MEDICAL PLANNING FOR DISASTER—Brief Résumé of Accomplishments in California 1950-1959

Extensive accumulation and dispersal of medical supplies and equipment has been carried out in this state since 1950. Although such medical supplies and equipment are inadequate for an all out war type disaster their addition to the medical disaster preparedness program represents a great contribution and efforts must be made to continually supplement them.All hospitals must have a disaster plan which is well understood and which must be tested by actual test exercises at least once each year.Preparations for major disasters of all types are costly and time-consuming but represent one of the best possible investments which we can make as insurance against the loss of thousands of casualties.It is the responsibility of each physician to prepare himself and his family in anticipation of being exposed to natural or man-made disasters.     

Hématome pharyngolaryngé asphyxiant durant l'anticoagulothérapie.

Canada has a good National Medical Stockpile valued at 21 million dollars and consisting of packaged emergency medical units ready for use in peacetime or wartime disaster. These units are available for release to provinces for pre-positioning in selected communities provided that certain storage conditions are met and that physicians and other key health workers are prepared to take operational charge of the equipment. The major packaged units are the Emergency Hospital with a capacity of 200 beds, the Advanced Treatment Centre with equipment to give emergency medical care to 500 casualties, the Casualty Collecting Unit with equipment to give first-aid care to 500 casualties, the Emergency Blood Depot, the Emergency Clinic and the Emergency Public Health Laboratory. In addition, training equipment, supplies and units are provided.The value of the stockpile has already been demonstrated in disasters occurring inside and outside Canada. Ten Emergency Hospitals have been shipped to South Vietnam for civilian use. A similar Emergency Hospital was flown to Yellowknife, N.W.T., within 24 hours of the destruction, by fire, of the Stanton Yellowknife Hospital in May 1966.     

The Summerland Disaster.

The reception, admission, and subsequent management of casualties from the Summerland fire are described. A senior member ofthe staff assessed priorities and direceted casualties to different prearranged teams, and a nurse was allocated to each patient to aid continuity of treatment and documentation. Though regular revision and discussion of major accident procedures with all members of the hospital staff and co-ordination with other rescue workers is helpful expensive rehearsals are of limited value in a civilian incident.     

REPORT FROM OTTAWA

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada''s 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada''s 6396 dentists could supply 30% reinforcement. The dentist''s training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

Emergency Blood Services

The prime and essential function of any emergency blood service is to provide ample supplies of blood and blood derivatives to the medical services operating in the post-nuclear disaster period with as much despatch and precision as possible. To meet these needs, a plan has been devised in Canada whereby 600,000 units of whole blood may become available for the treatment of an estimated 200,000 living casualties in the two- to three-week period immediately following a national disaster. The disaster organization is based upon the existing Canadian Red Cross Blood Transfusion Service which is currently providing blood and blood fractions to all hospitals, coast to coast, through its 16 depots.The key to the emergency operation is the establishment of shadow depots in preselected sites 50 to 75 miles from the existing depots and in places free of fallout.Stockpiling of essential blood transfusion supplies and equipment, along with a peace-time training program of essential personnel, is a prerequisite for the success of the plan.     

Moorgate tube train disaster. Part II. Clinicopathological review.

A review of the injuries sustained by the 113 casualties of the Moorgate tube train disaster has shown the need for rapid evacuation of casualties. Recognition of the "crush syndrome" and its early consequence, hyperkalaemia, is important and a radical surgical approach is suggested. Chest injuries were common and contributed to many of the deaths.     

Occult Enterobacter aerogenes pneumonia diagnosed by indium 111-labeled leukocyte scan.

A major earthquake may strike while a surgeon is performing an operation in an office surgical facility. A sudden major fault disruption will lead to thousands of casualties and widespread destruction. Surgeons who operate in offices can help lessen havoc by careful preparation. These plans should coordinate with other disaster plans for effective triage, evacuation, and the treatment of casualties.     

PROBLEMS ASSOCIATED WITH MEDICAL DISASTER CARE—Preparations in a Large Southern California Area

In the organization for dealing with medical disaster, the region is in an intermediary position, between the State Disaster Office and the operational areas. Regional functions are largely those of coordinating the activities of the areas, and are based upon directives and plans from the state level.The regional medical chief is a member of the staff of the Civil Defense coordinator and must advise him in all matters related to the health of the people, including medical and casualty care, hospitalization, public health, sanitation, preventive medicine and the special problems of biological, chemical and radiation hazards. Coordination with the other Civil Defense services is necessary.The basic medical plan is to give emergency care in the first aid stations and then evacuate casualties to hospitals when and how the situation permits. Regional function is to obtain personnel, supply, equipment and hospitalization support when required.Dispersal of danger zone populations to support areas creates many medical and public health problems among the displaced people and the residents.Survival of the nation requires altered concepts of casualty management. The least injured who have the greatest productive potential should have the highest treatment priority. Short, lifesaving surgical procedures must have precedence over long, complicated operations.No plan is any better than the individual doctors, nurses and other personnel who will put it into operation.     

Exercise London: a disaster exercise involving numerous casualties

A large-scale disaster exercise was conducted to assess how one large community would handle such a situation — particularly, how it would deal with 150 casualties. The planning, undertaken by a subcommittee composed of representatives of all resource groups in the city, took more than a year. The deficiencies of the disaster plan detected during the exercise, which included a lack of trained personnel and various problems of communication, are now being corrected.     

Echelons of Medical Care

The mortality rate of wounded soldiers who survived long enough to leave the Crimean battlefields was nearly 20%. A similar rate can be expected in Canada among casualties evacuated from target cities if no preparations are made.From their considerable experience over the last 100 years the military medical services have developed effective techniques for caring for large numbers of casualties under adverse conditions, thereby reducing the mortality rate to 3.6%. The Emergency Health Services in Canada are employing these same techniques.The basic planning technique is the establishment of echelons or levels of medical care. It evolved from the fact that casualties usually occur at places remote from hospitals and have to be given sustaining care and shelter at staging points on the evacuation route. The opportunity was taken to institute a system of progressive care at these points, and four echelons of care became recognized. The productivity of available treatment personnel was increased by dividing the labour and by standardizing the treatment. Minor casualties should be diverted elsewhere so that serious casualties may receive better attention. The problem of the proper transportation of casualties is still unsolved in Canada.     

Medical response to a natural disaster: the Barrie tornado.

On May 31, 1985, a tornado devastated an area of Barrie, Ont. Following a prepared disaster plan, the staff of the local hospital managed 155 casualties, including 16 cases of multiple trauma, over 5 hours. The authors summarize the hospital''s experience and give recommendations to help the staff of other hospitals improve their disaster plans.     

DISASTER MEDICAL CARE AND SHELTER-The Federal Program

The role of the physician in event of natural disaster or overwhelming (perhaps nuclear) attack by an enemy is:To assist the layman in preparing to meet his own health needs in a disaster situation until organized health services can reach him. To prepare and plan for the provision of organized medical care when conditions permit. To extend his own capability to render medical care outside his normal specialty. To assist in the training of allied and professional health workers and laymen for specific mobilization assignments in health services.     

DISASTER MEDICAL CARE AND SHELTER—The Federal Program

The role of the physician in event of natural disaster or overwhelming (perhaps nuclear) attack by an enemy is:To assist the layman in preparing to meet his own health needs in a disaster situation until organized health services can reach him.To prepare and plan for the provision of organized medical care when conditions permit.To extend his own capability to render medical care outside his normal specialty.To assist in the training of allied and professional health workers and laymen for specific mobilization assignments in health services.     

Knowledge Levels and Training Needs of Disaster Medicine among Health Professionals,Medical Students,and Local Residents in Shanghai,China

Background

Disaster is a serious public health issue. Health professionals and community residents are main players in disaster responses but their knowledge levels of disaster medicine are not readily available. This study aimed to evaluate knowledge levels and training needs of disaster medicine among potential disaster responders and presented a necessity to popularize disaster medicine education.

Methods

A self-reporting questionnaire survey on knowledge level and training needs of disaster medicine was conducted in Shanghai, China, in 2012. A total of randomly selected 547 health professionals, 456 medical students, and 1,526 local residents provided intact information. The total response rate was 93.7%.

Results

Overall, 1.3% of these participants have received systematic disaster medicine training. News media (87.1%) was the most common channel to acquire disaster medicine knowledge. Although health professionals were more knowledgeable than community residents, their knowledge structure of disaster medicine was not intact. Medical teachers were more knowledgeable than medical practitioners and health administrators (p = 0.002). Clinicians performed better than public health physicians (p<0.001), whereas public health students performed better than clinical medical students (p<0.001). In community residents, education background significantly affected the knowledge level on disaster medicine (p<0.001). Training needs of disaster medicine were generally high among the surveyed. ‘Lecture’ and ‘practical training’ were preferred teaching methods. The selected key and interested contents on disaster medicine training were similar between health professionals and medical students, while the priorities chosen by local residents were quite different from health professionals and medical students (p<0.001).

Conclusions

Traditional clinical-oriented medical education might lead to a huge gap between the knowledge level on disaster medicine and the current needs of disaster preparedness. Continuing medical education and public education plans on disaster medicine via media should be practice-oriented, and selectively applied to different populations and take the knowledge levels and training needs into consideration.     

Quality Improvement Report: Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital

Problem In-hospital cardiac arrest often represents failure of optimal clinical care. The use of medical emergency teams to prevent such events is controversial. In-hospital cardiac arrests have been reduced in several single centre historical control studies, but the only randomised prospective study showed no such benefit. In our hospital an important problem was failure to call the medical emergency team or cardiac arrest team when, before in-hospital cardiac arrest, patients had fulfilled the criteria for calling the team.Design Single centre, prospective audit of cardiac arrests and data on use of the medical emergency team during 2000 to 2005.Setting 400 bed general outer suburban metropolitan teaching hospital.Strategies for change Three initiatives in the hospital to improve use of the medical emergency team: orientation programme for first year doctors, professional development course for medical registrars, and the evolving role of liaison intensive care unit nurses.Key measures for improvement Incidence of cardiac arrests.Effects of the change Incidence of cardiac arrests decreased 24% per year, from 2.4/1000 admissions in 2000 to 0.66/1000 admissions in 2005.Lessons learnt Medical emergency teams can be efficacious when supported with a multidisciplinary, multifaceted education system for clinical staff.     

Emergency calls in the Samu system

The French emergency medical system is public and medical. Named Samu, it is almost entirely managed by anesthesiologists specially trained for emergency medical assistance and advanced medical support. The system comprises a reception and dispatching center for emergency calls, directly connected to police and firemen, but assuring patient confidentiality. This fixed center is managing mobile units which are Medical Intensive Care Ambulances (MICA named Smur in France). The Samu's mission consists in performing urgent individual medical assistance and also medical services for treatment of mass casualties. It is also to find adequate hospital units for the patients, to perform medical transport and to be a consultant for general practitioners in emergency.     

Psychological and social evaluation in cases of deliberate self-poisoning admitted to a general hospital.

In a prospective clinical trial 312 cases of self-poisoning (276 patients) consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision as to "disposal." Junior doctors and nurses received some instruction in this work. Both groups of assessors asked for help from social workers when necessary. Once the medical teams had completed their assessments, psychiatrists provided most of the hospital treatment. Follow-up at one year showed no significant difference between the two groups of patients in the numbers who repeated their self-poisoning or self-injury (or both), or committed suicide. Provided junior doctors and nurses are taught to assess self-poisoned patients, we think medical teams can evaluate the suicidal risk and identify patients requiring psychiatric treatment or help from social workers, or both. Contrary to the Department of Health''s recommendation that all cases of deliberate self-poisoning should be seen by psychiatrists, we have reached the conclusion that physicians should decide for each of their patients if specialist psychiatric advice is necessary.     

高等医学院校教学秘书队伍建设存在问题及对策

高校教学秘书主要从事教学管理工作,其工作水平的高低直接关系到整个教学秩序的稳定和人才培养质量的优劣。本文对新形势下教学秘书岗位吸引力、工作性质、晋升、薪酬、业务培训及情感激励等因素进行系统分析,认为教学秘书应该认清职责,加强业务学习,勇于探索教学服务与管理新思路并付之实践,为教研室的发展做出更大的贡献;与此同时,院校应逐步实现教学秘书的专业化,以解决教学秘书专业不对口、职称评定错位等诸多问题,以期建立一支稳定的教学秘书队伍,从而切实提高教研室教学管理工作的水平和效率。     

Detecting the Impacts of Socioeconomic Factors on Regional Severity of Work-Related Casualties in China

Work-related casualties always cause serious damages to regional social and economic development. China's rapid development is raising a series of concerns about work-related casualties. The self-organizing maps (SOM) approach is applied in this study to detect the impacts of socioeconomic factors on the severity of work-related casualties in 31 regions of mainland China. The results show that: (1) the regional severity of work-related casualties and socioeconomic development seem to follow an inverted U-shaped pattern (i.e., the number of work-related fatalities increases to a peak at a certain stage and then decline along with socioeconomic development); (2) the industrial and employment structure have negative correlation with the regional severity of work-related casualties, specifically, the higher percentage of tertiary industry in gross regional product (GRP) and percentage of employed persons in tertiary industry may lead to fewer numbers of work-related fatalities in one region; (3) some socioeconomic factors like education level, medical condition, and insurance coverage have negative impacts on the regional severity of work-related casualties. Furthermore, the study also shows that the SOM approach is capable of improving clustering quality and visualization effects when facing multidimensional datasets compared with traditional cluster approaches such as K-Means and hierarchical-based clustering methods.     

Consultation-liaison scheme for self-poisoned patients in a general hospital.

In a prospective clinical trial 276 self-poisoned patients consecutively admitted to hospital were randomly allocated to medical teams or to psychiatrists for an initial psychiatric assessment and a decision about "disposal." Junior doctors and nurses received instruction in this work. While awaiting the outcome of the trial the randomisation was continued for 13 months and 729 allocations were made altogether. Physicians requested psychiatric opinions for roughly one in five of their patients. In other respects medical teams performed similarly to psychiatrists. Provided that due attention is given to teaching junior staff and to ensuring that psychiatric treatment and social-work support are available once patients have been assessed, such a consultation-liaison scheme could be adopted in other hospitals. This would help to change unfavourable attitudes towards self-poisoned patients and contribute to the general training of doctors and nurses.