31.8), and cardiac/respiratory diagnoses (AOR = 6.5 and 95% CI = 3.6-12.0) were significantly associated with death. Conclusions: Following earthquakes in resource limited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained post-earthquake response should address these needs and include pediatric- specific preparation and long-term critical care requirements. Key words: disaster medicine; earthquake; field hospital; Haiti; mortality DOI:10.5055/ajdm.2011.0066


Article
Radiostethoscopes: An innovative solution for auscultation while wearing protective gear
Keith A. Candiotti, MD; Yiliam Rodriguez, MD; Luciana Curia, MD; Bruce Saltzman, MD; Ilya Shekhter, MS; Lisa Rosen, MA; David J. Birnbach, MD, MPH
September/October 2011; pages 285-288

Abstract
Objective: To demonstrate a radiostethoscope that could be modified and successfully used while wearing protective gear to solve the problem of auscultation in a hazardous material or infectious disease setting. Design: This study was a randomized, prospective, and blinded investigation. Setting: The study was conducted at the University of Miami-Jackson Memorial Hospital Center for Patient Safety. Participants: Two blinded anesthesiologists using a radiostethoscope performed a total of 100 assessments (50 each) to evaluate endotracheal tube position on a human patient simulator (HPS). Interventions: Each lung of the HPS was ventilated separately using a double lumen tube. Four ventilation patterns (ie, right lung ventilation only; left lung ventilation only; ventilation of both lungs; and an esophageal intubation or no breath sounds) were simulated. The ventilation pattern was determined randomly and participants were blinded. An Ambu-Bag was used for ventilation. An assistant moved the radiostethoscope to the right and left lung fields and then to the abdomen of the HPS while ventilating. Subjects had to identify the ventilation pattern after listening to all three locations. A third member of the research team collected responses. Each subject, who wore both types of respirator (positive and negative), performed a total of 25 trials. Participants later compared the two types of respirators and their ability to auscultate for breath sounds. Results: Subjects were able to verify the correct ventilation pattern in all attempts (100 percent). Conclusions: Radiostethoscopes appear to provide a viable solution for the problem of patient auscultation while wearing protective gear. Key words: auscultation, disaster training, emergency preparedness,medical education,HAZMAT gear DOI:10.5055/ajdm.2011.0067


Article
Comparative study of physiological and anatomical triage in major incidents using a new simulation model
Kristina Lennquist Montán, RN; Amir Khorram-Manesh, MD, PhD; Per Örtenwall, MD, PhD; Sten Lennquist, MD, PhD
September/October 2011; pages 289-298

Abstract
Objectives: To develop and evaluate a simulation model making it possible to evaluate the accuracy and efficiency of different triage methods; to compare the results of physiological and anatomical triage performed by medical staff with different levels of skills with the use of this model. Design and outcome measures: A simulation model was created based on patient cards giving sufficient physiological data as a base for physiological triage and anatomical data as description of findings at exposure, providing a base for anatomical triage. Three groups with different skills in disaster medicine, nurse students (n = 23), ambulance nurses (n = 20), and surgeons (n = 30), performed triage based on the patient cards. The outcome was given as potential avoidable mortality. The results of the triage for the two methods were compared to the result of the same triage performed by an expert group. Results: Differences in triage: Within the groups, the difference between the two triage methods was only significant for the surgeons (p < 0.001), who had a better result using the anatomical triage. For the “physiological triage,” there were no significant differences between the three groups. Regarding the results for the “anatomical triage,” there were significant differences between both the nurse students and the surgeons (p < 0.001) and the ambulance nurses and the surgeons (p < 0.05). Results in distribution of patients and potential avoidable mortality: Within the groups, the difference between the two methods was significant for all the groups (nurse students, p < 0.01; ambulance nurses, p < 0.01; and surgeons, p < 0.001). They all had a better outcome with anatomical triage (nurse students, 6.1 percent; ambulance nurses, 6.1 percent; and surgeons 19.5 percent less mortality than physiological triage). The group that made the best outcome from physiological triage was the ambulance nurses who had a significantly better result than both nurse students (p < 0.01) and surgeons (p < 0.001). The mean mortality rate for ambulance nurses was 31.1 percent, nurse students, 37 percent, and surgeons was 38.1 percent. Regarding the anatomical triage, there was a significant difference (p < 0.001) between the groups of nurse students (30.9 percent mortality) and surgeons (18.9 percent mortality). The differences between the rest of the groups were also significant (p < 0.05). Conclusions: The model developed for this study made it possible to compare different methods of triage and also triage performed by staff of different levels of training and experience. Anatomical triage for all test groups in this study gave significantly better results than physiological triage regarding calculated outcome and this difference increased with increasing experience. Key words: triage, physiological triage, triage sort, anatomical triage, simulation model, mass casualty, major incident, disaster medicine DOI:10.5055/ajdm.2011.0068


Article
Characterizing public health emergency perceptions and influential modifiers of willingness to respond among pediatric healthcare staff
Christopher M. Watson, MD, MPH; Daniel J. Barnett, MD, MPH; Carol B. Thompson, MS; Edbert B. Hsu, MD, MPH; Christina L. Catlett, MD; Howard S. Gwon, MS; Natalie L. Semon, MSEd; Ran D. Balicer, MD, MPH; Jonathan M. Links, PhD
September/October 2011; pages 299-308

Abstract
Objectives: The aim of this study was to characterize the public health emergency perceptions and willingness to respond (WTR) of hospital-based pediatric staff and to use these findings to propose a methodology for developing an institution-specific training package to improve response willingness. Methods: A prospective anonymous web-based survey was conducted at the Johns Hopkins Hospital, including the 180-bed Johns Hopkins Children’s Center, between January and March 2009. In this survey, participants’ attitudes/beliefs regarding emergency response to a pandemic influenza and a radiological dispersal device (RDD or “dirty bomb”) event were assessed. Results: Of the 1,620 eligible pediatric staff, 246 replies (15.2 percent response rate) were received, compared with an overall staff response rate of 18.4 percent. Characteristics of respondent demographics and professions were similar to those of overall hospital staff. Self-reported WTR was greater for a pandemic influenza than for an RDD event if required (84.6 percent vs 75.1 percent), and if asked, but not required (74.4 percent vs 64.5 percent).The majority of pediatric staff were not confident in their safety at work (pandemic influenza: 51.8 percent and RDD: 76.6 percent), were far less likely to respond if personal protective equipment was unavailable (pandemic influenza: 33.5 percent and RDD: 21.6 percent), and wanted further prevent preparation and training (pandemic influenza: 89.6 percent and RDD: 82.6 percent). The following six distinct perceived attitudes/beliefs were identified as having institution-specific high impact on response willingness: colleague response, skill mastery, safety getting to work, safety at work, ability to perform duties, and individual response efficacy. Conclusions: Children represent a uniquely vulnerable population in public health emergencies, and pediatric hospital staff accordingly represent a vital subset of responders distinguished by specialized education, training, clinical skills, and disaster competencies. Even though the majority of pediatric hospital staff report WTR, nearly 15 percent for a pandemic influenza emergency and 25 percent for an RDD event would not respond if required. Other institutions can apply the methodology used here to identify particularly influential response willingness modifiers for pediatric care providers. These insights can inform customized preparedness training for pediatric healthcare workers, through identification of high-impact attitudes/beliefs, and training initiatives focused on addressing these modifiers. Key words: willingness to respond, disaster perceptions, pandemic influenza, radiological dispersal device, pediatric staff DOI:10.5055/ajdm.2011.0069


Article
A survey on disaster management among postgraduate students in a private dental institution in India
G. Rajesh, MDS; Kumar Gaurav Chhabra, MDS; Preetha J. Shetty, MDS; K. V. V. Prasad, MPH; S. B. Javali, MPhil, PhD
September/October 2011; pages 309-318

Abstract
Objective: To assess the knowledge, attitude, and behavior regarding disaster management among postgraduate (PG) students in a private dental institution in India. Design: Questionnaire survey with cross-sectional design. Setting: Sri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, Dharwad, Karnataka, India. Patients and participants: All PG students in SDM college of Dental Sciences and Hospital, Dharwad, Karnataka, were included. Interventions: None. Main outcome measures: Knowledge, attitude, and behavior regarding disaster management. Results: A total of 125 of 135 PG students participated (response rate of 92.59 percent) in the study. Mean knowledge, attitude, and behavior scores were 58.74, 85.78, and 31.60 percent, respectively. Significant correlations were observed between knowledge and year of study (?2 value = 45.301, p = 0.000), and behavior and place of residence of respondents (?2 value = 4.112, p = 0.043). Conclusions: Participants had low knowledge and behavior scores, but high attitude scores regarding disaster management. The year of study and the place of residence were associated with knowledge and behavior, respectively. This study highlights the need for curriculum changes in dental education and has policy implications for disaster management in India. Key words: disaster management, questionnaire, postgraduate students, Indian context DOI:10.5055/ajdm.2011.0070


Article
Case study Experience with the use of close-relative allograft for the management of extensive thermal injury in local national casualties during Operation Iraqi Freedom
MAJ Jonathan B. Lundy, MC, USA; COL Leopoldo C. Cancio, MD; LTC Booker T. King, MC, USA; Steven E. Wolf, MD; COL Evan M. Renz, MD; COL Lorne H. Blackbourne, MD
September/October 2011; pages 319-324

Abstract
The care of host nation burn victims in Iraq and Afghanistan has been a significant challenge to US military healthcare providers. To provide burn care in an austere environment is more challenging by limitations in resources such as inadequate medical supplies, infection control issues, and a lack of blood or tissue banking capabilities. Large full thickness burns pose a significant obstacle due to limitations in the casualties’ available donor skin, which can be used to achieve wound coverage. In US burn centers, allograft stored in skin banks provides temporary coverage during donor site healing in the management of large total body surface area burns.This report is a study of two severely burned Iraqi children with inadequate donor site surface area to achieve wound coverage that were managed with close-relative allograft harvested from their fathers to achieve temporary wound closure. A brief literature review and future recommendations are included. Key words: close-relative allograft, combat, burns DOI:10.5055/ajdm.2011.0071

American Journal of Disaster Medicine
November/December 2011, Volume 6
, Number 6


Article
ICU triage: The potential legal liability of withdrawing ICU care during a catastrophic event
Darren P. Mareiniss, MD, JD; Frederick Levy, MD, JD; Linda Regan, MD
November/December 2011; pages 329-338

Abstract
In the event of a catastrophic disaster, healthcare resources may be completely overwhelmed. To address this, the federal Agency for Healthcare Research and Quality has recommended using “crisis standards of care” during such an event. These standards would recommend allocating scarce medical resources to do the greatest good for the greatest number of patients. In a dire catastrophic event, such standards may include the allocation of intensive care unit (ICU) resources to maximize patient survival. Triage protocols that seek to efficiently allocate ICU resources during a disaster have been reviewed by the Institute of Medicine. Such protocols suggest the exclusion of patients with high mortality or high resource requirements from ICU care to do the most good for the greatest number of patients. In extreme circumstances, these protocols recommend withdrawing ICU resources from sicker patients in favor of more salvageable patients. However, if providers were to follow the earlier protocols in a disaster and withdraw and reallocate ICU care, criminal or civil liability could result. Two legal solutions to avoid this potential for liability have been suggested in this article. Key words: disaster medicine, triage, ICU, liability DOI:10.5055/ajdm.2011.0072


Article
The public health impact of tsunami disasters
Mark E. Keim, MD
November/December 2011; pages 341-349

Abstract
Tsunamis have the potential to cause an enormous impact on the health of millions of people. During the last half of the twentieth century, more people were killed by tsunamis than by earthquakes.1 Most recently, a major emergency response operation has been underway in northeast Japan following a devastating tsunami triggered by the biggest earthquake on record in Japan. This natural disaster has been described as the most expensive in world history.2 There are few resources in the public health literature that describe the characteristics and epidemiology of tsunamirelated disasters, as a whole. This article reviews the phenomenology and impact of tsunamis as a significant public health hazard. Key words: tsunami, natural disasters, public health emergency, disasters DOI:10.5055/ajdm.2011.0073


Article
Enhancing crisis standards of care using innovative point-of-care testing
Gerald J. Kost, MD, PhD, MS, FACB; Ann Sakaguchi, MPH, PhD; Corbin Curtis; Nam K. Tran, PhD, MS; Pratheep Katip, BS, MT; Richard F. Louie, PhD
November/December 2011; pages 351-368

Abstract
Objective: To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to effectively improve outcomes in emergencies, disasters, and public health crises, especially where community infrastructure is compromised. Design: Logic model-critical path-feedback identified needs for improving practices. Reverse stress analysis showed POC should be integrated, responders should be properly trained, and devices should be staged in small-world networks (SWNs). First responder POC resources were summarized, test clusters were strategized, assay environmental vulnerabilities were assessed, and tactics useful for SWNs, alternate care facilities, shelters, point-of-distribution centers, and community hospitals were designed. Participants and environment: Emergency-disaster needs assessment survey respondents and Center experience. Outcomes: Important tactics are as follows: a) develop training/education courses and “just-in-time” on-line web resources to ensure the competency of POC coordinators and high-quality testing performance; b) protect equipment from environmental extremes by sealing reagents, by controlling temperature and humidity to which they are exposed, and by establishing near-patient testing in defined environments that operate within current Food and Drug Administration licensing claims (illustrated with human immunodeficiency virus-1/2 tests); c) position testing in defined sites within SWNs and other environments; d) harden POC devices and reagents to withstand wider ranges of environmental extremes in field applications; e) promote new POC technologies for pathogen detection and other assays, per needs assessment results; and f) select tests according to mission objectives and value propositions. Conclusions: Careful implementation of POC testing will facilitate evidence-based triage, diagnosis, treatment, and monitoring of victims and patients, while advancing standards of care in emergencies and disasters, as well as public health crises. Key words: alternate care facility, bedside testing, critical path, emergency medical system, environmental stress, near-patient testing, needs assessment, point of distribution, reverse stress analysis, therapeutic turnaround time, triage, small-world network, shelter, value proposition DOI:10.5055/ajdm.2011.0074


Article
High-frequency percussive ventilation for intercontinental aeromedical evacuation
COL David J. Barillo, MD, FACS, FCCM; COL Evan M. Renz, MD; SFC Gabriel R. Wright, CRT; MAJ Kristine P. Broger, CCRN; LTC Kevin K. Chung, MD; Charles K. Thompson, PA-C; COL Leopoldo C. Cancio, MD, FACS
November/December 2011; pages 369-378

Abstract
High-frequency percussive ventilation (HFPV) has been used for the management of patients with smoke inhalation injury for more than 20 years and is considered a standard of care at many burn centers. Because the ventilator is powered by air and oxygen rather than electricity, prehospital use has been limited by large volume medical gas requirements. Since 2003, Operations Iraqi Freedom and Enduring Freedom have created a need for long-range aeromedical transfer of service members with severe burn and inhalation injuries. Unique to these conflicts is the availability of US Air Force C-17 cargo aircraft as the primary long-distance airframe. Because C-17 aircraft have a built-in medical oxygen supply, transcontinental patient transport using HFPV has become feasible. In this study, the authors report their initial experiences with the aeromedical transportation of 33 burn patients over a combined distance of 174,145 air miles using HFPV. HFPV is safe and efficacious for transcontinental flight when used by an experienced medical transport team. Key words: burn, trauma, aeromedical transport, high-frequency percussive ventilation, critical care air transport DOI:10.5055/ajdm.2011.0075


Article
Mobile phones and short message service texts to collect situational awareness data during simulated public health critical events
Matthew Magee, MPH; Alex Isakov, MD, MPH; Helen Tang Paradise, MD, MPH; Patrick Sullivan, PhD, DVM
November/December 2011; pages 379-386

Abstract
Objective: Text messages are useful for timely communication during public health emergencies and for transmitting health data in infrastructure-limited settings. Little is known about the feasibility of two-way short message service (SMS) communication to collect public health preparedness and surveillance data. The authors aimed to determine the feasibility and acceptability of using two-way SMS texts to collect situational assessment (SA) data in simulated disaster events during a university-based pilot study. Design: Eligible participants included university students with a mobile phone and messaging plan. Enrollment began in September 2009, and was open until the end of the study in May 2010. Participants attended a training session and provided demographic and phone use information using a baseline survey. Participants responded to SMS SAs that were sent directly to their phones throughout the study period. Frequency, completeness, and time to reporting were recorded for each procedure using an online commercial software package. Results: Sixty-three participants enrolled; median age was 25 years, most were female (74.6 percent), lived off campus (76.2 percent), and were graduate students (76.2 percent). Most participants had a family/joint mobile phone account (73.0 percent) with unlimited messaging (60.3 percent). The median daily number of texts sent and received was 8 and 9, respectively. During five SAs, 194 (76.7 percent) of 253 prompted text surveys were completed. Nearly 60 percent of surveys were completed within 20 minutes of text deployment. Conclusions: Using two-way SMS communication for surveillance and reporting was feasible among a group of motivated students. Similar methods may provide timely data during public health critical events. Key words: mobile phone, text message, preparedness, surveillance, simulation DOI:10.5055/ajdm.2011.0076